When Your Loved One Is Confused

James Avery | posted February 13, 2009 |

I had just begun my medical internship in Chicago—and my wife, Jan, and I were more than a thousand miles from our nearest family member—when our first child, Jonathan, was born. Everything was new, there was much to learn, and there was much we didn’t know. We turned to books and manuals for guidelines on how to care for a newborn.

After 25 years of practicing medicine and taking care of patients who suffer with confusion, I realize there is a need for something similar for caregivers of confused patients.

Whether your loved one’s confusion is temporary (e.g., due to medications) or permanent, here are 10 important guidelines to consider. It shouldn’t surprise you that many of these guidelines are the same ones Jan and I learned more than two decades ago when Jonathan, now a medical school student, was a newborn.

1. Establish Routines. Try to keep to routines, such as eating breakfast at a certain time, going to church, taking a walk, eating familiar foods, and watching favorite television shows. The body responds to rhythms that are familiar. These routines will keep your loved one calmer and help make them more predictable.

2. Create visual reminders. Patients who are confused often need reminders about the date and time. Consider having a calendar and clock prominently displayed in your house. That is why nursing homes place signs in conspicuous places that say, for example, “Today is Thursday, July 7, 2009.”

3. Have reasonable expectations. Don’t expect loved ones to do tasks beyond their capabilities. I remember a man who asked his wife to let the dog into the house. Evidently, the dog had been barking at the door to come in. Instead, his wife let the dog loose from the yard and “Lassie” was found days later. Although familiar tasks need not be ruled out, most confused patients will no longer be able to perform tasks previously done. Use tact and wisdom to assist them, while avoiding condescension and embarrassment.

4. Be respectful. Try to respond respectfully to questions and comments—even when the talk is nonsensical. It is hard to believe that the intelligent person you once knew is so “out of touch.” Consequently, it is hard to avoid becoming impatient and frustrated. But keep in mind that your impatience or frustration will usually make the person worse.

5. Maintain regular sleep patterns. Getting a good night’s sleep is important for you and your loved one. Have regular rituals before bedtime; such as, getting into your pajamas an hour before bedtime, dimming the lights at a certain time or having a glass of milk before retiring.

6. Resist taking things personally. Don’t try to dwell on or psychoanalyze wild thoughts and paranoid behavior. Simply do your best to change the topic. Your loved one may even say hurtful things. Don’t take it personally—always remember that it is a diseased and confused mind that is talking.

7. Record medications, complaints and problems. Keep records of all of the medications (past and present) that your loved one has taken. Be sure to write down any adverse reactions. Also, keep a list of medical complaints and problems so you can tell the doctor about these as your loved one may forget.

8. Accompany them to the doctor’s office. Because of the confusion, your loved one will need help presenting his or her medical history to their physician. Ride along with them and talk to the physician separately, if needed. (One of my patients with dementia would forget about his chest pain moments after it subsided. Wisely, his wife told me and we easily controlled the pain with a simple medication. During the entire office visit, the patient vehemently denied any such pain and accused his wife of making it up!)

9. Schedule respite times for yourself. Being a caregiver for a confused loved one can be physically, emotionally and spiritually draining. It is a stressful undertaking. Someone coming in for a few hours can give you the time away you need to do chores and simply have some time for yourself. The time may come when you will no longer be able to care for your loved one. Be realistic about this possibility.

10. Remain loving. No matter how confused, patients will sense an uncaring tone or atmosphere. Just like newborn babies, adults can somehow feel whether someone is being loving or harsh. I am always uncomfortable holding newborn babies. I can never seem to get their head in the right spot and I worry that I might drop them. Babies sense this and often cry when I hold them. But when Jan holds them, they can sense love and assurance and they immediately calm down. Don’t forget that despite their confusion, your loved one will sense your attitude—just like a newborn.

Finally let me close with three things I want you to always remember:

1. Remember to ask for help. Don’t hesitate to ask others and God for help. Share the care with family members and others—it will help you and it will be a blessing to them.

2. Remember to be kind to yourself. The days and hours can be very long when you are taking care of a confused and disoriented loved one. On bad days you will become impatient and frustrated. Be kind to yourself and be thankful that your loved one won’t remember your anger or frustration. Thankfully, Jonathan doesn’t remember all of the mistakes that I made as a parent!

3. Remember that you are blessed. You are blessed to have someone you love and your loved one is blessed to have you. “And now these three remain: faith, hope, and love. But the greatest of these is love.”— 1 Corinthians 13:13