Dementia care educator Teepa Snow explains ‘brain change’ and what it means for caregivers

(Aging Untold) — Dementia can change how families talk, plan and get through a normal day, and many caregivers are working out what to do in real time.

Teepa Snow, a nationally recognized dementia care educator, occupational therapist and founder of Positive Approach to Care, joined Aging Untold to talk about what she has taught families and care teams for decades.

She discussed why she uses the term “brain change,” how she approaches refusals such as taking a shower and why written reminders may not help.

Why Snow says ‘brain change’

Snow said people with dementia lose some abilities but change others, and she uses “brain change” instead of language that focuses on decline.

“Although people are losing some abilities, they’re actually changing others,” Snow said.

For example, some people who never swore may begin to, and people who would never have asked strangers for help may walk up and say they need to get home, Snow said.

“People think all the time of brain failure and brain loss, and I talk about brain change because the reality is neuroplasticity exists whether you have dementia or you don’t,” Snow said. “So let’s use what we have and let’s use what they have.”

What to try when someone refuses a shower

Gerontologist and Aging Untold expert “Sam” Cradduck presented Snow with a challenge families might face – how would she respond if a parent with dementia continually refused to shower, take medication or get dressed?

Snow said she would not try to force a shower.

Instead, Snow said, ask the loved one for help with a smaller task.

She presented this as an example:

“I have no business trying to force you to take a shower. That’s ridiculous. What I would ask you is, you’ve got something like right here,” Snow said, pointing to her cheek. “And I don’t know if it’s from breakfast or what. It’s out here on this outer edge. Let’s go to the bathroom, look in the mirror I’m going to give you a washcloth and see if you can’t get that off.”

Another example she offered was to ask the person to wash their hands before cooking dinner.

Snow said that if a person will not take part in those smaller steps, a shower is unlikely.

“I’ve got to back up a little bit and try to figure out what’s getting in our way of the interaction,” Snow said.

Why sticky notes may not work

Cradduck brought up written reminders, such as sticky notes and reminders labeled “coffee cups” and “plates,” and why they don’t work.

Snow said families may think they can take written information and translate it into an action.

But following a written sequence requires the hippocampus, which she described as the learning and memory center, to access and use what the person just did and what the next step is. And the front of the brain is trying to sequence, she said.

Snow said families should recognize that the person likely needs more support for completing tasks.

The one thing Snow wants families to know

Asked what one message she would give every family affected by dementia, Snow said both the person with dementia and the caregiver are doing the best they can.

“You’re both doing the best you can, and if you want something to change, one of you is going to have to change,” Snow said.

She said the person with dementia is already experiencing brain change, so caregivers will need to build awareness, knowledge and skills they may not have expected to need.

And recognize, Snow said, that not every family member is suited to be the person providing hands-on care.

“You can be great at organizing care because not every family member is built for this,” Snow said. “I mean, it’s hard work.”