What to Do When a Loved One with Dementia Resists Care

Caring for a loved one with dementia can present unique challenges, and few are as tricky as navigating moments of resistance to care. It's a situation that occupational therapists and family caregivers alike are likely to encounter. While frustrating and sometimes heartbreaking, understanding and responding effectively to resistance is key to maintaining connection and providing compassionate care.

Resistance during daily care tasks like bathing, dressing, or hygiene is common in dementia and can be incredibly stressful and emotional. It's often misunderstood, seen as defiance when it's a form of communication stemming from fear, confusion, or a feeling of losing control. This guide offers practical, evidence-based dementia resistance to care strategies to help caregivers navigate these moments with empathy and effectiveness.

Why Does Resistance Happen in Dementia?

Understanding why resistance occurs is the crucial first step. Behavior often labeled as resistance is usually just a message. According to the Alzheimer's Society and the Dementia Behavior Management Advisory Service, common triggers include sensory overload, an inability to communicate unmet needs, or confusion about routines. Someone might refuse a bath because they don't recognize the caregiver, feel exposed, or are cold, but they lack the words to explain.

The key mindset shift is seeing behavior as communication rather than a problem to be fixed. When you adopt this perspective, it becomes easier to find the right solution for the moment.

Strategies to Reduce Resistance and Build Trust

Several evidence-based strategies can help reduce resistance and foster cooperation.

Use Music as a Mood and Memory Tool

Music is a powerful gateway that taps into memory and emotions, even in later stages of dementia. It can increase cooperation during daily care tasks like bathing or dressing. Music therapy is an evidence-based practice that uses music to promote health, manage stress and pain, and improve memory.

Trying simple music interventions at home can make a difference. Consider singing a favorite song before initiating care to change the mood, or playing calming background music to ease transitions. Playlists tied to specific parts of the daily routine can also be helpful. Resources for music therapy are available, such as at SoundScapingSource.com.

Reframe the Task

The way you phrase requests matters significantly. Instead of focusing on the task with a command like, "Let's get you dressed," reframe it to be specific and focused on the person. Asking for their help, such as "Can you help me pick out your favorite shirt today?" shifts from "I'm doing this for you" to "let's do this together". This builds trust and autonomy, making it easier to elicit the desired action. Even if you don't get an immediate verbal response, using fewer and more specific words can help their processing and participation.

Visual Cues and Familiar Objects

Visual cues and familiar objects can trigger task recognition and reduce confusion. Instead of asking, "Can you brush your teeth?", hold up a toothbrush or show a picture of one alongside your words. This visual cue supports verbal instruction, making processing what needs to be done easier.

Environmental and sensory familiarity also significantly reduce anxiety and confusion. Maintaining consistent, clutter-free environments and routines is crucial. Witnessing the struggle caused by changing environments, like a hospital stay, highlights the importance of familiarity. Tools like ZinniaTV visually model tasks, which can be played before initiating care. This helps prime the person for the activity without extensive verbal instruction.

Use the Hand-Under-Hand Technique

The hand-under-and technique, developed by dementia expert Teepa Snow, is a physical cueing method to initiate action or cooperation without force. Instead of grabbing or pulling someone's hand, you gently slide your hand underneath theirs to guide them towards the object or movement needed. For example, to help them pick up a cup, you would place your hand under theirs and guide it towards the cup.

This technique reduces the startle response that can occur with sudden movements and builds trust. It gives the person a sense of control, allowing their brain time to process the movement. Often, as you guide them, they may understand what is needed and complete the action themselves. Teepa Snow offers free videos with more information on this technique.

Adjust Timing and Track Patterns

Paying attention to daily patterns in your loved one's behavior and adjusting the timing of activities is an evidence-based strategy. Behavioral symptoms in dementia often follow daily rhythms. A well-known example is sundowning, where agitation and challenging behaviors can increase in the late afternoon or evening.

If mornings are typically difficult, try scheduling more challenging tasks like bathing or showering for a time when your loved one is usually more relaxed or receptive. Tracking these patterns can help you optimize the timing for activities like dressing, bathing, or hair care, planning them around their best windows of energy and calm.

What to Say Instead

Using short, clear, and supportive language is a core dementia resistance to care strategy. Instead of a direct command that might feel demanding, try phrases that invite cooperation or frame the task in a less confrontational way.

For example:

• Instead of "Hey, we gotta take a shower," try, "How about we go check the water temperature together and make sure it's right?" This guides them towards the bathroom, where the familiar environment (running water, towels) can trigger memories of the routine.
• Instead of "Let me do this for you," try "Can we do this together? I need your help." Especially if you are an adult child caring for a parent, tapping into the parent-child dynamic where they cared for you can be helpful.

These phrases honor their dignity and tap into long-held routines or desires to be helpful.

When to Walk Away and Come Back

Despite using these strategies, there will be times when resistance persists. In these moments, you are not failing; you are adapting. One effective strategy is to walk away. Give yourself and your loved one a moment to reset. Return after 10–15 minutes, perhaps with a different tone, new words, or a slightly altered approach. Often, a short break can make a significant difference. This simple strategy is part of managing dementia resistance to care effectively.

In short, here are the key takeaways for dementia resistance to care strategies:

• Mindset Shift
• Identify Triggers
• Use Music
• Reframe Language
• Employ Visuals and Familiarity 
• Hand-Under-Hand Technique
• Optimize Timing
• Supportive Language
• Know When to Pause

Conclusion

Caring for someone with dementia is undeniably challenging, and moments of resistance can feel overwhelming. However, by shifting your mindset to see behavior as communication, understanding potential triggers, and employing evidence-based dementia resistance to care strategies, you can navigate these moments with more creativity, compassion, and connection. It's not about perfection; it's about presence and adapting. Remember, you are not alone and doing better than you think.