How to Care for Veterans Living with Dementia

veteranEach November, we observe Veterans Day as a way to honor all U.S. military veterans. As we pay tribute to these worthy men and women, it’s important to remember that their time of service may have left its mark on them physically, emotionally, psychologically, and/or socially. These “scars” may become even more apparent as the individuals age, particularly if they develop dementia and their brains begin to change.

Alzheimer’s disease or other forms of dementia play out differently in each person, depending on the type of dementia, other health conditions, and even military background. Special challenges can arise if an individual has post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety, or loss of a limb. These conditions can significantly impact the progression of dementia. Interestingly, there is a greater risk of dementia among veterans and other emergency responders (police officers, firemen, search and rescue personnel, and EMTs), largely due to traumatic experiences and/or related injuries.

If you’re caring for or supporting a veteran who is living with dementia, here is a list of five things you should be aware of:

1. Avoid war scenes on television or in movies. One of the first areas of the brain to get damaged from dementia is the hippocampal region. This part of the brain is responsible for helping to keep a timeline of your life events and orient yourself to your surroundings. As the disease progresses and more of the hippocampal area is damaged, destroyed, or chemically altered, people have a very difficult time recalling the timeline of their lives. The part of the brain that tells you where you are or how you got there is no longer working properly. Now imagine if you’ve experienced a traumatic life event in your past. If someone turns on a TV program or movie that reenacts a scene similar to what you’ve lived through, and you don’t recall what year it is or where you are, you can imagine how disoriented or emotional you might become. Even the daily news might show war or accident scenes. Do your best as a caregiver to meet the person’s needs for information or entertainment while avoiding any potential triggers.

2. Avoid loud, sudden noises. Many veterans have experienced a war zone with exploding bombs or sudden gunfire. The trauma of those kinds of situations tends to stay with a person throughout the years. A popping balloon, fireworks, or even a group of friends shouting, “Surprise!” could trigger a very negative response, especially if the veteran is living with both dementia and PTSD. As caregivers planning activities or events, be mindful of avoiding anything that might lead to distress.

3. Don’t approach the person from behind. It’s not a good idea in general to approach a person with dementia from behind, but this becomes especially true with a veteran who has lived in a combat zone. Not only might this become a trigger for those who have lived through traumatic events, but it could also cause them to go into self-defense mode. Soldiers have to go through rigorous self-defense training, which automatically kicks into gear in dangerous situations. You don’t want to unknowingly approach a person from behind only to have him or her begin attacking you in self-defense. Instead, approach the individual from the front. Make sure you’re within his or her visual field, remembering that dementia can also cause vision changes (including the loss of peripheral vision). Move slowly and give time for the person to register your presence.

4. Don’t quietly sneak into the person’s room. This point is similar to the one above. If the lights are down low and the person is resting or sleeping, avoid any element of surprise. Remember that s/he may not remember where they are or who you are, and any former combat training may kick into action if it seems that you’re sneaking up on him or her. Instead, before engaging the person, knock on the door and give a verbal greeting. Once the individual is aware of your presence, approach slowly from the front, then sit, squat, or kneel down so you’re at his or her level. Be conscientious about appearing non-confrontational and give the person more visual space.

5. Don’t back the person into a corner. The individual may be the one actually backing into a corner as s/he moves away from you while you try to get the person dressed. However, once s/he is in the corner, the innate fight or flight response may kick into gear if the situation feels threatening. This could become especially precarious for the caregiver if the veteran is confused about time and place and reverts to military training. If a veteran has backed into a corner, show the person a way of escape. Provide extra visual and physical space by not standing directly in front of the individual, but instead turning your body to the side in a supportive stance. If the person becomes distressed, don’t try to push through and finish the task. Just back off, give space, and try again later. This approach is investing in your relationship, as the person will remember how you made them feel later on.

While these five points will give you a good place to start in caring for a veteran with dementia, you’ll also want to make some assessments of your own. Don’t make any assumptions. Learn about the person’s military background. While routines and structure are helpful for anybody with dementia, they may be especially beneficial to veterans who were used to a military regimen. Learn about any possible triggers or brain-related injuries. By doing the necessary research, your relationship will be off to a healthy start!