Using the No big deal mindset for repetitive stories and questions from someone with dementia.

*This is an abbreviated version of a full article. The full article can be found here.*

Several years ago, I was the director of a dementia unit. On my way back to my office, a resident left the common bathroom. It was obvious he was unsuccessful in toileting independently. I caught a glimpse of the bathroom and recognized he had made a great effort to do so, but failed. It was a mess and both he and the bathroom had to be cleaned up.

Making it a big deal

Here is how it may have gone down with my resident and me if I made it a big deal:

Me: Oh my gosh! Mr. Smith! You’re a mess. Oh gosh. Don’t move. Don’t move. You’re making a mess everywhere!

But that doesn’t help anyone. When we make this kind of thing a big deal, we:

1. Embarrass the person with dementia, which breaks our rapport.
2. Weakens the morale of the staff and fosters a fearful culture.
3. Leads to staff burnout.
4. Raises our own blood pressure!

What is the “No Big Deal Mindset"?

The "No Big Deal mindset" ("NBD Mindset") is having that chill attitude towards any challenge that pops up with dementia. It’s knowing that no matter what, it will work out and therefore, staying calm is the better option.

Instead of making it a big deal, I used the NBD Mindset. I grabbed a pair of gloves, waived over an employee, handed them a pair of gloves, and asked them to take the resident into his room to get ready for dinner. Then I got on my hands and knees and started to clean.

Prepare yourself for the NBD Mindset:

I advise my clients and trainees to get physically prepared for the NBD Mindset. This will make the execution more successful. Here is how you physically prepare yourself:

1. Take a deep breath.
2. Roll your shoulders back and relax your posture.
3. Smile!
4. Say it in your head (or out loud if appropriate) “No big deal!”

Problematic Behaviors and Expressions

Families and professionals often reach out to me for help managing challenging behaviors. Sometimes, the behavior or expression is something that is problematic, which I define as something that is harmful to that person or someone else. So ask yourself:

1. Is this harmful to the person?
2. Is this harmful to someone else?
3. Is this just frustrating or tiresome for me?

Why are they repeating things?

I have noticed that as we age, we get more excited about sharing stories. Whether they’re from our past or something recent. For someone with dementia, the repetitive stories and questions may come from the emotional aspect. It could be something that really upset that person or something that made them really happy. So, they may not remember that they’ve told you but they do remember the experience because of the feeling behind it.

How do I tell them they’ve already told me?

Here is the NBD mindset: Finish the story for them while matching their emotion. For example, if they are excited about the story you may say “Oh! That’s right! And then this happened!” in an excited tone.

What if their repetitive story or questions come from anger?

I have a client who lost an item, believes it was stolen, and then it was found again. The story he believes does not match the reality. Frustrated, many people try to explain what actually happened but that isn’t his reality so it makes him more frustrated.

When I visited with him, he started to talk about this. He was going on and on about it and how he wanted it to be handled differently. This comes with a few steps.

Step 1: Apologize. This is an underused and underrated technique. I like to keep it simple “I’m sorry that happened. It shouldn’t have.”

Step 2: Restate. You can use this technique in a lot of situations “So, you would like this to happen and you’d be satisfied?”

Step 3: Reassure. Offering comfort that you believe this won’t happen again is good. But avoid lying and keep it simple.

Step 4: Redirect. You can redirect to something more enjoyable and less frustrating for that person. “Right now, why don’t we take a walk around the community together.”

It may come up again and you may have to go through the steps again.

Can you stop a repetitive behavior?

It is possible to change a repetitive behavior. Sometimes, the behavior comes from an unmet need and through some investigation, we can determine that need, meet the need, and therefore resolving the behavior. However, that can take time. So, it’s best to use the NBD mindset while trying to determine and fulfill the unmet need.

If the behavior is problematic, then you may want to consult with a dementia expert.

*This is an abbreviated version of a full article. The full article can be found here.*