A Little Improv Can Go a Long Way with Dementia

improv-sign-crop2

Credit: Tom Magliery

Most days, dad sleeps a lot. But today, he’s wide awake. He’s on the phone, yelling at me. He’s so angry, but there’s sadness in his voice, too. “I don’t have any money, I don’t have a car. I don’t even have any shoes,” he tells me. “And I’ve got to go down and see mom and dad.”

Now, my dad is 92 and his parents have been gone for decades. He has money in bank accounts that he doesn’t remember how to access, and he has a car he’s no longer able to drive. These days, his shoes mostly stay in the closet. He wears his slippers when he has the energy to walk down to the dining room to eat with his friends Leo and John, or when he gets the urge to bust out of the skilled nursing wing where he lives. He heads straight for the locked doors until one of his caregivers redirects him.

I can sense his frustration as the dementia that grips him continues to increase. Confusion rolls in like a fog. Words fail him. And I imagine he just wants to find something familiar that he can hold onto. Since my mom died two years ago, he’s become unmoored, slowly drifting farther and farther away. After being together for 67 years, he can’t get used to being alone.

Sometimes when I call, he tells me of his plans to marry a nurse or one of his aides. “We’re having the wedding before the end of the year,” he’ll say emphatically. “So you better hurry up and get over here.”

Since we are so far away from each other, the phone is our main means of communication. Often, the sound of my voice calms him down, but today it’s not working. Nothing I say helps. I feel useless and small. I shut down and he rails on. I’m reminded of when I was a little girl and he would get angry. I would close my eyes and picture him as a giant bear or a roaring lion. Strong. Powerful. Now the dynamics have shifted, but I can’t always process the change I’ve made from daughter to caregiver. Even though I know I’m a grown woman and he’s an old man, I still have to push down my fear at his words and his reproach, and remind myself he’s the one who feels powerless now.

Suddenly, the conversation takes a turn. “Did you even know that I won $8 million?” he demands.

I tell myself not to argue with him. And I try to remember to treat it like improv. Yes, I mean improvisational comedy, the form of live theater where the storyline, character and dialogue are made up in the moment.

I’m a big fan of the hilarious Tina Fey, creator of the sitcom 30 Rock and so much more. In her memoir, Bossypants, she lays out some cardinal rules for improv comedy. I’ve discovered these guidelines can also help when communicating with someone you love who has dementia. In both situations, you try your best to work with the situation you’re given, no matter how crazy it may seem. The end goal: Understanding, connection, and if you’re lucky, a little shared laughter.

Rule number 1: “Agree. Always agree and say yes.” Tina Fey notes that in the real world you won’t always say yes to everything. And that’s true with someone who has dementia, too. But yes is often better than no. It does no good to argue whether or not your dad has really just won $8 million when he tells you so. He believes he has. In improv, the rule of agreement reminds you to “respect what your partner has created” and to at least start from an open place. “Start with yes and see where that takes you.” Maintaining respect for your loved one with dementia and staying open to what they’re saying goes a long way.

Rule number 2: “Say yes AND …” In improv, you’re supposed to not only say yes, but also add something of your own. This idea of contributing and “staying in the scene,” really staying present in the conversation, also helps with someone who has dementia. Say dad is still talking about winning that $8 million. Instead of trying to force him to realize his belief is untrue, ask him what he would do with the money.

Rule number 3: “Make statements.” This is a positive way of saying don’t just sit around raising questions and pointing out obstacles. Whatever the problem, be part of the solution. Instead of insisting that there’s no way Dad hit the jackpot, now imagine what you would do if you won that kind of money. Tell him about it.

Rule number 4: “There are no mistakes, only opportunities.” Things don’t always go your way in improv and you have to learn to be flexible and adapt. Dementia? Same. Sometimes, the “news” of Dad winning $8 million leads to a great conversation about his capitalist hopes and dreams. Other times, you end up getting accused of stealing his shoes.

Having a parent with dementia can feel a lot like the movie Groundhog Day. Events are likely to repeat themselves. So when things go wrong, I try to keep my sense of humor and remind myself that chances are, dad and I will have this talk again soon. And at least then, I’ll have another opportunity to get it right.

197 thoughts on “A Little Improv Can Go a Long Way with Dementia

  1. Wonderful and hopeful and optimistic during such a frustrating time and seemingly helpless situation. My thoughts are that you ARE getting it right, Diana! Keep saying yes, keep trying, (keep some of that $8 million for his “honeymoon”) and keep the faith!

  2. I’m Chaplain in a senior living facility with a number of residents with dementia. I’ve been saying for many years that the seminary course that most prepared me for working with my dementia residents was the improv class. I wish someone had taught me this way, but I learned it all on the ground and now I teach others about it. This is right on.

    • Hi Ruth! I really appreciate your comment as well as the validation that I’m headed in the right direction with the improv. Would love to hear more about your work and other things you’ve discovered about communicating with people who have dementia as well as how you teach others the approach. Great to hear from you and also to see Lori’s comment on FB.

  3. Oh, Diana, I’m sorry to hear about your mama’s death. And I’m sorry too about your father, though I’m glad he is where he is safe, and that you have found improv as way to take care of you and him. Thanks for the blog. Another nice creative outlet, and a great way friends can stay in touch with you and yours.

    • Jamie! Great to hear from you. Thanks so much for your condolences. Losing my mom was really hard and I will definitely be writing about that in this blog. I would love to hear how you and John are doing and also about your parents. I know there are so many challenges with caregiving wherever our parents are. Please stay in touch and keep me posted. xo

  4. Diana,
    What a lovely blog! I can’t wait for the next entry. Your dad is so blessed to have you in his life. You are totally right about the need to agree with him. I hope others in need find youp blog – and I’ll take the liberty of sharing it with a few of my friends.
    Take care and happy birthay to your dad!
    Love,
    Pam

    • Hi Pam,

      Thanks so much for reading and please do share with anyone who you think might be interested. Also, if you think of any good topics to cover in the blog or know of great experts (in addition to yourself, of course :)), please let me know. xo

  5. You have already gotten it right, my friend. No one could be a more loving, devoted, and patient daughter than you have been. Congratulations on launching this long-dreamed-of blog…I am so proud of you.

  6. Diana what a wonderful post!!
    I loved reading it. So much of the advice you give is not only true for dealing with aging parents with dementia also can be helpful for people dealing with loved ones with cancer, or just plain solution resolutions in all relationships!
    I love it!!
    Keep posting your pearls of wisdom xo

  7. Great post! Thank you for the valuable information – so much so that I shared it on my personal page on facebook. It took me almost two years to learn how to really handle my mother’s Alzheimer’s and now I look back and wish I knew then what I know now. I hope by posting your article I can help others that need it.

    • Hi- Thank you so much for posting the blog and thanks for reading! Figuring out how to make a person with Alzheimers feel safe and understood can be so challenging. And every person is different. But I have found having this mindset goes a long way.I really hope this helps others.

  8. Diana,
    What a great blog! You are right on target and have such great insight. As a long distance caregiver for my Dad, I tend to turn my life upside down & jump on a plane when I hear too much distress over the phone. It is so hard to transition from “Daddy’s little girl” to caregiver & my brain remembers the very grumbly, stern father who was adimant that there was never a place for lies or manipulation in relationships or life. I need to remember your ideas when talking to him & look at it as improv, not being disrespectful. Thank you for sharing. I look forward to future posts.

    • Hi Teresa,
      I totally agree that it’s difficult to reset expectations when you have had a certain kind of relationship with a parent and that changes. My dad is a military kind of guy, WWII Navy vet and quite stern, he ruled with an iron fist, as he liked to say. So now, I still kind of have to steel myself when he yells at me, and really try and see things from his changing perspective. Not always easy and sometimes scary when there’s hostility.

      I also used to hop on planes at the spur of the moment, but it got crazy and so disruptive to my family. Now if there’s an emergency I go, but otherwise I plot out my visits carefully and in a regular cadence. That way, I can always tell dad I have my next visit planned, even tho he forgets.At least it makes me feel better.
      Thanks so much again for writing and hang in there!!

  9. Great reading. I care for my 92 year old husband. Now by remembering the word “improv” evety time I want to disagree I will be able to change tack and steer our conversation into placid waters. Hopefully. Thanks for this, and more to come. Bee

  10. I honestly think that you are doing everything in your power to make things okay between you two. Coming from a guy that grew up without a dad, I think you are doing okay. I mean the fact that you are trying to study and understand your dad’s condition is a big deal. It means that you care and you love him, never feel small because you are doing what you can. So hang on.

  11. Sorry to hear about your dad. It must be hard, especially since you have to learn all over again how to act with him. I once seen a show about people with dementia and people would play them music from their time and the way their faces lit up and started to remember song lyrics and memories so quickly was beautiful. I definitely think you should find some of your dad’s old favorites and play them for him and see the effect it has on him. Good luck with everything

  12. It is a wonderful post.. I am so glad that to know that you have found such an optimistic way to be with your dad…I have faced this kind of a situation with my grandfather so I exactly understand your situation. Thanks for sharing this lovely blog.

  13. I loved this post and the wonderful suggestion of dealing with dementia through improv techniques. My mother recently departed this world after slowly suffering with vascular dementia for over ten years. My sister would often vent her frustration when my mother asked the same questions over and over. She often tried to re-direct my mother from the past to present day. I on the other hand, went right with the flow and would answer her questions patiently. “Yes mom school was great today! I loved the meatball sandwich you packed me!” (I was fifty at the time). It made our time together all the more pleasant. Why bother to upset her further by trying to correct what she was living at the moment? She was my beautiful mother whether or not she saw me as a child of ten or a middle aged daughter with two sons of her own. Though as I answered her questions as my ten year old self, my heart broke a little more with each answer.

  14. This is great. My Grandpa was recently diagnosed with dementia..I get so frustrated when he calls and asks the same questions he did in the last phone call. This will definitely help understand what’s going on in his head. I can hear in his voice that he senses change, not only in himself but from his family and friends. I just want to hear his optimistic thoughts and sayings. I am definitely going to try a little improv next time!

  15. Although I don’t have experience like yours, I agree that communication sometimes is like an improv. I have seen people who always have to be right by disproving others or by pointing out the mistakes in others’ comments. But communication isn’t about fact as much as about expressing one’s feelings and be understood. What is so bad about adding some creativity or imagination in the conversation? What is so wrong about going with it? It is communications like these that leads us to new perspectives and ideas. And this is the beauty of being social animals because discoveries are made due to collaborative efforts and contributions. This is what separates us from other animals.

  16. I volunteer at an elderly center specifically for those who have dementia and while reading of your father, I saw habits of some who I have gotten to know. They always seem so confused and frustrated and constantly are asking for when their loved ones will come to get them out. Sometimes they have good days and sometimes they have bad days. I wish you luck with caring for you father, and I wish for more good days for him.
    -lindsay

  17. I recently lost a grandmother who had mild dementia with whom I had lived. It was quite often very difficult to keep my cool. I know it’s not only frustrating for your dad but it must be for you as well. The way that you’re facing this frustration is so admirable. I find myself missing my grandmother often and if she were still with me I would definitely have found encouragement in your optimism.

  18. Great post! I’ve been a social service director in skilled nursing facilities for ten years. So familiar with the pain, laughter, tears and heartache that come with this awful disease! I continue to hold the faith with continued research (some really promising new results!) we can bring an end to this disease.

  19. I took an adult improv class in our little town from a brilliant teacher. He said “Say yes to everything.” He had us say “No” for a while to see how the improv died. I said that the class was very much like meeting a new patient in clinic: how do I help this person no matter what they say? If they say “Martians have injected spiders into my ears.” it is not helpful to say, “No they didn’t.” It is more helpful to say, “That sounds awful! May I look in your ears right away?”
    I wrote this poem about it: https://drkottaway.wordpress.com/2014/12/04/say-yes-2/

  20. What a pleasure to read this beautiful post and hear your voice. Your father sounds like a wonderful man and he is blessed to have such a kind, caring and funny daughter. I remember when my grandma got sick and also suffered from dementia I would play along with his funny thoughts. This made me think of those special moments we shared before he died and I’m laughing and crying all at once. Thank you so much for this special unexpected moment this morning. xo

  21. I read your piece my dear and it was enlightening. I didn’t make it to work today, because my car wouldn’t start. My last day of work before retirement is tomorrow. My Dad is 92, but very clear and sound. I’m sorry… for you. You must miss the way your Pops once was, but I like your attitude a lot. Good luck and fun to read your writing. Ulric

  22. I understand. My mom past away just about a year ago she would have been 93. I understand and feel your pain. What you have written should be read by each caregiver and family member. I pray that God continue to grant you wisdom and understanding.
    Pastor Lester

  23. I’m still somewhat in shock and denial about my mom. So I haven’t discovered what works best and when. Thank you for sharing. It’s a hard topic to be open about. Keep sharing and being optimistic.

    • It took me years to actually start writing this blog, so I understand about shock and denial. Someone very knowledgable about dementia once told me, if you’ve seen one person with dementia, you’ve seen one person with dementia. So though there are some general guidelines, like try not to argue with the reality of someone who has dementia, go with the flow as much as you can, no two people are the same. So I feel like it’s always a work in progress. Hang in there!

  24. Really incredible ideas, I wish I had had this optimism and patience when my grandfather was diagnosed with Alzheimer’s. As a 13/14 year old it only scared me and drew me away from him, it is something I have always regretted. My heart is with you.

    • Hi Sharon,
      Please don’t be too hard on yourself. It is very difficult for kids to deal with dementia …there are plenty of adults who don’t feel comfortable with it. I think you should give yourself a break. Sounds like you really loved your grandfather. Thanks for reading!

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