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.

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

  1. My mother is 98 and until last month was lively, intelligent and a font of all knowledge when my son and I were researching our family tree. She knew when her parents got married ( my children would have to think about when my anniversary was) and loads about my father’s family. She had a stroke and is unable to communicate . The look in her eyes as she attempts to speak is terrible to see. The loss of speech and movement in my parent is terrible but it is of short standing and not so devastating as dementia. I wish you and your dad the best , he is still there somewhere and I think your view of accepting his imaginings is excellent. Why would you insist that he can’t have won anything because he doesn’t do the lottery ? It really ,doesn’t matter. If it makes him happy, you are happy. Take care of yourself as well.

  2. Yes! Excellent post. Well said. This is what I do with my MIL too. So what if we have strange conversations, or if we have the same conversations several times? Go with the flow, I say. That’s the loving thing to do. There’s a very good book called Contented Dementia by Oliver James. Highly recommend it to anyone with a friend or relative with dementia. 🙂

  3. Congratulations on the birth of LongDistanceDaughter.com!
    We loved your inaugural column. Your words hold such gentle humor and pathos, it’s easy to see how LDD’s practical and poignant advice will change lives for the better.
    xo Jul and Lucia

  4. Great post. I also found this true in coping with a relative with mental illness. When he was delusional, arguing made things worse. Going with the situation and staying engaged in the conversation (without promising things you can’t deliver) established that I was on my relative’s side, and encouraged him to see me as an ally, not an obstacle. You’re very kind to share a painful experience like this for the benefit of so many. Sending gratitude and a spirit of endurance your way.

    • Thanks so much for your kind comment. i agree, that just going with it helps both you and your loved one with dementia cope. It is not only better for them to feel like they have an ally, it also feels so much better to be the ally rather than the obstacle.

  5. Wonderfully put!!! I was a caregiver for my grandmother who had Alzheimer’s and some of the sweetest moments we had in her end stages was improved scenarios she came up with. It was my job to keep her safe and as happy as possible…if that meant that we were “going to France this weekend” then we would talk about what we would do. Thank you for sharing!! Keep up the ways your are caregiving! Our world needs more caregivers who care enough to improv ❤️

  6. Great way of approaching this situation . I lost my mom to Alzheimer’s last June. Those years were the most challenging and heart-wrenching. It is so great to read the words of others that understand the struggle.

  7. This is right on. I lost my dad to early onset Alzheimers a few months ago (he was only 69). You just have to accept them where they are, and go with the flow. My mom had a really hard time doing that, but if you can it makes your last years with your loved one so much better. I love the improv approach, it is spot on. Being a caregiver isn’t easy, especially over the telephone. Just keep doing what you can and try to make the most of your time with him.

  8. I had a friend who had dementia, who also obsessed about money and winning the lottery. On one visit, I called his bluff and asked him if did win the lottery where would he keep all of that money. He looked at me for at least a minute and then said, “in my pockets.” Sadly he is gone, but the improv of that moment will linger on in my mind as much as anytime as when he was healthy. I guess that was Rule #2. Great Post and congrats on being Freshly Pressed.

  9. I loved this post! It’s the first I’ve read of your blog. My dad had Alzheimer’s and one of the first things the social worker at the nursing home told me, immediately after he was moved there, was, “Whatever he says or believes, go with it! Don’t argue with him, don’t try to bring him back to ‘reality’ and for heavens sake, if he asks about someone who has passed away, don’t tell him they’ve passed away because if you do, each time he will grieve like the first time.” I found her advice very valuable. I had never thought myself an actor or a master of improv, but I quickly became one and it became fun! It was a great way to stay connected with my dad and I actually learned a lot about him that I didn’t know before. Sometimes it was a ticket into his youth in the 1920’s and sometimes it was a ticket into his relationship and true feelings for my already deceased mom. (There were days he thought I was her. I discovered he adored her and always had done so. They were married for 66 years.) Anyway, your improv analogy is perfect. Your dad is very fortunate to have you and it is fortunate you have him. I won’t lie and tell you all will be sunshine and buttercups as your father’s dementia further develops, but I will tell you that I cherish the final couple of years with my father almost more than any other time of our relationship. I was so fortunate to get to be there with and for my dad. I felt it an honor to be able to give back to him what he had given me, which was love, support and protection, and if I had to become a cousin in 1941 on certain days or my mother in the 1930’s on others, then so it was! I WILL be sharing your post! I know several people right now who will greatly benefit from it. Blessings to you and your father, Elaine

    • Hi Elaine, I know how you feel. Sometimes dad calls me his sister (he doesn’t have one) or his cousin, and often he thinks I’m his brother Richard, which doesn’t exactly make me feel all feminine and girly, but so what? He knows we’re related somehow, and he knows I love him. So that’s OK. It’s great to hear you were able to cultivate such a nice relationship with your dad using improv.

  10. Thank you for taking the time to put this together. I feel as though you wrote it for me. I so agree with everything, but know how hard it is to leave our literal world and go to theirs in an instant. You hang in there daughter; you are doing a good job. Even great at times. hugs. Susan

  11. My Dad died of dementia. I wish I had got angry. People with dementia are being hid away behind keypads, they are denied access to their rooms in the day because who knows, maybe they will pull a sink off the wall, but sufferers are still termed “residents” People with dementia are not residents, they are patients, but nobody treats them as such. It wont hit you until they are gone, and you one day meet an person who still has all their brainpower.

    Rise and rise again, until Lambs become Lions.

  12. This was a great piece! I loved everything about it. Enlightening it sure was, and very informative! You are so creative to couple improv and dementia together. It must have been very hard what you went through and still going through, but I’m glad you are finding a better way to deal with it. I wish you and your father the best!

  13. Congrats on being Freshly Pressed today! This is a fantastic read. Thanks for sharing humor in the middle of one of life’s worst storms. You’ve found such a GREAT way to keep things in perspective. Keep working on that improv! 🙂 I look forward to reading more from you.

  14. Hi thank you for your post. I recently had a very hard time with my mom. Dad was in the hospital and she got so tired her mind went in all different directions. She wanted to stay at the hospital with him and after I had to make her leave kicking and screaming it has made her different.
    I like how you break your points down and yes patience is a key. Never point things out just keep an eye on them.
    Thank you again.

  15. So practical. Thanks for sharing. Life is too short not to laugh. I love your perspective. My grandpa has dementia and sometimes it’s hard knowing how to respond to his statements. Love this approach.

  16. I’ve often thought it would be fun to do standup at a nursing home, if it weren’t for two nagging problems – all the time it takes to write a routine and my lack of ability to keep the audience engaged. Now I might just have the perfect solution. Your prospective is priceless! (Your patience is also enviable by the way.)

  17. Reblogged this on BeckyB of Winchester and commented:
    Not easy being a family caregiver, whether in situ or long distance, to remember the good practice day in day out all we can do is aim to get it right. Posts like this one though help enormously.

    Thank you Diana for sharing. Really great advice – I sometimes forget the AND, but your lovely post will help me remember why it is so vital.

  18. Wow I love this read. My father had Alzheimer’s and died over 20 up years ago, I had no idea how to deal with his confusion and I was constantly trying to bring him back into the here and now by arguing with his crazy statements. Now many years later I understand that what I was doing only exacerbated the confusion and upset him and me. If only I had ready you blog back then. Really insightful and enlightened article and my heart goes out to you and everyone whose relatives suffer from dementia.

    • Thanks for reading and commenting. It’s really hard to adjust to their reality and my first reaction is always to try to bring him back to my world. I have to constantly remind myself to do it. It definitely does not come naturally!

  19. I really enjoyed reading this. I work in aged care, and I see families of residents’ with dementia every day, and I have seen that the ones that can look at dementia with humour, and use humour to cope, are more…not ‘at ease’ but I feel that they are coping a bit better than those who do try and argue, and refuse to believe that this is how things are. I love that you have shared your story. 🙂

  20. My mother has Alzheimer’s and is in memory care. I do a lot of improvising and have become quite the actress. To her, sometimes I’m a friend that’s visiting. Sometimes, I’m her sister (she never had one), every once in a while, she realizes that I am her daughter. In any case, she sees me as a friendly face and I never correct her. Why? It only upsets her to realize she’s “confused”. She knows her grandchildren are hers, but she confuses them too. That’s OK. I had lots of practice with my dad. I was his closest sister the last 3-4 years of his life. It is never easy. It is what it is. My experience as a nurse has helped me tremendously, but in the end, I’m still the daughter watching a parent slowly slip away. Thanks for sharing this!

  21. So well written! Diagnosed with early onset Alzheimer’s at 48 I pray that if I reach that stage my kids and husband have the same attitude you have, I certainly don’t want to be a burden and have asked to be put into a home. They will have none of it at this stage and are in severe denial! When the time comes that I believe I have won the lottery I hope they will have fun with it, have a good laugh….. and just go with it! I will be rebooting this, maybe one day while reading my blog they can use your advise!

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