Repetition in people with dementia
Memory problems in dementia often cause people to repeat themselves. This may test our patience, but there are various things we can do to help. Memories that are shared frequently are often very significant for the person. People with dementia often repeat words or actions, and this is because of problems with short-term memory caused by dementia. Although this can be difficult, we can respond more effectively if we take notice of the feelings and needs behind the repetition.
People with dementia often have fascinating stories to tell, and we can learn much about the past.
It’s important to be aware that the person’s poor memory is something they can’t help. The memory loss in dementia is caused by physical changes: the parts of the brain that record and store new information become damaged, so the person is unable to hold the memory of what they’ve said, asked or done and any response they’ve received.
Why is this happening?
Some reasons why a person with dementia may repeat themselves:
- The person’s short-term memory is impaired and they have no recollection of having already said or asked something.
- The person’s repetitive questions may suggest both a need for information and an emotional need. Repeated stories often represent highly significant memories.
- The person may repeat themselves because they want to communicate and cannot find anything else to say.
- The person might have become ‘stuck’ on a particular word, phrase or action.
- The person might be bored and under-occupied.
Supporting the person to find a way of recording the information they keep asking for – perhaps by writing in a diary or notebook – may help. Providing a visual reminder of the information the person needs, such as a large clock to help a person who frequently asks the time, is another idea.
Feelings and repetition
It is also important to be alert to the feelings that the person is expressing. A frequently asked question might, for instance, represent strong feelings of anxiety as well as the need for information.
For example, a man in respite care who repetitively asks when he’s going home may do so not only because he needs information about the date when he’s leaving, but also because he’s feeling uncomfortable and unwelcome.
Sometimes people can get ‘stuck’ – repeating a particular set of words or phrase. Here, we will need to work out whether the person is using these words to communicate something, or whether the repetition is outside the person’s own control, in which case it can be helpful to prompt the person gently to help them get ‘unstuck’.
People may also repeat actions – for example, someone may take clothes out of a drawer, re-fold them and put them away again, and continue to do this many times. This could represent a meaningful activity for the individual (perhaps relating to a past habit) but if repeated actions seem to be causing distress, or seem to suggest that the person is bored, it may be appropriate to try to interest the person in a new activity.
See the Keeping active and occupied section for more ideas on this.
Valuing long-term memories
Although short-term memory is often badly damaged in dementia, memory for the past is usually much better. People with dementia often have fascinating stories to tell, and through listening closely we can learn much about the past. When people repeat the same stories or anecdotes over and over, we need to be aware that the memories we are hearing about are important for the individual.
The past and now
It might be that the subject the person is talking about represents a particular need that they have now. Someone who keeps talking about a key achievement might be doing so because he feels that he is no longer achieving anything, which means we need to think about involving him in a meaningful activity so that he can achieve something now. (See the Keeping active and occupied section.) Someone who talks on and on about a sad event in her life may have unresolved feelings about it, and our attention and understanding will be vital in enabling her to express some of these feelings.
Reaching for a response
It can be hard to keep on listening to the same story, but we need to recognise that the person who is repeating themselves is doing so because they need some kind of response. It may be, for instance, that the person just needs to communicate and feel close to someone – in which case, we could try changing the subject to one that we will find more interesting, so that we find it easier to stay talking with the person.
A person may also repeat stories from their past because they have very little memory left, and these memories are helping them to hold on to and sustain their sense of identity. It could be helpful to work with the person to create a record of their life story – celebrating remaining memories and perhaps including some other key features of the person’s life that we have been told about by their relatives. Life story work doesn’t need to be a major project – it could be something as simple as collecting a box of memorabilia or making a scrapbook, using lots of photos and pictures with short captions. This will help to affirm the value of the person’s memories and life, and will help to reassure them that their remaining memories will not be lost.
People with dementia often repeat words or actions, and this is because of problems with short-term memory caused by dementia. Although this can be difficult, we can respond more effectively if we take notice of the feelings and needs behind the repetition.
For more on these ideas, look at the section on Communicating well.
All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:
- QCF Mapping: Repetition
- Activity: Repetition
- What the research says: Difficult situations
Further reading Open
Killick, J. and Allan, K. (2001) Communication and the care of people with dementia, Buckingham: Open University Press.
Murphy, C. (1994) It started with a sea-shell: Life story work and people with dementia, Stirling: Dementia Services Development Centre, University of Stirling.
www.atdementia.org.uk: this website provides information on assistive technology products that can help with memory problems and other difficulties experienced by people with dementia.
Useful links Open
Alternatives to antipsychotic medication: psychological approaches in managing psychological and behavioural distress in people with dementia
This 2013 British Psychological Society briefing paper sets out guidance for practitioners on how to respond to distress in people with dementia by following a ‘staged approach’: a series of steps involving identifying, understanding and implementing individualised interventions.
The Alzheimer’s Society produces over 80 factsheets on all sorts of topics related to dementia, including many that relate to difficult situations in supporting a person living with dementia: Dementia and aggressive behaviour (509), Sight, perceptions and hallucinations in dementia (520), Managing toilet problems and incontinence (502), Walking about (501), and Sex and intimate relationships (514).
Dementia: Supporting people with dementia and their carers in health and social care
This 2006 guideline jointly published by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) offers comprehensive best-practice advice on the care of people with dementia and on support for carers.
Positive and proactive care: reducing the need for restrictive interventions
The Department of Health’s 2014 guidance on restraint is aimed at all health and social care staff working with adults in England.
Related pages from this section Open