Dementia expert urges families to drop force and written cues

A fundamental clash exists in how many families handle daily routines for relatives with dementia. They often attempt to force compliance with standard tasks, while the patient's brain has shifted how it processes those demands. Teepa Snow, a nationally recognized occupational therapist and founder of Positive Approach to Care, argues that this mismatch causes unnecessary conflict for both parties.

Snow recently joined the program Aging Untold to explain her methodology. She rejects the common terminology of brain loss or failure. Instead, she prefers the term 'brain change.' She notes that while individuals lose certain abilities, other traits often emerge or intensify. For instance, Snow observed that people who rarely swore in public may begin doing so, or those who usually avoid strangers may ask for help getting home.

"Although people are losing some abilities, they’re actually changing others," Snow said. She explained that neuroplasticity remains active regardless of diagnosis. Her approach focuses on utilizing the current state of the brain rather than mourning what is missing.

When asked how to handle a parent who refuses to shower, take medication, or dress, Snow advised against force. She suggested asking the individual to assist with a much smaller, specific task. In one example, she pointed to a spot on her cheek and told a hypothetical patient to use a washcloth to remove it. Another suggestion was asking the person to wash their hands before cooking. If the person refuses these minor steps, Snow said a full shower is unlikely to succeed.

Snow also addressed the use of written reminders. She stated that sticky notes and labeled objects often fail because the hippocampus, the brain's learning and memory center, is required to access the written information and sequence the next step. The front of the brain is already struggling with sequencing, so adding a written layer can overwhelm the patient. Families should recognize that the person likely needs more direct support to complete tasks.

Snow told gerontologist Sam Cradduck that caregivers must build new awareness and skills. She emphasized that not every family member is suited for hands-on care, and some are better at organizing the broader plan. "You’re both doing the best you can, and if you want something to change, one of you is going to have to change," Snow said. She noted that the person with dementia is already experiencing brain change, placing the burden of adaptation largely on the caregiver.

The next step for families is to assess which members can handle physical care and who should manage logistics. Snow said this is hard work that requires specific knowledge, and caregivers should not expect the patient's previous habits to return.