How do you respond to a woman (92) in AL who has increasing dementia and keeps saying "I have no purpose in life anymore"?

InWyoo, how about notifying her family she feels this way?

I understand your frustration when you see this person whom you care about give up.

You know I'm just 47 and yet I feel like I should be able to do the things I did when I was 25. I can only imagine what a 90 yo must be feeling: trapped in a body that is betraying them mentally and physically; not able to do the things they used to love doing. It is such a reality check when you realize you can't do those things anymore.
There is only so much you can do to help so don't feel bad about it. One thing you might be able to do is throw her a surprise party. It doesn't have to be a huge affair- maybe a few friends from church, a cake and some punch? It sounds to me like she needs to feel needed and right now she feels isolated, trapped. There are no easy answers when the person you're trying to help doesn't want to cooperate. Ultimately it must be up to them.

Regarding outside activities, she has declined so many offers from church members that most have given up. The general consensus of those who know her best is the (1) she refuses to accept the current reality of her life and (2) she still wants to be the queen bee, where people come to her. She said she wants to dance, drive, and have parties in her room, but doesn't want the parties to be potluck, but rather food she prepares herself (adding, "But that would be too expensive."). She complains that all the activities at the ALF are too simple minded or not challenging or not interesting to her -- always some reason. She, with a breathing issue and mobility issues, complains that the chair exercise class isn't challenging.
As I have mentioned before, I cannot involve myself with her medical care.
Also, the ALF is not interested in talking to non-family members about her. I very gently tried to speak with a staff member about getting her involved in actitivities there, and I was "blown off."
I think that something she said when she was about 90 years old and recovering from a serious illness gives great insight into her personality, and she said this several months before her family placed her in the ALF. "I want to get back to where I was when I was at 55, busy with all sorts of activities in and out of my home, going to parties, and I want to do it all from 7 AM till 10 PM without a nap!"

I don't have an answer, but I have the same question...my 90 year old keeps saying that she is useless and does not know how to use technology, doesn't understand much news, etc. and has no intention of even trying. How can anyone force someone to feel worth living. Her memory, both long term and short term, are slipping. I just bought her two jumbled word books for some challenging things for her brain. (She used to do them.) What else will.
Of help?

If she is bored or not interested in the activities at the ALF, consider a day outing: A museum, an art gallery, a restaurant, just shopping at the mall or an outing to a park. It could be she's feeling cooped up due to her limited mobility while she was healing. maybe you could get her interested in what you like to do or find something new to have in common. Maybe take up an exercise like Yoga. They have classes for the elderly. I also highly recommend pet therapy. If her depressed mood continues, make sure the caregivers at the facility know; it could be she needs a change in her meds.

I agree with graceterry that you risk being drawn in to her drama. If she doesn't want to participate, that is her choice, and for your sake...consider letting the matter rest there.

You can assure her that she has made her impact upon society, and this is
the time to be content with herself. If she has been badly hurt, quiet and meditation or prayer are best. Letting go of things that are no longer important
is a way of letting go of her 'ego' and finding inner peace. Self importance no longer play a part for her, and as she finds inner peace, some of it may come back. It sounds like she has a lot to let go of. Just be gentle and loving and acknowledge that she may be right. If she is depressed, you may want to express concern to her doctor, but in fact this can be essential in ongoing spiritual discovery. Don't worry. Tell her about something meaningful for you.

In defense of your friend...I do not have dementia and live in my home. BUT....7 yrs ago my son passed away. He had been my primary focus for the 10 yrs before that due to his brain disease. My daughter was married (did everything with her husband) and pregnant (now has a 2, 6 & 7 yr old). Anyhow, my point is, for the first time in my life No One Needed Me. My realization was that I could disappear and no ones life would be changed in any noticeable way. In an ALF everything is done for you:meals prepared, clothes laundered, room cleaned. You aren't doing things for other people. You aren't preparing lunch for your friends, planting flowers for the neighbors and yourself to admire, etc. It was a very difficult time for me emotionally and I was on anti-depressants. So what is her purpose in life? She needs something to make her feel useful. I like the coupons, stuffing bears, those type of activities where you are doing something to make a difference in someone else's life, someone who will need or appreciate what you've done. I am fortunate to work as an LPN twice a week and try to make my residents feel important, this gives me a sense of purpose too. I also am fortunate to be a major fixture in my grandchildrens lives (my greatest satisfaction). I hope your friend can find her purpose no matter how small or simplistic it is.

Sometimes, this comes with a great deal of anger that she is now not the center of attention in her world nor in control as she once was and, no matter what you do, nothing will make this better. It is one of the cruelties of old age.

Thank you all for your continuing responses!
graceterry's response is one that I have been thinking about, even before I read it here in black-and-white: "You seem to have been 'sucked in' by the black hole of her neediness/obstinacy. It may be that the harder you try to change her, the more she will resist you. Don't work harder for her happiness than she does." You are so very correct that I need to emotionally stand back from this situation. Yes, I have heard of the Serenity Prayer. I will go on-line, print a copy, and tape it up by my computer!
Regarding a support group, yes, I regularly attend the weekly caregivers' support group at our local Senior Citizens Center, since late last year. A couple weeks ago another woman from our church has also started attending the support group -- she spends more time with our friend than I do. I usually go to the AL to see our mutual friend once a week for about two hours. By no means are we the only people who visit her.
Regarding the suggestion that we conduct mini self-empowerment groups with her, two of us are planning some mini discussion groups in her room. I don't know how that will work out since she has difficulty tracking conversations, but we can certainly give it a try. (Several months she dropped out of the regular book discussion group she had belonged to for many years, even though the other members would provide transportation and once came to the AL for the meeting. At least part of the reason that she dropped out was that she could no longer keep track of the location of the book in her room when she was studying it between meetings.)
I have joined her for dinner occasionally in the communal dining room, and that has gone well. I have attended a couple activities at the AL with her; one was a vocal performance by young people, the other was a wine-and-cheese gathering of residents. Both times it took two people so long to convince her to attend that, frankly, I was ready to walk out the door. (The comment "Don't work harder for her happiness than she does" comes to mind here.) She enjoyed the singing, but not the wine-and-cheese gathering, saying, "I'm not like these people."
As suggested, we may find someone with a small dog to take along on visits; she doesn't care for cats.
The idea of videotaping her memories is worth pursuing. I have no idea how she will respond to that idea.
Again, thank you all for your time and effort in responding.

From my experience - the feelings of uselessness comes and goes. Some times it changes so quickly it's hard to know why or what happened. Just another symptom of the disease. It seems that every day a new change comes or goes. Just keep loving and supporting.

I don't know about the dementia bit, but when I hear that I try to make a joke out of it. In my context I hear it as "I'm useless." So I say something like, "Come on, you know that's not true. You have at least three useable parts. You're not ready for recycling yet!" It never fails to get a laugh.

My goodness......the outpouring of truly excellent suggestions are hard to add to, but.....I still want to put in my two cents. It occurs to me that since she held self empowerment workshops, and this is her niche, that she could still hold an empowerment workshop there at the facility, but much more scaled down.....with only one or two people at a time due to the their own health, mental issues as well as your friends declining health. I would highly encourage you, as her friend, to be there at the workshop, assisting her in every and any way possible as well as those attending. It has great potential and possibility for all involved but it would absolutely have to be only one or two attending so your friend would not get overwhelmed and it would have to be a pretty simplified version of her former workshops. I'd say she could absolutely be used to breathe life back into the people there who also feel very similar to herself. Since she has trouble tracking, it wouldn't be unusual for those attending to also have the same or similar problems. Ultimately, what matters here is that your friend feels she is helping someone and those attending feel someone cares enough to empower them. That would have to be the higher goal here.......about caring about each other instead of getting bogged down in the specifics of the doing. Hope this helps.
Chris

My mom is in memory care and the activities director tells me mom will not participate in certain activities unless she (the director) purposely involves her. The director will get those can, up to dance...my mom will not join in unless the director goes over to her and starts dancing with her.

Another way to get your friend involved in activities is to join her in the activities. Once she sees she can have fun with it, she may do it on her own.

"Then do what's in front of you" misses the point. She's not saying "I need to be busy." She's saying "I have no purpose in life." That's a very different thing, and it's a legitimate and profound sense of void that playing Bingo is not going to fill. Talk about the real deal! Ask her about what her purpose has been in the past, find out what the phrase means to her. It's likely to have something to do with helping people, using her mind.... It will give you ideas for an honest and real response, like how she continues to help you by enriching your life, and how that conversation itself is thought-provoking and helpful, and such. Joanne's answer deserves to be read and re-read and re-read, way to go Joanne.

okay, this puts another whole light on the subject. I think writing down her stories could be good, also, have you thought about videotaping her? Then she really would be in center stage! She really does sound depressed to me (I've been a mental health professional for 30+ years, but of course my perspective is not really valid since I have no personal contact with your friend). My dear, I would say to you that perhaps you are trying too hard. You seem to have been "sucked in" by the black hole of her neediness/obstinacy. It may be that the harder you try to change her, the more she will resist you. Don't work harder for her happiness than she does. You will only end up as unhappy as she is and she will be no better! This is the voice of experience. Have you thought about attending a caregiver's support group for a reality check and, well, support? Make reasonable attempts to provide friendship and support, then let it go and trust that a Power greater than you is working in her situation whether we can see it or not. Take good care of YOU. Are you familiar with the Serenity Prayer? Works for me. Bless you for being a kind and caring friend. G~

Thank you, everyone, for taking the time to share your thoughts and ideas. My friend's situation has changed since I posted the initial question. At that time she was recovering from a broken hip. Within the past week, her closest friend in the AL had to be moved from the AL to a nursing home on the other side of town, and the chances that she will be returning to AL are zero. My friend was always very possessive of her friendship with the woman who was moved, and my friend took it as a personal affront that the woman's family had moved her without my friend's knowledge. (The AL facility told my friend of the move.) In this same time frame, one of my friend's daughters received a grim prognosis for the cancer she has been dealing with for a long time. This combination of circumstances would be difficult for most people, no matter what their age.
Stepping back in time, before this trio of circumstances, I think pstegman's answer addressed the root cause, apart from the dementia. "She has a purpose, but what she wants is the center of the stage." Years before she went into assisted living, her son used to get after her for not returning phone calls. I was very surprised that she told me that (more than once), especially since she always added, "I've never had to call people. They always have called me." With the recent broken hip, she told me (and at least one other person) that she did not want to return to AL because she liked all the (one-on-one) attention she got at the hospital, in both acute care and the transitional (rehab) unit. It is indeed true, that despite her many good points, she is a prima donna of sorts and always has been from what I've heard from people who have known her a lot longer than I have.
Regarding anti-depressant medication, I don't know if she takes it. I do not involve myself in her medical care at all. Her children have forceful personalities and are quite protective of her and would most certainly see this as none of my business. They see to it that she gets medical attention.
Most of the activities, including clipping coupons and preparing care baskets, mentioned in the answers to my post are available at her AL. But she will not participate. As some of you have suggested, I've offered to help her plan her self-empowerment groups that she's always talking about, but she says no. Regarding a visitors' log, her daughter got her one, but my friend told me she doesn't want to use it, and I have no idea where she hid it.
When I asked her what she wanted to do as "purpose," she replied, "Help someone out of a tough spot, dance, and sing" (yet she doesn't sing the hymns at church and never has). Then a bit later she said, "I'm just waiting for something good to happen!" I replied, "Well, while you are waiting, you could do what is in front of you, like the activities here!" She said no. She does have an interest in history and writing, so I will talk to her friend who gathers (military) oral histories to see if she has any ideas. Also, if someone could tell me more about "Writing Down the Bones," I'd appreciate it.
Thank you!

I think if I had a loved one who always said, "I don't have a purpose ANY MORE...", I might say, "tell me about when your life DID have purpose....what was that like? what was your purpose then? ....what would you like your purpose to be now?" ...then listen...Listening to a person helps them feel valued and valuable, which is what I really think this is about. .I've also been told that sometimes people with dementia feel "purposeful" and useful if they are asked to "help out" by folding the laundry, for example - even if they fold the same half dozen dish towels a half dozen time...simple, repetitive tasks followed by praise, recognition, and appreciation might be helpful. ....and please, please, people - don't tell anyone to "Get over themselves" even as a last resort. With all due respect to our friend who posted earlier, that kind of scolding is not helpful to people who are younger and who don't have dementia, and it's certainly not helpful to frail elders with dementia. If that kind of "encouragement" was helpful, I'm sure we would all be doing great. Blessings to all, G~

My sister sat with my parents and wrote down the stories they told about their childhood etc. It was such a different time. My parents enjoyed relating the stories, and there is a record of them to hand down to grandkids. Maybe you could leave a spiral binder and write out a new story when you visit. Or, if she is able, she could write the stories herself. At her age, she went through the roaring 20s, silent movies, wwII, depression and gathering needed food (some of my dad's stories were about getting fish in the winter for his family when he was a boy), TV, Talking movies, Color TV, commercial use of airplanes....on and on... My mom joined the army, unusual for then. My father's dad made moonshine, and dad was in the army air corp. He was also quite a prankster as a teen. Usually old memories remain easier to get to for elderly so it flows rather than remind them they can't remember stuff.

Have you ever asked her what she would like to be doing? And then possibly amend that to her present abilities. She may not be able to concentrate for long, or not do it well, ect....but being a caregiver for someone with any stage of Alz/dementia is a constant task of being a magician... pulling tricks out of our hat to keep them busy and entertained.... just have to use our imagination and if something doesn't work, then try something else...one time I had Ruth help with some Yard Sale posters... at first she was excited to be helping... but it tired her out.... her mind was having trouble concentrating on one task... but it did calm her down... so onward thru the fog of trying one thing after another.

Come on Captain - this is a new century. Women were given the right to vote many years ago. You may have noticed that the majority of people on this site are women. And these suggestions for the friend are thoughtful and helpful. Encourage her to do what she is good at - as someone suggested - who cares if she rereads pages - at least she is doing something she enjoys. I wish I could get my husband interested in doing something other than sleep.

She has a purpose, but what she wants is the center of the stage. Tell her she may no longer be the conductor, but she is still in the orchestra. If she is still here, god still expects some work from her, and she should ask her angels to guide her to the answer.

i aint done ranting yet dammit. try not to take over the elder care recipients life. i push aunt edna in her wheelchair but she locks, unlocks the door, fumbles with her own keyed mailbox, punches the elevator buttons, etc. please let the patient feel in charge of all decisions. they are old but far from stupid.
this is where my sis and niece fell short of good caregiving -- they smothered the patient and micro managed their life.

Let staff know what statements she is making so they can alert the doctor she is depressed. As a friend you can only support her, and recognize she is depressed and probably would do well on some medication, but that is for the doctor and her family to decide. The re-reading of papers, books is symptomatic of about stage 3 of dementia and there will come a time when she will be unable to read. So what if she re-reads things? She has dementia and others in her unit probably have it too and they don't mind. Try to look at her illness from her viewpoint. When you have lost your mind (thinking), that is pretty devastating. Keep visiting, until she doesn't recognize you, and visit still. You will not always have your friend, so cherish her while you do...

Oh dear. My first thought when I read the initial post was, "Agree with her." Agree that it is sad and difficult to figure out one's purpose when one's resources and even strength have all changed. And also tell her that she has been resourceful before, and that as time goes on, you are sure she will find something that is helping others, and learn to share it more. I also like the idea of clipping the coupons for the veterans - I joined an elder group organized to write addresses on envelopes to send out to rally voters for Obama. I find it insulting for younger people, to try too hard to find activities for others - the thing for the younger people to do, in order to help, is to visit and relax in visiting, so that simply joy comes the visit - we (and I've done it too) get so eager to help, we don't realize that life holds gems in every person, and with patience and calm, those gems emerge. I find the idea of putting someone on antidepressants to be one that is depressing in itself - bypassing the opportunity for real communication, into trying to turn it into something always cheerful. Cheerful may be nice, but only if it comes from hope and sharing. We mean well, but we often confuse tasks that can be done by younger people, versus older. I'm 70 now, and struggling with a similar issue - how to be useful when I find I cannot count on the same enduring energy I had when young. I'm grateful that I learned to take a writing class, where we do timed writings of 3, 5, or 10 minutes - then share our writing with others. I find this a fabulous way to access some of my individual thoughts and impressions, not just always my fix-it mentality, so that my life feels more fun, as I find myself interesting, and other writers in my group interesting too. The model is based on Writing Down the Bones - a great book to recover enjoyment in writing.

My father went through this phase, and what I discovered that helped was to sit and talk with him about what he accomplished in life....how important he was as a father and what he 'gave' to my brother and I ....and then I just took it forward to my kids and their kids and how he went and helped the homeschooled with their math (he was an electrical engineer, computer programmer and mathematician....so his BRAIN was very important to him...and he dealt with knowing he had dementia for 8 years before it really got bad) I just pointed out that when you get to 90, and you've left a legacy of helping to shape all these young lives....and they will never forget you...then, it's OK to not remember some things, and to lose strength and to not be able to do everything you used to. Then I would talk about my Grandpa, who was in his 70s when I was born, and how important to me he was, but he had always been old, retired, sitting in rocking chair, reading the bible and smoking his pipe, while everyone took care of him....and yet, he shaped my life in many ways...while 'doing nothing'.....It was a great conversation with him, and he got tearful and admitted that the "really scary part being old, was just always wondering if your life had made any difference to anybody". At that point in time, he had already quit paying bills and turned over the trust and POA to me, because Mom couldn't do any of that stuff herself....and I assured him repeatedly that no matter what, I loved him and I would always try to do things remembering how he liked them done...and if he got too forgetful, I would help his mind with my mind, and that I would keep Mom safe and cared for too. Now, he's in a facility and he's past the point of caring. He wants to know he's loved and we are still coming to visit and occasionally he asks if he still has enough money in the bank and if Mom is doing ok. Sometimes he wants to go home, or he wants to know why he is not at home and why he has to be at 'this hotel'....and we just tell him he is staying where he is at because the doctor says he should be there while they try to keep his mind working as good as it can work. That is very satisfying to him....he's always wanted to do what the doctor suggested and he's always wanted his mind to stay in the best shape it could be in....so he says, "Oh OK....well, you know, my memory isn't what it used to be anymore...." and we just go to another topic.

I would first try telling her that she give you a place to come and visit- and a good friend to see. That you count on her being here. You might remind her of all the good things that she has accomplished and end the conversation with a hug.

maybe some people are just inclined to overachieve. my aunt edna ( 89 ) lives in an IL facility and just a ride around a country block and an arbys sandwich always makes her proclaim that " we had fun " . of course shes an old school girl. she considered cooking and cleaning to be her " job " , she took pride in it , and she didnt need degrees and a career to feel good about herself. if american women could only see that they were pushed into the workplace by a govt intent on perpetual growth at the expense of the family unit they might feel less empowered and more exploited. hell, i took her to the er last night per her docs recommendation. she had aquired a bad flu bug , and ill be damned if at the end of the 3 hr ordeal, blizzard and all , she still sez, " oh well, we had fun " .. sadly, they dont make em like edna anymore. she nursed both of her parents right till their final breath.

There are Prayer Warriors all over the world. Maybe her church can send someone with a weekly list of those to be prayed for. That will surely help all of them and give her something to do. The problem is the hours in AL are long and no matter how many tasks, loneliness is part of the existence in one.

I would have to agree with all the other suggestions, that if you can, try to find a way to keep your friend busy and to help her feel like she has goals. The elderly just don't feel useful anymore.
My mom's life and attitude turned around 180 degrees when she was put on anti-depressants. It was a long road, bc she said she wasn't depressed. She sure was irritable and ugly, though! If your friend has family, and you can talk to them, maybe gently suggest that it might help if they talked with her doctor about prescribing some to her. You seem like an awesome friend!!

I don't know if pets are allowed but if visits from dogs or cats that come in with their trained assistant might help (for 20 minutes at a time--not a pet left roaming through the facility) would be a day brightener and she could become involved in pet rescue efforts by cutting coupons for cat food or rescue supplies. Animals don't care if you repeat yourself hundreds of times. They just love you.