Choices in Dementialand (aka Confessions of a Spoiled Dinner Brat)

At any given time, there are several blog posts in my “drafts” that I haven’t published. Sometimes they aren’t published because I think they are poorly-written and need some polishing. Once in a while I hold something back because I haven’t quite found the right words to explain what I want to explain. And then there are a few that I haven’t published because they are somewhat rambling and pointless.

However, this one has been a “draft” for quite some time for a different reason. I have not published this post yet because it will make everyone think I’m a spoiled brat. In a way, maybe I am.

Let me start by saying that my husband is a really good cook. Not only is he a good cook, he enjoys cooking. On the contrary, I am definitely not known for my cooking. And I don’t enjoy cooking nearly as much as he does. However, I do enjoy eating.

In the middle of any given day, he is likely to ask me, “What do you want for dinner?” He’s not asking which frozen pizza he should throw in the oven or if he should pick something up at Panchero’s (although both of these options are completely acceptable in my book). He’s asking what he should stop at the grocery store to buy and go home to prepare. Whether I say pasta, tuna steak, or an egg sandwich, he’s on it. Pretty amazing, right?

Well, yeah…except I hate the question “What do you want for dinner?” The great thing is that he’d go get and make absolutely anything I name, but that is also the struggle. Even though I’m a vegetarian who generally avoids fried food and doesn’t do spicy, there are probably a million options. That’s precisely why it’s such a hard question to answer. When he asks me what I want for dinner (especially in the midst of a long day at work), I usually can’t come up with a single idea.

I don’t mean to complain. The guy is willing to go grocery shopping and prepare dinner. You’d think I’d have the mental energy to make a decision about what we should have, but sometimes it’s just too overwhelming. When you can choose anything, sometimes it’s hard to chose anything. So when he asks me what I want for dinner, I usually say I don’t know or that I don’t care.

Choice is great. Being able to make our own decisions is what empowers us and makes us the people we are. If you think about some of the punishments that we hand out to criminals, an important factor is that we take away choice. People in prison don’t get too much choice about what to eat or when to go outside. Others make those decisions for them. This is a big part of why people in prison feel dehumanized and stripped of their identity.

While we don’t like our choices made for us, making decisions for ourselves takes mental energy. The other night, we went out for froyo. We were at one of those places where you top your own frozen yogurt and they weigh it to figure your price. (Total tab for my husband and me: Almost $15.) It’s great to be able to have choices in yogurt and toppings, of course. And, yet, I’m not sure choosing from 27 flavors of yogurt really makes a person happier than choosing from six flavors. That’s before you even get to the toppings. (I should add that we now have four top-your-own froyo places in town, so this all happens after we decide which one to visit.)

Evaluating and making choices, whether these choices are big or small, taxes our brains. There are times when we have so many options that we shut down and can’t make a choice. The brain becomes flooded and it’s just easier to not make a decision. I once had an international student in my class from Africa. He told me that the first time he went to buy laundry detergent in the US he looked at all the options and, completely overwhelmed, left the store without buying any. I recently read an article that said that women who have a ridiculous amount of clothes often look in their closet and say they have nothing to wear because the amount of clothing is overwhelming. For that reason, fewer clothes in a well-organized closet may make getting dressed in the morning less stressful.

Choices take mental energy for all of us, and the dementia brain may have even more limited mental energy. Decisions that require evaluating many options can be really difficult, even they are decisions that most of us consider minor and pretty inconsequential. What do you want to do today? What do you want for lunch? Where do you want to go? What do you want to wear? 

Sometimes we can help people (and not just those with dementia) by giving options. As people have more limited mental energy, the number of options should decrease accordingly.

Would you rather go to the park, the coffee shop, or the art museum today?

Do you want to wear your blue shirt or your red shirt?

A family caregiver I once talked to told me that she was worried about her mom’s appetite. She would often ask her mom what she wanted to eat. Her mom would say that she wasn’t hungry. A simple change in how she asked the question made a huge difference. She starting asking questions in a different way. She made her questions multiple-choice and limited the options.

“Would you like a turkey sandwich or a salad?” she would ask. Her mom would respond with her preference. It wasn’t that her mom wasn’t hungry. It was that she was overwhelmed by the question.

Not surprisingly, processing options may take longer for people who have dementia. Often we have the tendency to jump in and make a decision when someone doesn’t respond immediately. Or we ask the question again–in a louder voice. (Why is it so common for us to think someone will be able to process our question more efficiently if we yell at them when the opposite is true?)

When I was in graduate school and first started teaching college classes, I was frustrated that my students were not participating in the discussion when I asked questions in class. My major professor, who had thirty years of teaching experience, observed my teaching and gave me some helpful feedback.

“Elaine, obviously no one is answering your questions in class,” he said in his heavy Dutch accent. “You ask a question and no one responds because you don’t give them a chance. They don’t have time to process the question before you jump in and answer it yourself.”

I taught myself to slowly count to ten in my head (and tolerate the silence) after I ask a question to a classroom of students. Fortunately, my students seem to think silence is awkward so they jump in at about seven to answer–even if they don’t want to.

I’ve started using this same strategy when I talk to someone with dementia. To tell you the truth, I probably should use it with everyone. Because we perceive silence as uncomfortable, we often don’t give people time to process questions they are asked.

So…a note to my husband. Please give me 3-4 dinner options and then plenty of time to process my choices. Maybe a printed menu with photos would be nice.

He packs my lunch for work, too. Yeah, maybe I am a tad spoiled.

7 thoughts on “Choices in Dementialand (aka Confessions of a Spoiled Dinner Brat)

  1. One of the first obvious struggles my dad had was at restaurants telling the staff what he wanted to eat. When we go out now, I ask him does he want the shrimp plate or the blt, etc, depending upon where we are. It gives him the opportunity to tell me what he wants if he is able to that day or he may look at me and say, whatever you think, if he is confused. It saves him from becoming embarrassed or frustrated if he can’t think straight right then. It becomes the little things that matter.

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  2. Wow, Elaine – this is helpful to me on so many levels! Cooking, teaching, conversations…

    Thanks! (BTW, do you remember me?)

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  3. ABout halfway through this post, I was wondering where you were trying to go with this one…and then I got it. I could see my Mother, not able to answer an open question like “what do you want to watch?”, or “what do you want for lunch?”, yet we still want her to be engaged in those few things she still has choice about. Of course waiting the 10 seconds for an answer won’t work, either, so I will use the strategy of ” option A or B?”.
    Thanks again, Elaine…you are engaged in meaningful work!

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  4. Again, perfectly stated. Thank you. It’s the most (yes a harsh word ahead) annoying question I get all the time… What do you want for dinner? or What do you want to do? I hate it. No one realizes how much pressure those few words can put on me. I’m so glad that you finally published this and you worded it perfectly. It is so overwhelming to have so many choices. People I know would love to have that, but not me, not those with this disease. Simply told above in your blog – just give me a couple choices and the wording is dead on. Ask do you want this or that? Do you want to do this or that? Perfect. Take out the thousands of options and also give me a bit to think about even answering that basic question. It takes me a much longer time now to process any question asked of me. I wish and hope more people, family, caregivers etc can understand and read this. 🙂

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  5. Elaine:
    Great post and so informative. Great advice in many situations. I can relate as I have asked Grandma where she would like to go for dinner and she will answer by saying we could go to (names several) restaurants. A choice of two or three places works best and since I am the eater in our family I might as well make those choices where I would like to go. Makes for an easier conversation all the way around. She doesn’t have dementia but with this example I can see how totally overwhelming making decisions could be for a person with dementia.
    Thank you for the advice!

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