This blog post on tolerance is the seventh and final installment of a seven-part series on common sense caregiving for people with dementia. The series features seven principles that can improve quality of life for caregivers and their loved ones. R-E-S-P-E-C-T is a helpful mnemonic (memory device) for remembering these tried and true tips:

The Seven Common Senses of Dementia Care

1. Respect
2. Enlist help
3. Safety
4. Preparation
5. Engagement
6. Consistency
7. Tolerance

  People with dementia often don’t acknowledge loss of abilities, or at least the extent or consequences. Loss of insight is part of the disease. As dementia progresses, they will likely have even greater difficulty acknowledging and coping with their impairments. Therefore, caregivers must be the ones who adapt. Here are my Top Ten Tips on Tolerance:     1.  Embrace change Be open to accepting change. Acknowledge alterations in your loved one with dementia and adapt as needed. Take time to mourn losses. Writing down what you miss in your loved one or discussing it with others can help.     2.  Go with the flow Be flexible. Let your loved one guide your responses in the moment and in planning for the future.     3.  Enter their world Reassurance is more important than a reality check. If a loved one with dementia wants to discuss a dead family member as if the person were still alive, it is not necessary to remind or correct. Listen. Bring out old photographs, etc. Reminisce together.     4.  Keep the peace Identify and minimize any behavioral triggers that cause agitation. Common triggers include large groups, television, noise, and clutter.     5.  Address apathy Most behavioral issues in dementia require patience and tolerance. However, lack of motivation is a problem that may need to be addressed. Structured activities are the antidote to lying in bed or sitting in a chair all day.     6.  Everyone needs a good night's sleep Nighttime insomnia and daytime sleepiness also need to be addressed, not tolerated. Exercise good sleep hygiene for you and your loved one with dementia. Consider professional medical help, especially as many over-the-counter sleep aids aren’t good for memory.     7.  Don't let the little things get you down Your loved one with dementia may engage in repetitive behaviors. If this bothers you, try distraction. You may also use such behavior to keep your loved one engaged. Fill a basket with clean laundry that can be folded over and over again. Prepare a drawer or box that is safe to rummage through. Have a safe place to pace. Or give yourself a break and try going to another room and/or engaging another caregiver.     8.  Balance tolerance with safety Others must step in immediately if a person with dementia is engaging in an activity or behavior that may endanger safety. Professional assistance such as that available through Cariloop may provide guidance in securing help long-term.     9.  It take two to tolerate Your loved one with dementia has to tolerate you, too. Overwork, exhaustion, and stress can make any of us less enjoyable to be around. Follow the principles set forth in this series, enlist support, and take breaks.     10.  Aim for acceptance Advance from tolerance to acceptance. No one asks to be a caregiver for someone with dementia. But it may be the greatest challenge and reward you’ll ever know.   By Anne M. Lipton, M.D., Ph.D. Neurologist and Author of The Common Sense Guide to Dementia For more information on the Seven Common Senses, see Dr. Lipton’s book, The Common Sense Guide to Dementia for Clinicians and Caregivers.