"Choice Distress" - a few Ways to Avoid Creating This

What stimulated me to write this blog today was a show on CBC Radio1 about residents of nursing homes, specifically those with dementia, and something called the "Butterfly Model" of care (https://fco.ngo/files/Resource-Spotlight-Butterfly-Model-1.pdf). A specific example of a discussion between an elderly mother with dementia and her daughter, had the daughter asking something like "what do you want to do today?" This had me remember the many times I saw placements of people, formerly institutionalized at one of the large regional centres that used to house about 1000 Ontario citizens with developmental disability, "crash and burn" in what I described as the "culture shock" of arriving in communities where there was much freedom and choice offered to them. Many suffered high levels of anxiety and distress despite the privilege of so much freedom, respect, choice, and deference by community staff.

What's wrong with the question "what do you want to do today?" - especially asked of a formerly independent, self-reliant, but now somewhat disabled (by dementia) woman? For me, this is too open-ended a question, and the woman's response (as reported by the daughter) suggested I may be on to something in this opinion. Apparently the response was something like "whatever you want to do, dear", after perhaps a delay, and maybe even the facial expression that suggested confusion and/or difficulty processing an answer. Those readers who have studied Executive Function disorders tied to impaired functioning of the frontal areas of the brain, know that an open-ended question may require the answerer to "construct" the answer, involving insight, planning, goal orientation and judgment. A better framing of such a question might be to take it in stages - i.e. "is there something you'd like to do today?" - requiring initially, only a "yes or no" response. If the answer is "yes", follow up can help the person answering frame their response better. If they struggle to elucidate, the questioner can start to play the "20 Questions" game to narrow down the possibilities. The more informed the questioner, the smoother the conversation could be in arriving at the person's actual choices.

Below are some other examples of possibly stress-inducing questions, and some suggestions about ways of asking those types of questions in a less stress-inducing manner. Generally, the difference between stress-inducing and less stress-inducing types of queries has the questioner substitute "yes or no" questions for the "open-ended" questions we often tend to ask.

"What do you want to do today?" - vs. - "Is there something you'd like to do today?"

"Where do you want to go?" - vs. - "Is there somewhere you'd like to go?"

"Why are you [doing that]?" - vs. - "Is there a reason you are [doing that]?"

"Who are you looking for?" - vs. - "Is there someone you are looking for?"

"When do you want to [do that]?" - vs. "What [day/time] do you want to [do that]?"

Rather than open-ended choices, offering a slightly more limited number of options (choices), such as:

"What would you like to wear today?" - vs. - "Here are some [two, or at most, three] outfits you might want to wear today - which one would you like - or do you want me to get another outfit for you?"

As always, dialogue on this idea, or any other idea from our blog, is welcome. Learning about options and ways to avoid triggering anxiety or distress needlessly, always welcome!