Not challenging, just can't see properly

Les was ... well, it struck me as quite aggressive at our last meeting.  Except his carer's body language was saying: relax, he's a pussycat, same as he always is.

Les has had Alzheimer's for a year or two now.  I've seen him rise to various challenges within the limitations of his condition; he's always been creative and now his inhibitions have gone, so he creates more extravagently, sings louder, paints more vividly.  But it seemed to me that the frustrations of shrinking vocabulary, of not being able to make himself clear were getting to him and making him want to use not so much gestures as actual contact.  And Les is not a guy you'd pick a fight with, should he ever be in a fighty mood.  He was standing quite close, tapping me, poking, feeling where I was.

Pat, his carer, said it's to do with deteriorating vision.  Perhaps she meant visual-spatial awareness, losing the sense of how close or far away things are.  Les knew I was within his field of vision, but could no longer gauge the distance between us with his eyes alone, so was using his hands to help.  Perhaps it's like those optical illusion rooms which play a trick on your habits of perception so that you mis-judge the size of objects: have a look at this for instance.  Les's dementia has played a similar trick on his cognition, compromising his abilty to judge distance in ordinary contexts.

Pat reassured me that I didn't need to back off, but I thought how easy it would have been to misinterpret his behaviour as "challenging".  Her complaint was how often people talk past the person with dementia to the carer, treating him/her as "normal" and the dementia sufferer as wholly incapacitated.  The "does he take sugar" syndrome.  Les is still a person, she protested, and of course he is: I hope I always respect the patients I work with, however severe their illness has become.  The other side of that coin is that Les cannot always answer for himself, not on every issue at least, and needs Pat to interpret.  I know that I shall be talking past my dad when we meet with his social services assessor in a couple of weeks, and I'm never going to forget that he's a person who needs to be treated with more respect than he is now able to give himself, bless.  But he's not going to tell them that his standards of hygeine have slipped is he?  Not because he's too ashamed to admit it, but because he doesn't altogether realise that they have.