verb [ intrans. ] Psychology
repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased.
I would add to this definition: confusing to those subjected to it.
Perseveration is something we expect of young children. We’ve all seen a child hold on to an idea or thought long after the thing that triggered it is past. The idea is often often predicated by “I want…”. They can hold on tenaciously and be difficult to redirect. When this behavior occurs in public and the only right answer is “no”, it can lead to further escalation – sometimes hysterics — especially if one’s child is tired. We’ve all been there. It’s a challenge with our children. Small wonder when we stumble into aged parents exhibiting this same behavior, we don’t know what to do!
With perseveration, the repetitive phrase almost becomes a mantra, and perhaps this is where the brain becomes wired to separate “want” from “have”; power over our desires to relinquishing them. It is where we learn “wait”, “not now”, or “you are safe”. Rarely can a young child be reasoned with logically, distraction tends to be a parent’s best friend in this situation. With children, it may take us by surprise, but it isn’t frightening (frustrating maybe!), or dangerous (usually). As their ability to understand time, patience, limitations increases with maturation, perseverating happens less frequently.
It feels very different when Elders, perhaps due to subclinical dementia, demonstrate perseveration. I heard a story recently about an elderly father who showed up to a Memorial with an agenda. He wanted something. He had apparently wanted this item for some time, and felt entitled to it. He spoke about it to family for several days before the memorial, where he would see the people he needed to talk to about it. His immediate family didn’t know what to do about his pit bull like tenacity, and when he did engage with the family who owned the object – loudly, publicly and at the gathering after the memorial – they were mortified. He wanted what he wanted, and that was all. Perseveration. “I wish I could have been this big” (demonstrated his daughter, closing her index finger and thumb together). “I wish I could have become invisible. We didn’t know what to do.”
In the end, this daughter left her father at the gathering. He could still drive. He lived independently and could engage in intelligent conversation but his behavior around his object of desire baffled and deeply embarrassed his family. Listening to the story and empathizing with the adult child, I thought again about how a lack of understanding regarding behavioral changes left everyone powerless to help him. Arguments ensued (with the inheritor of the belonging denying anyone else had any rights to it), upsets happened. No one had insight to de-escalate or re-direct his behavior, in part, out of respect for his position as a family Elder. No one wanted to appear patronizing.
Bad behavior is bad behavior and it doesn’t matter what the age. With our children, we know it is lack of understanding, patience, experience. But when our parents exhibit that same behavior, we expect more. They have demonstrated (and taught us!) appropriate boundaries, social skills, understanding and higher functioning emotions like empathy.
Perseveration is different from bad behavior, though. It suggests that a pathway in the brain is not working correctly, a thought becomes a compulsion. In the extreme, it can be a symptom of serious mental illness or an abrupt cognitive decline, but can also just be a more benign indication of changed cognition in that one instance. The individual likely won’t recognize they are doing this; and they aren’t engaging that way on purpose. Some automated thought loop in their head has been triggered. The challenge is for family or caregivers to find a way through it.
As a mother, I used to say “distraction and bribery” were my two best friends. This can be just as true with Elders who are stuck in a thought loop like this. I offer the following as tools for coping:
1. Validate their experience, whether it be something they want, they lost, they fear losing. Validate it, let them know they are heard. NOTE: if an Elder seems to be perseverating on a bad caregiver, living situation or expresses the same story of exploitation, abuse or neglect, this MUST be investigated thoroughly. Just because they repeat the story doesn’t mean it isn’t real. In the case of abusive care, the abuser is counting on the fact that people discount the Elder’s story because they have dementia or a history of perseverating.
2. Examine how you can relieve the anxiety. What can be changed to make the Elder more comfortable? How can they feel more powerful in this situation?
3. How can you redirect the thought process? One option would be to tell Dad “I hear that this is very important to you. You know that everyone is going to be sad and upset at the Memorial. Let’s talk to Bill and ask him not to do anything with what you want until after you and he have had a chance to talk about it, and we’ll make a time to do that together.” This probably would have had to be restated in many ways, several times, right up to the point of seeing Bill. (“Remember Dad, we’re going to make a special time to talk to Bill about this later. Please be patient.”)
4. Follow through. Trust-building and integrity is as important with Elders as it is with children. When they perceive a lack of trust and integrity, anxiety escalates. Elders have little to depend on. Make sure that you can be counted on to watch their back.
5. Don’t quit. If your child was screaming an “I want” statement in the grocery, you wouldn’t stop trying to find a way to redirect or de-escalate the situation. Treat the Elders in your life the same — with calm, patience and understanding. Your anxiety will magnify theirs. Perseveration means that something is beyond their self-control, and Elder or no, they need a kind intervention to break the thought cycle loose and see beyond it’s immediacy.
We don’t want to “Parent our parents”, but we can use our parenting skills to be better children, better advocates and better friends to them as their ability to “roll with the tide” becomes less flexible. They need us, as we needed them when we were young. Breathe deeply. You can do this!