Have you ever walked away from a difficult moment with your loved one and wondered, “What just happened?”
When we talk about challenging situations in dementia care, we often hear that they come from unmet needs. That’s true—but figuring out what those needs are can be tough. In this post, I’d love to share one perspective that’s really helped me, and that might help you make sense of those tricky moments too: stress.
We’ll take a look at the N.U.T.S. Model by Sonia Lupien—a simple framework that explains how stress shows up in everyday situations. And we’ll explore how it connects to dementia care, with an example that might feel all too familiar: helping someone shower.
The N.U.T.S Model of Stress
We often think of stress as being caused by time pressure. In her book Well Stressed: Manage Stress Before It Turns Toxic (2012), Sonia Lupien (2012) offers another perspective that I find especially helpful when reflecting on our stress and that experienced by people with dementia.
Sonia Lupien’s N.U.T.S. model includes four key ingredients that can lead to stress—and just one is enough to trigger it:
- Novelty – something new you haven’t experienced before
- Unpredictability – not knowing what will happen next
- Threat to the ego – feeling your competence is questioned
- Sense of low control – feeling like you have little or no control over a situation
Knowing these four components when caring for someone with dementia can help prevent situations of refusal by diminishing the stress response (fight or flight). Take, for example, assistance with showering.
A Showering Example
For most of us, the idea of being assisted in the shower is unsettling; it threatens our ego and lowers our sense of control. The situation may also feel unpredictable and novel to us. While this situation is likely to be stressful, as a care partner you can help decrease the stress created by the situation by providing a sense of safety, control and predictability to the person.
How you will do this depends on the person, their ability and your relationship with them. Here are some examples:
- Protect their intimacy by having big towels they can wrap around, for instance.
- If they can turn on the shower themselves, let them. If you need to, then ask them to guide you: “Too hot or too cold?”
- Offer choices – sometimes, two options are the most someone can handle.
- Improve predictability by explaining each step in clear, calm language.
- If the person gets frustrated, apologise for the situation being uncomfortable
(a blog post about the ‘5 Sorries’ by Teepa Snow will be published soon)
Side note: This situation may be triggering for you too. Preparing mentally for the situation can lower your stress level. Seek help if needed. You matter.
The Importance of Fostering Relationship
Knowing the person you care for and spending quality time with them will help you better understand their preferences and routines. This will help create a sense of safety—one where the ego isn’t as threatened, and where control and trust can be nurtured.
While this model aims to explain stress in healthy people, I find it to be very well suited to the stress people living with dementia can experience. Have you experienced any of these stress triggers while caregiving? I’d love to hear what’s helped you ease them.
Sonia Lupien and her team are experts in the field of stress and I highly recommend checking out their research at the Centre for Studies on Human Stress for more information about the model.
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