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Locus of Control

July—August   2011

locus of control for persons with dementia

Why is “locus of control” an important and a timely issue for persons with dementia? Unfortunately, most of what is known to date about the impact of locus of control for persons with dementia is anecdotal and lacking in scientific research methods.

WHERE IS MY TEA??!!!!

Muriel sits in her wheelchair feeling the warmth on her shoulders of the early morning sunshine streaming through the kitchen window. Her face has a starched look of mingled confusion and despair. Every morning Muriel sits here waiting for her care partner to arrive and fix her cup of tea. This morning is no different.

But Muriel does not have much patience when it comes to waiting. Muriel is blind and has been diagnosed with early stage dementia. When she has to wait even a short time for anything, this seems to set off an angry button in her brain. In fact, she is beginning to feel distressed right now.

“Good morning Muriel, I am here finally,” says her care partner, Ruth, as she runs in the kitchen door, puffing and out of breath. “I am sorry to be so late, I missed my bus, and then I stopped on the way to get you these nice flowers,” smiles Ruth, holding up the daisies for Muriel to smell.

Muriel is not amused. She does not smile at the smell of the daisies, rather states, “What is the matter with you? Where is my tea? I always have my tea at 7:30 AM. It is nearly 9 AM and I have not had even a sip of tea. If you cannot do anything right, maybe just take your silly flowers and go away.” Muriel is beginning to become agitated and her voice is getting louder.

“Please let me put these flowers in a vase, and then I will make your tea for you,” replies Ruth.

“I already told you I do not want your silly flowers. WHERE IS MY TEA? DO YOU NOT SPEAK ENGLISH?” Muriel is now shouting.

“I understand,” says Ruth sadly, “I will do as you wish.”

“UNDERSTAND! UNDERSTAND! UNDERSTAND! HOW CAN YOU POSSIBLY UNDERSTAND?” screams Muriel. Her nostrils are flaring and her arms are reaching as though to pull her hair out root by root. “You do NOT know what I am going through. I have lost my home, I have lost my husband, my children have all moved away, I have lost my vision, and now I am losing my mind. And you tell me you understand. GET OUT! GET OUT! I TELL YOU, GO AWAY AND LEAVE ME ALONE!!” Muriel is red in the face as she is screaming. The tea has taken on secondary importance.

Ruth leaves the room; Muriel is left alone weeping.

Significance of “locus of control” for persons with dementia.

Why is this a timely issue for Muriel and other persons with dementia? Unfortunately, most of what is known to date about the impact of locus of control for persons with dementia is anecdotal and lacking in scientific research methods.

Locus of control refers to the attributions individuals make regarding outcomes of personal consequence (Rotter, 1966). Individuals with internal locus of control believe their behavior influences outcomes pertinent to them, while individuals with external locus of control feel that such outcomes are unpredictable or a function of chance. Rotter proposed that locus of control, results from a person’s broad expectancy of the world.

Muriel has dementia; she may no longer have persistence of memory of her earlier experiences with the world. For this reason she is constantly trying to make sense of her world. She is engaged in attaching meaning to what is happening around her. If Muriel has developed internal coping strategies, which allow her to understand her environment and deal with inevitable changes occurring around her, she will then be empowered to handle any upsets or changes in schedule.

In the above situation, Muriel only knows that she is without her cup of tea. The one person in her environment, Ruth, who is responsible for delivering this to Muriel, has let her down. Muriel feels she must be able to control her environment and all those persons in it (external locus of control).

What should Ruth have done differently?

What works

  • find out who is Muriel? What makes her tick?
  • involve Muriel in decision–making
  • create a routine for Muriel that is familiar and comfortable

What does NOT work

  • using reason or logic
  • change of routine
  • lengthy discussion

RELATED ARTICLES

Organizational Commitment, Relationship Commitment And Their Association With Attachment Style And Locus Of Control
This exploratory study examined the similarities between these conceptually parallel commitment models by determining how the dimensions of the two types of commitment correlate with one another, attachment style and locus of control.

Subjective forgetfulness in a normal Dutch population: possibilities for health education and other interventions
Many, especially elderly people, are worried about their diminishing memory. In order to be able to improve health education activities about forgetfulness and aging processes, nearly 2000 healthy Dutch people, aged 25–85 years, participated in a postal survey into the determinants of subjective forgetfulness.

Culture Change in Nursing Homes: An Ethical Perspective
Culture change is a philosophy and a process that seeks to transform nursing homes from restrictive institutions to vibrant communities of older adults and the people who care for them. A key principle of culture change is that residents and staff will become empowered, self-determining decision makers.

Beliefs About Psychological Control And Ageing
For the sake of survival, humans have a need as well as a motivation to maintain a control of their environment, to bring about desired events and to forestall undesired events.

References

Rotter, J. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychological Monographs, 80 (Whole No. 609).

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