When It Starts to Look Like Refusal or Laziness
If you’re caring for someone living with dementia, there often comes a point when the questions change.
Why won’t they get up?
Why are they moving so slowly?
Why does everything seem harder than it used to be?
Why does it feel like they are resisting things they could do before?
And this is where many caregivers start to doubt themselves.
It looks physical, but it gets labeled as behavior.
“They’re being stubborn.”
“They’re not trying.”
“They did this yesterday.”
As a physical therapist, I want to say this clearly and gently.
Most of the time, the body is no longer doing what the brain is asking it to do.
Not because the person doesn’t want to.
Not because you’re doing something wrong.
But because dementia changes how movement works.
This post is about the physical component of function, and why understanding it can completely change how you interpret daily struggles.
A Quick Reminder: Function Is the Whole Picture
Function is not one skill. It is not memory alone.
Function is what happens when multiple systems work together so a person can move through their day.
So far, we have talked about:
- The sensory system, including pain, vision, hearing, and body awareness
- The emotional system, including fear, frustration, and overwhelm
Now we add the physical system.
This is where strength, balance, coordination, endurance, posture, and movement live.
When this system starts to break down, everything else feels harder.
What the Physical System Really Includes
When caregivers hear the word physical, they often think only about strength.
But the physical system is much broader than that.
It includes:
- Muscle strength and endurance
- Joint stiffness and mobility
- Balance and postural control
- Walking patterns
- Coordination
- Motor planning, or the ability to start and sequence movement
- Reaction time
- Fatigue tolerance
Dementia affects how the brain sends and processes movement signals. Over time, the body responds by moving less efficiently, becoming stiffer, and tiring more quickly.
This is not a motivation problem.
It is a processing problem.
What Physical Changes Look Like Day to Day
Many caregivers notice physical changes long before they understand what is happening.
You might see:
- Slower walking
- Shorter steps or shuffling
- Hesitation before standing
- Difficulty rising from a chair
- Holding onto furniture or walls
- Needing more time to initiate movement
- Increased fatigue with small tasks
- More falls or near falls
These changes often happen gradually, which makes them easy to explain away.
Until one day, everything feels different.
Why Physical Changes Trigger Emotional Reactions
When movement becomes harder, people naturally protect themselves.
If standing feels unsteady, being asked to get dressed feels stressful.
If walking feels unsafe, being asked to go to the bathroom feels overwhelming.
If balance feels shaky, being rushed feels frightening.
So the person may say no.
They may freeze.
They may become upset or defensive.
From the outside, it can look like refusal.
From the inside, it often feels like fear.
This is how physical changes drive emotional responses, which then get labeled as behavior.
Small Physical Losses Add Up
One of the biggest misunderstandings about physical decline in dementia is the idea that it happens suddenly.
Most of the time, it does not.
It is subtle.
A little less walking.
A little more sitting.
A little more hesitation.
A little less confidence.
Over time:
- Muscles weaken
- Balance reactions slow
- Movement feels less automatic
- Fatigue sets in faster
Eventually, everyday tasks feel overwhelming, even if they look simple from the outside.
Why “Just Move More” Often Backfires
Caregivers are often told to:
- Encourage independence
- Keep the person active
- Avoid doing too much for them
The intention behind this advice is good.
But without understanding physical limitations, it can create more stress.
If a task feels unsafe, pushing increases fear.
Fear increases resistance.
Resistance gets labeled as behavior.
Support is not the same as giving up independence.
It means matching expectations to ability.
That is not failure.
That is skilled, compassionate care.
What Caregivers Are Often Missing
Many caregivers are navigating physical decline without ever being told what is happening.
No one explains that:
- Dementia affects movement, not just memory
- Balance and strength loss increase fear
- Falls change how people move long before the fall itself
- Avoidance is often protective, not defiant
Once you understand the physical system, so many moments start to make sense.
A Gentle Reframe
If movement feels harder lately, you are not imagining it.
If daily tasks feel heavier, you are not doing something wrong.
You are seeing the physical side of dementia show up in real time.
And it deserves understanding, not judgment.
What’s Coming Next
In the next post, we will shift from understanding to support.
We will talk about:
- How to support movement during daily tasks
- Transfers like standing up and sitting down
- Walking and fall risk
- Fatigue and energy conservation
- When physical therapy can help and what to ask for
For now, take a breath.
You are not alone in this, and you do not have to figure it out by trial and error.
Notes
1. Alzheimer’s Association. (n.d.). Stages and behaviors.
2. Alzheimer’s Society. (n.d.). Disability and mobility benefits for people affected by dementia.
https://www.alzheimers.org.uk/get-support/legal-financial/benefits-dementia/disability-mobility-benefits
3. My Action Physical Therapy. (n.d.). Physical therapy guide to Alzheimer’s disease.
https://www.myactionpt.com/physical-therapy-guide-to-alzheimer-s-disease
4. Montero-Odasso, M., Verghese, J., Beauchet, O., & Hausdorff, J. M. (2012). Gait and cognition: A complementary approach to understanding brain function and the risk of falling. Journal of the American Geriatrics Society, 60(11), 2127–2136.
https://pubmed.ncbi.nlm.nih.gov/23110433/
5. National Institute on Aging. (n.d.). 2024 Report to Congress: Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias
Disclaimer
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual’s needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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