Tips For Dealing With Specific Dementia Problematic Behaviors

  • Agitation - Individuals with dementia frequently become restless, anxious, or upset (when filling out a behavior chart, it is helpful to use specific, concrete words that clearly describe what your loved one is doing so you can truly track whether your changes work to decrease the behavior). To decrease agitation, listen to the person as he or she expresses her frustration to get a clue about what kind of antecedent is a trigger; try to eliminate and/or decrease triggers as much as possible. Pain, discomfort (being too hot, too cold, hungry, needing to use the bathroom, etc.), frustration, and overstimulation are all common triggers of agitation. It is also very important to examine your behavior in response to the person. If you are not already doing so, reassure the person that you are there to provide assistance and comfort. If it seems like the person needs something to do, try redirection to an enjoyable activity.
  • Aggression - Aggressive behavior can include shouting, cornering someone, raising a hand to someone, or actually pushing or hitting. Unfortunately, aggression among people with dementia can happen suddenly and seemingly without warning. Try to identify what triggered the aggression so that the antecedent can be eliminated or modified as soon as possible. As difficult as it may be, react in a calm, reassuring way and focus on the person's feelings. Reduce environmental distractions as much as possible, such as loud noises or potentially frightening shadows or movements. Redirecting an aggressive person to an enjoyable activity can be remarkably effective.
  • Repetition - People with dementia often repeat a word, question, or action over and over again (e.g., saying "What are we doing today?" repeatedly). This behavior is usually harmless, but it can be unnerving and annoying for those who are caring for the person. Repetitive behavior is usually a sign of insecurity, since people with dementia are often looking for something comfortable and familiar - something over which they have some degree of control. To address repetition, look for a specific antecedent or reason for the repetition as well as for the emotion behind it. This can reduce your chances of responding impatiently with the person. If the repetition is an action, try turning it into an activity that makes the person feel useful. For example, if the person is constantly fidgeting with his hands, try giving him some socks to sort or some knick knacks to clean.
  • Hallucinations - Hallucinations are sensory experiences that seem real, but are not. The most common hallucinations are visual (i.e., seeing something that is not really there) and auditory (i.e., hearing something that is not really there), but hallucinations can also occur in regard to taste, smell, and touch. Because hallucinations seem real to those with dementia, it is not helpful to try to convince the person that she is imagining things. Instead, recognize the person's feelings, reassure the person that you are there to help, and redirect her to a pleasant activity. Also consider whether the hallucination is actually bothersome. If it is a "nice" hallucination (e.g., seeing a pretty orchard outside that is not really there), there may be no benefit in trying to discourage the behavior.
  • Suspicion - Memory loss and disorientation can cause individuals with dementia to perceive situations inaccurately. They may become suspicious of others - even those close to them - and accuse them of theft, infidelity, or other offenses. As hurtful as it may be to be accused of something you did not do, try not to become offended. Remember that the behavior is caused by a disease that is affecting the person's brain. Try to imagine what it would be like to continuously think your possessions are being taken or hidden (because you cannot remember where you put them). Do not try to argue with the person or convince him or her of your innocence. Instead, share a simple response with the person (e.g., "I see that you're upset that your purse is missing; I'll do my best to find it for you.") and avoid giving complicated explanations. Redirection to another activity can also be effective in these situations. Another option is to store "back-ups" of commonly misplaced items (e.g., hats, wallets).
  • Apathy - Apathy is a lack of interest in or motivation to engage in activities. While apathy may not seem like a serious behavior problem, it is not healthy for someone with dementia to simply sit around passively. Try to find out what may be triggering the apathy (e.g., being ignored or becoming overwhelmed with a task) as well as what kinds of consequences may be reinforcing it (again, being ignored, not having appropriate choices of pleasant activities). Even though the person is ill, it is important to keep him or her moving and as active as possible in order to maintain physical health and to prevent depression. Try adapting previously pleasurable activities so the person can participate at a level that is comfortable and not overwhelming. Even a small amount of activity is better than none at all.
  • Confusion - Dementia often causes confusion about person, place, and time. In other words, the person may still know who he or she is, but may not recognize others and/or the current location, time, date, or year. An individual with dementia may also become confused about the purpose of objects, such as forks or pens. As frustrating as this can be for caregivers, the best way to respond is to stay calm and provide simple, clear, positive answers when the person asks for help. For example, if the person seems confused about the purpose of a spoon, simply say, "Here's your spoon for eating your soup." You could also calmly show the person how to use the utensil (e.g., by saying "watch me"). Never scold the person or talk to him or her in a belittling way for becoming confused.
  • Sundowning - Sundowning is a term used to describe behaviors that intensify (e.g., increased confusion and agitation) in the late afternoon and early evening, and is most common with Alzheimer's disease. There are several theories about why sundowning occurs, such as increased fatigue (and as a result, a reduced ability to tolerate stressful situations, such as a chaotic dinnertime or a rushed bedtime routine) or increasing confusion due to darkness and shadows. The best way to approach sundowning is to make late afternoons and evenings as simple and relaxing as possible. Reduce distractions, unscheduled activities, and behaviors that could be done at a different time of the day (e.g., switch to bathing in the morning) and keep rooms well-lit until bedtime.
  • Wandering - One of the more dangerous behaviors among individuals with dementia, wandering may be goal-directed (e.g., the person thinks that he or she is going to a job or going "home" to a childhood residence) or non-goal-directed (i.e., the person wanders aimlessly). To reduce the frequency of wandering, make sure the person has plenty of supervised activity to channel his or her energy. Redirecting the person to another activity can also work. Interestingly, dementia sometimes affects perception in such a way that environmental approaches can help reduce wandering. For instance, a black square painted on the floor in front of a doorway - or simply a black doormat - may be perceived as a hole, which can prevent the person from leaving the home.
Comments
  • (anonymous)

    It's all well and good to say "Remain calm" when the situation of caregiving for someone with dementia is frustrating. We know we're supposed to remain calm. We know it's useless, unproductive, and actually exacerbating to argue. We know the natural emotions of irritation, annoyance and impatience are NOT what is needed in the situation. But we need some concrete tips for reducing our own frustration. Simply saying it needs to happen is not enough. Otherwise, fine article.

  • Anonymous-1

    I agree with the previous comment. Unless someone has experienced this, he/she will have no clue as to how difficult it may be. My spouse's mother is 90 years old and is taking a medication to help retardation of the dementia, however, the personality traits are amplified: nosiness, self-righteous attitude, lack of gratuity, wastefulness. The laundry is like a "science project" and she can never find anything she's looking for. The sibling is absolutely no help, in fact, it's more work with the sibilng and difficult spouse around. It's not even my mother and the whole thing stresses me out.

  • Anonymous-2

    Is there anyone who has a parent with dementia that had other problems prior? My mother was depressed, co-dependant and insecure and now at age 63 has dementia. There is no way to give her husband a break. She will not go with anyone else without freaking out and becoming violent. What do you do? How do you handle a person who cannot be without her husband all of the time?

  • Allan N. Schwartz, Phd

    The key phrase you used is that your mother becomes violent. Under those circumstances you or her husband needs to call 911. Your mother, who is suffering from dementia, has limited capacity and that means she is no longer capable of making decisions for herself. Therefore, you and the family must take action. What actions?

    1. If violent, call 911 to protect her and others. 2. Have her placed in a nursing home. 3. Get in touch with the American Alzheimers Association and they will assist you and getting help for her and her husband, help that can be given to keep her at home..

    I am not suggesting any of this lightly. Dementia is a tragedy for the patient and their loved one's. What ever problems the patient had prior to this now takes a back seat to the dementia.

    By the way, the American Alzheimers Association can also direct you to get support for her husband and for you.

    Dr. Schwartz

  • Anonymous_satx2010

    I would blame the doctors for prescribing Aricept to the patients. My father is on this but the doctors at Wilford Hall Medical Center at Lackland AFB in San Antonio Texas needs to start listening to the caregivers who are suffering from their love ones who has dementia and Alzsheimers.

  • jeannie

    I know how difficult AD is....my Mom and now my sister and she is ONLY 63. It is the worst disease in the world...at least cancer allows the sick person to still reason and socialize. imagine going from a functioning adult to a childlike burden...at least children are cute. Adults acting out like children is extremely difficult for family caretakers to accept and witness. it is a sad demise and I only want to state that if ever you want to get angry or lash out.....remember who they were before their brain became ravaged. remember the love and always think of them as fragile and easily hurt. we would not be angry at a baby or a young child and in my experience, the AD relative is the new child.....new rules....new conversations and of course many battles. love is all there is left, then compassion, pain management if needed and human touch....always human touch.

    sincerely,

    jeannie AD survivor

  • Anonymous-3

    My grandma 96yrs is suffering dementia and is bed ridden. She's being taken careof by her eldest daughter(72 yrs) and i just wonder how the two are coping. As the latter gets irritated when she's asked the same question over and over, and when the other thinks her daughter is too ignorant. When daughter makes noise to the mom the mom decides to go mum and stiff and sometimes nil by mouth. Which is the right age to take care of dementia patients? how useful is the B12 injection for the patient? i realised when she runs late to have it she gets violent by raising her hand or sometimes pinching if your insist that they eat. Please advise.

  • Amanda

    I'll agree that caring for a family member with dementia is quite difficult. I have been a nurse for 7 years and a CNA for 5 years prior to thet. All my experience has been in mental health or advanced dementia. So here is my advice, stay calm. I know how hard it is, but dementia patients are very sensitive to other's emotions and tend to mirror them. If you appear or sound frustrated,so will they. My next advice is step away. You need time for you. Believe me taking care of persons with dementia just completely drains you, physically mentally and emotionally. You're not alone, try respite care.

  • Jodie

    Hello, I have worked in very small assisted living home for about 2 years. I currently have no outlet or source of support in the way of talking about the challenges of my job, simply because none of my family or friends have any exposure to this experience. It sure would be nice to talk to a professional who may be able to clue me in on some things relating to some specific behaviors & how to deal with them. We get a general informational instruction via dvd at my work, but something personal would be further helpful. Sorting through all the junk on the internet is far from helpful. If anyone is interested please let me know. Thank you.

  • Yeti

    We are convinced mum is not changing clothes for days on end, including panties. We do her washing but she claims to wash pants out at night then dry them on a radiator but we see no evidence of this.

    Shouldvwe insist on her changing her clothes as she is a little smelly but against her will which causes a battle or should we respect her choice to be in the same clothing .

    She has loads of clothes and does not have favourite outfits so will choose an outfit and wear it til we take it away for washing.

    She really believes she does her own laundry, this is not the case at all.

    Any views