Alzheimer’s and Dementia Behavior Management
Tips for Managing Common Symptoms and Problems in Dementia PatientsWhen a loved one with Alzheimer’s or another dementia experiences behavior problems such as wandering, aggressiveness, hallucinations, or sleeping and eating difficulties, it’s distressing. It can also make your role as caregiver even more challenging. While you may think that behavior problems are an inevitable part of your loved one’s dementia, behavioral problems are made worse by the patient’s environment or their inability to deal with stress. By making simple changes in the caring atmosphere, you can ease stress and significantly improve both your loved one’s well-being and your own caregiving experience.
Understanding Alzheimer's or dementia behavior problems
One of the major challenges of caring for a loved one with Alzheimer’s or dementia can be coping with the troubling behavior and personality changes that often occur. It’s important to remember that the person with dementia is not being deliberately difficult. Your loved one’s behavior can often be a reaction to stress or a frustrated attempt to communicate. If you can establish why the patient is stressed or what’s triggering a discomfort, you should be able to resolve the behavior. Remember, the patient responds to your facial expression, tone of voice, and body language far more than your words. Use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. Try not to take problem behaviors personally and do your best to maintain your sense of humor.
5 ways to help identify the causes of problem behavior:
- Look at your loved one's body language and imagine what he or she might be feeling or trying to express.
- Ask yourself, what happened just before the problem behavior started? Did something trigger the behavior?
- Are the patient’s needs being met? Is your loved one hungry, thirsty, or in pain?
- Does changing the environment by introducing favorite music, for example, help to comfort the person?
- How did you react to the problem behavior? Did your reaction help to soothe the patient or did it make the behavior worse?
Causes of Problem Behavior
Create a calm and soothing environment
The environment and atmosphere you create while caregiving can play a large part in helping an Alzheimer’s or dementia patient feel calm and safe.
Modify the environment to reduce potential stressors that can create agitation and disorientation. These include loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish colors, and patterned wallpaper.
Maintain calm within yourself. Getting anxious or upset in response to problem behavior can increase the patient’s stress. Respond to the emotion being communicated by the behavior, not the behavior itself. Try to remain flexible, patient, and relaxed. If you find yourself becoming anxious or losing control, take time out to cool down.
Manage stress in an Alzheimer’s patient
Different stress-reducing techniques work better for some Alzheimer’s patients than others, so you may need to experiment to find the ones that best help your loved one.
|Stress management tips for Alzheimer's patients|
Exercise is one of the best stress-relievers for both the Alzheimer’s patient and you, the caregiver. Regular walking, dancing, or seated exercises can have a positive effect on many problem behaviors, such as aggression, wandering, and difficulty sleeping. Indoor shopping malls are vast walking opportunities protected from the weather.
Simple activities can be a way for your loved one to reconnect with their earlier life. Someone who used to enjoy cooking, for example, may still gain pleasure from the simple chore of washing vegetables for dinner. Try to involve your loved one in as many daily activities as possible. Folding laundry, watering plants, or going for a drive in the country can all help to manage stress.
Remembering the past may also help soothe an Alzheimer’s patient. Even if your loved one can’t remember what happened a few minutes ago, he or she may still clearly recall things from decades ago. Try asking general questions about your loved one’s distant past.
Use calming music or play your loved one’s favorite type of music as a way to relax them when agitated. Music therapy can also help soothe someone with Alzheimer’s during mealtimes and bath times, making the processes easier for both of you.
Interacting with other people is still important. While large groups of strangers may increase stress for an Alzheimer’s patient, spending time with different people in one-on-one situations can help to increase physical and social activity and relieve stress.
Pets can provide a source of positive, nonverbal communication. The playful interaction and gentle touch from a well-trained, docile animal can help soothe an Alzheimer’s patient and decrease aggressive behavior. If you don’t have a pet of your own, see Resources section below for organizations that offer pet visits.
Taking time to really connect with the person you’re caring for can release hormones that boost the patient’s mood and reduce stress—and it can have the same effect on you, too. Even if your loved one can no longer communicate verbally, it’s important to take a short time when you’re at your calmest to focus fully on him or her. Avoid all distractions—such as the TV, cell phone, and computer—make eye contact if possible, hold the person’s hand or stroke his or her cheek, and talk in a calm, reassuring tone of voice. When you connect in this way, you’ll both experience a process that lowers stress and supports well-being.
Dealing with dementia behavior: Wandering
Two characteristic precursors to wandering are restlessness and disorientation. An Alzheimer’s patient may exhibit signs of restlessness when hungry, thirsty, constipated, or in pain. They may also become disoriented, pace, or wander when bored, anxious or stressed due to an uncomfortable environment or lack of exercise. As well as adding physical activity to your loved one’s daily routine, you can:
- Immediately redirect pacing or restless behavior into productive activity or exercise
- Reassure the person if they appear disoriented
- Distract the person with another activity at the time of day wandering most often occurs
- Reduce noise levels and confusion. Turn off the TV or radio, close the curtains, or move to quieter surroundings
- Consult the doctor as disorientation can be a result of medication side effects, drug interactions, or over-medicating
Practical ways to prevent wandering
- Install child-safety devices in your home to keep doors and windows secured
- Hide items like purses, shoes, or glasses that your loved one would always want if they left the house
- Acquire comfortable chairs that restrict movement, making it difficult for the patient to stand up without assistance
Planning for when your loved one does wander
In case your loved one does wander, it’s a good idea to have a plan in place.
- Notify neighbors and local police about your loved one’s tendency to wander, and circulate your phone number.
- Have your loved one wear an ID bracelet or labels in clothing. New digital devices using GPS technology can track your loved one’s location.
- In case a police search becomes necessary, have a recent photo of your loved one and some unwashed clothing to help search-and-rescue dogs. (Place clothing in a plastic bag with gloved hands, and replace the clothing monthly.)
- In the U.S., sign up for the Alzheimer’s Association’s Medic Alert and Safe Return Program, an identification system to help rescue lost Alzheimer's patients (see Resources section below).
How to find a missing Alzheimer’s patient
A person with dementia may not call out for help or answer your calls, even when trapped somewhere, leaving them at risk for dehydration and hypothermia.
Check dangerous areas near the home, such as bodies of water, dense foliage, tunnels, bus stops, and high balconies.
Look within a one-mile radius of where the patient was before wandering.
Look within one hundred feet of a road, as most wanderers start out on roads and remain close by. Especially look carefully into bushes and ditches, as your loved one may have fallen or become trapped.
Search in the direction of the wanderer’s dominant hand. People usually travel first in their dominant direction.
Investigate familiar places, such as former residences or favorite spots. Often, wandering has a particular destination.
Rummaging and hiding things
Caring for a patient who rummages around or hides things in the home is a challenge, but not an insurmountable one.
|Rummaging/hiding things behavior management|
Lock certain rooms or cabinets to protect their contents, and lock up all valuables.
Have mail delivered out of reach of your loved one—perhaps to a post office box.
If items do disappear, learn the person’s preferred hiding places.
Restrict access to trashcans, and check all wastebaskets before disposing of their contents in case objects have been hidden there.
|Protecting your loved one from harm|
Prevent access to unsafe substances, such as cleaning products, alcohol, firearms, power tools, sharp knives, and medications.
Block unused electrical outlets with childproofing devices. Hide stove knobs so the person can’t turn on the burners.
Lower the temperature on water heaters.
Designate a special drawer of items that the person can safely “play” with when keen to rummage.
Anger and aggression
While creating a calm environment can have a large impact on managing the stress that often results in aggressive behavior, there are also some things you can do during an angry outburst.
Don’t confront the person or try to discuss the angry behavior. The person with dementia cannot reflect on unacceptable behavior and cannot learn to control it.
Do not initiate physical contact during the angry outburst. This may trigger physical violence.
Let the person play out the aggression. Give him or her space to be angry alone. Just be sure that both of you are safe.
Distract the person to a more pleasurable activity.
Look for patterns in the aggression. Consider factors such as privacy, independence, boredom, pain, or fatigue. Avoid activities or topics that anger the person.
Get help from others during the activities that anger the patient.
Don’t take the aggressiveness personally. It, too, is just part of the dementia.
Hallucinations and suspicion
Hallucinations can be the result of failing senses but maintaining calmness in the environment can help reduce their frequency.
When hallucinations or illusions do occur, don’t argue about what is real and what is fantasy, but respond to the emotional content of what the person is saying.
Alzheimer's and suspicion
Confusion and the loss of memory can cause Alzheimer’s patients to become suspicious of those around them, sometimes accusing their caretakers of theft, betrayal, or some other improper behavior. Violent movies or television can also contribute to paranoia.
- Offer a simple answer to any accusations, but don’t argue or try to convince them their suspicions are unfounded.
- Distract the patient with another activity, such as going for a walk.
- If suspicions of theft are focused on a particular object that is frequently mislaid, such as a wallet, try keeping a duplicate item on hand to quickly allay the patient’s fears.
Brain disease often disrupts the sleep-wake cycle. Alzheimer's patients may have wakefulness, disorientation, and confusion beginning at dusk and continuing throughout the night. This is called “sundowning.”
There are two aspects to sundowning. First, confusion, over-stimulation, and fatigue during the day may result in restlessness at night. And second, some Alzheimer's patients have fear of the dark, perhaps because of the lack of familiar daytime noises and activity. The patient may seek out security and protection at night to alleviate this discomfort.
|Tips to reduce nighttime restlessness|
Improve sleep hygiene. Provide a comfortable bed, reduce noise and light, and play soothing music to help them get to sleep. If the person prefers to sleep in a chair or on the couch, make sure they can’t fall out while sleeping.
Keep a regular sleep schedule. Be consistent with the time for sleeping and keep the nighttime routine the same. For example, give the person a bath and some warm milk before bed.
Keep a night light on. Some people with dementia imagine things in the dark and become upset. Stuffed animals or a pet may also help soothe the patient and allow them to sleep.
Place a commode next to the bed. Walking to the bathroom in the middle of the night may wake the person up too much, and then they can’t get back to sleep.
Increase physical activity during the day to help the person feel more tired at bedtime.
Monitor napping. If the person seems very fatigued during the day, a short rest in the afternoon can lead to a better night’s sleep. But keep naps short.
Limit the patient’s caffeine, sugar, and junk food intake during the day.
Dealing with nighttime wakefulness and pacing
If your loved one paces at night, make sure they have a safe room in which to do so, or have another caregiver take over at night. You need your rest, too. In the later stages of Alzheimer’s, you may want to consider a hospital bed with guardrails.
Bright lights, better sleep?
Often, people who have dementia find it harder to respond to day and night transitions, which can make it difficult to get to sleep or stay asleep. A recent study found that adding daytime bright light exposure to the use of melatonin supplements improved sleeping patterns in dementia patients. They enjoyed longer uninterrupted sleep, fewer episodes of getting out of bed at night, and less agitated behavior.
Adapted with permission from A Guide to Alzheimer's Disease, a special health report published by Harvard Health Publications.
Ensuring someone with Alzheimer’s eats and drinks enough can be a challenge for any caregiver. As well as encouraging exercise to make your loved one feel hungrier, try these tips:
Tip 1: Monitor medications
Some medications interfere with appetite. Others may cause dry mouth, so make sure that your loved one gets enough liquids with food. Discuss eating problems with your loved one’s doctor to see if medication needs to change.
Tip 2: Make mealtimes pleasing to your loved one
Add flowers to the table or play soothing music. Make your loved one’s favorite food and serve it on dishes that contrast highly with food colors. Reduce distractions in the eating area. Avoid foods that are too hot or too cold.
Tip 3: Make feeding playful, fun and simple
Give your loved little spoonfuls, and sing funny rhymes. When your loved one opens their mouth to smile, slip in a little food. Provide finger foods and children’s sipper cups, as someone with Alzheimer’s may have trouble using normal utensils.
Tip 4: Monitor chewing and swallowing
Chewing and swallowing difficulties can develop as Alzheimer's progresses. If necessary, give instructions on when to chew and when to swallow. Keep the patient upright for 30 minutes after eating to avoid choking.
Tip 5: Transition to puréed or soft foods
In the later stages of Alzheimer's, your loved one may no longer be able to swallow solid food. Begin a liquids-only diet when the time is right.
Don't forget to take care of yourself
Caregiving for a loved one with dementia can be extremely demanding and stressful. Each day can bring more challenges and higher levels of anxiety, often without any signs of appreciation from the person you're caring for. Taking care of yourself and getting help and support is essential for both your well-being and your loved one’s quality of life. Respite care can provide a break to help you relieve stress and restore energy. Make use of any services available to you and ask for help from family members. It can make all the difference to your success as a caregiver.
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Resources and references
Managing Alzheimer’s behavior problems
Dealing with Behavior Problems – Links to detailed materials on agitation/anxiety, aggressiveness/combativeness, delusions/paranoia, apathy/depression, screaming/vocalization, sexual behavior problems and sleep disorders. (Alzheimer’s Association)
for Someone with Dementia: Changes in Behaviour – Provides tips for dealing with unusual behaviors such as repetitive questions, phrases, or motions; following; calling out; lack of inhibition; laughing or crying uncontrollably; pacing; fidgeting; and suspiciousness. Links to articles on more common behaviors like wandering and aggressiveness. (Alzheimer's Society of the UK)
Hands-On Skills for Caregivers – Gives practical, insightful tips for how to physically approach a difficult patient; how to talk to them respectfully; and how to get them to co-operate with you, both physically and mentally. (Family Caregiver Alliance)
The Dartmouth Memory Handbook – Digital copy of the 4th Edition edited by Robert B. Santulli, M.D, associate professor of psychiatry at the Geisel School of Medicine at Dartmouth. Includes chapters on dealing with behavior problems. (Caldwell Law)
Pet therapy for managing Alzheimer’s behavior problems
Animal Therapy Group Listing – Offers an international directory of organizations that offer assisted animal therapy. (Land of PureGold Foundation)
Management of home safety; safe return program
Home Safety for People with Alzheimer's Disease – Ways to make your home safe for the Alzheimer's patient. (National Institute on Aging: Alzheimer's Disease Education & Referral Center)
Medic Alert and Safe Return Program – A nationwide U.S. program where you enroll the patient for help with wandering: includes identification products, a network of local chapters, a 24-hour emergency crisis line, and a photo database. (Alzheimer’s Association)
What other readers are saying
“The article was very informative. It also gave great points that I never considered and ideas that can be shared with others. I can also use them as a relief for the patient that I care for daily.” ~ Alabama
“This article was so helpful and so complete in such a concise way. I read it in about 5 minutes, but will refer to it many times and pass it along to other family and friends. We are recently dealing with all these issues in my 92-year-old mother who lives with us…and it came on quite suddenly. In the past three weeks she has changed so much that I am having trouble coping with it, understanding it and knowing just what to do. Again, this article was such a help.” ~ Washington
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