Jun 16

Understanding and Responding to Dementia Related Behaviors- Part 2

In Part 1 of this blog, we shared general techniques for understanding and responding to all types of dementia related behaviors as presented by Lisa Sobhian, LICSW and Certified Dementia Practitioner from the Alzheimer’s Association. In Part 2, we are discussing responding to specific common dementia behaviors and some likely causes. Behaviors include anxiety or agitation, confusion and suspicion, aggression, wandering and repetition. Using case examples, Sobhian shared ways to apply several techniques to these common behaviors that occur with dementia.

Some signs of anxiety or agitation are restlessness, pacing or over-reliance on caregivers. One woman who had worked the night shift for her whole career began pacing late in the day and saying, “I have to go”. Caregivers figured out that she thought she had to go to work. Walking with her and telling her she didn’t have to work that day helped to settle her.  Confusion and suspicion impacted one person in the evening because her reflection in the windows when it was dark outside made her believe someone was watching her and trying to get into her home. Closing the shades before dark prevented that confusion. Reassurance that the caregiver was taking care of the situation was calming.

Aggression may be verbal, physical or both. While trying to assess triggers for aggression and trying to diffuse it, Sobhian recommends always having a charged cell phone on you to contact first responders if you need help. After the immediate situation is diffused, plan for next time by alerting neighbors about the person’s condition and calling police on a non-emergency number to let them know about that the person has dementia and you may need to call for help due to aggressive behavior in the future. Additionally, get rid of any guns that may be in the house. “Usually, aggressive behaviors associated with dementia are upsetting but not dangerous. If you are in danger, call 911,” emphasizes Sobhian.

Repetition of questions or conversation is one of the most common dementia behaviors and one of the most frustrating for caregivers. It is most helpful if the caregiver accepts the behavior and works with it rather than telling the person to stop asking. When the repetition involves an upcoming visit or activity, it may be helpful to not tell the person about it too far in advance or to provide activities to prepare. In the case of waiting for a family member to visit and repeatedly asking when they are coming, it might be helpful to briefly give the same answer, have a big wall calendar with cues of when the visit will occur and have a prep activity such as working on a welcome sign.   Repetition is a symptom of the disease and caregivers can teach themselves to have a calm response.

Sixty percent of people with dementia will wander. For their safety, follow them if you see them leave and call the police for assistance if you don’t see them leave. Be present and attempt to connect with the person about where they want to go. If they want to go for a walk or a drive and you can make that happen, do so. If the person wants to go on a longer trip that isn’t possible, try to delay and distract by discussing a plan to take the trip in the future. There are ways to secure doors and camouflage doors and doorknobs that can be implemented for safety.

Dementia behaviors can be challenging for caregivers. Sobhian encourages caregivers to be comfortable with their limitations. Caregivers don’t always know what to do. The Alzheimer’s Organization (www. alz.org ) has many resources to help. The Alzheimer’s Association has a 24/7 helpline at 800-272-3900.