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CaregiversElderly Care

Guide to Understanding Dementia Behaviors

Dementia is not a disease; it is a term that describes a group of symptoms linked to brain-related diseases. Dementia is associated with memory and other cognitive problems that reduce a person’s ability to think, reason, and even perform everyday activities. Dementia can pose a great challenge to the caregiver if not understood and treated well. Being a caregiver, you must have to master all the skills that can make the patient feel comfortable. 

You will face many issues when dealing with dementia patients like leaving home unnoticed, miscommunication, aggressiveness, nutrition problem, etc. This is why you need to learn dementia behaviors and tips that will help you fulfil the needs of dementia patients so you can understand and treat them right. 

In this article, we have put together a guide to help caregivers in understanding different types of dementia behaviors well. This guide is a summary of the guide published by FCA on Understanding Dementia Behaviors (Family Caregiver Alliance). Let’s get started.

First, you should learn how to handle troubling behavior that rises in people with dementia. Some of the greater challenges that you will face as a caregiver are the personality and behavior changes. You should try to do your best and overcome these challenges by using your creativity, compassion, patience, and flexibility. You should consider these ground rules before starting:

Consult a doctor first

You may not understand why the person is having behavioral problems. He might have an underlying medical reason for his behaviors. For example, he might be in pain or experiencing adverse side effects because of prescribed medicine but is not able to tell you. Consulting a doctor and letting him know about the behavioral changes may make the situation a bit more controllable for you. 

Don’t change the person, change your behavior

Don’t forget that the person you are caring for has a brain disorder that is slowly eating his/her cognitive abilities. You cannot just change the person or his behavior because if you do so, you will most likely be failed or meet resistance. It is essential to:

  • Accommodate the patient’s behavior instead of controlling their behavior. For instance, if the person insists on sleeping on the floor and not on the bed, you shouldn’t argue or resist him. Instead, you should place a soft mattress on the floor to make him more comfortable. 
  • Remember that we can change our physical environment or behavior and adjust it according to the patient’s behavior. This may result in a change in the patient’s behavior. 

There is a purpose behind the way your loved one is behaving

People with dementia are unable or find it hard to tell us how they are feeling or what they want. They might behave weird, for example, take all the clothes out of the closet on a regular basis, and leave you wonder “WHY?”

They are likely fulfilling their hobby to be productive and busy with something. As a caregiver, you should know what needs the person is trying to accomplish, by understanding his behavior, and accommodating him where possible.

Behavior is triggered

How the person with dementia behaves, depends on the thing that triggered that behavior – It might be something they did or a change in the physical environment. You can try doing the same thing with a different approach or try a different consequence for better results.

Here are some common dementia-related behaviors that you need to understand in order to treat and communicate with your patient or loved one in a much better way:

Wandering

This one is the most common dementia-related behavior that happens for a variety of reasons such as medication side effects, exploring something or looking for someone, or boredom. The person may walk aimlessly trying to fulfil a physical need such as thirst, hunger, using the toilet, or doing exercise. 

Here are some things that you can do to prevent its adverse side effects:

  • Add “child-safe” plastic covers to doorknobs.
  • Take some time out and do regular exercise with the person to minimize restlessness.
  • Install new locks that require a key. You should position the door below or above the eye level because many people with dementia won’t think to look beyond eye level. However, you should also ensure that the locks are accessible to other family members.
  • Mask the door with a colored streamer or a curtain. 
  • Have the person wear an ID bracelet/lanyard and sew ID labels in their clothes. 
  • Use a bed alarm system (link here) or consider installing a monitoring system or a home security system to keep close watch over the person with dementia. You can also use a GPS device to track the person’s whereabouts and locate him easily if he leaves home unnoticed. 
  • You should put away the person’s essential items such as his glasses, purse or coat. This is because some people with dementia won’t leave home without certain items. 
  • Let your neighbors know about the person’s wandering problem so they can inform you whenever they see him wandering outside. 

Incontinence

As dementia progresses, the loss of bowel control or bladder occurs. Also, people with dementia can forget where the restroom is located, and then accidents occur. If an accident occurs, you will have enough understanding after reading this article, to react well and take care of the situation in order to help the person minimize embarrassment and maintain dignity. 

Here are some things that you can do to take care of this problem:

  • Making a good routine of using the toilet is important. You should remind the person and assist him to the bathroom every two hours.
  • Schedule a time for fluid intake. Some drink such as tea, coffee, beer, or cola has more of a diuretic effect compared to others. You should limit the consumption of fluids in the evening before bedtime. 
  • Use easy-to-wash and easy-to-remove clothing with Velcro closures or elastic waistbands so the person can easily remove when using the restroom. 
  • You can buy incontinence pads and products from the supermarket or pharmacy to avoid bedwetting. You can contact a urologist so he/she can prescribe the best product or treatment. 
  • Use illustrations or signs to indicate the person which door leads to the bathroom, making it convenient for him to follow the directions and locate the restroom. 

Perseveration

According to speech-language pathology, psychology, and psychiatry, perseveration is the repetition of a particular response such as a phrase, word, or a gesture. It is common in people with dementia to repeat a question, activity, word, or a statement over and over. While such behavior would seem normal to the person himself, it can frustrate and annoy the caregiver. 

This type of behavior might be triggered due to boredom, environmental factors, fear, or anxiety. 

Here are some things that you can do to minimize perseveration in people with dementia:

  • Learn to understand certain actions. For example, if the person is feeling agitated or pulling at clothing, it might indicate a need to use the restroom. 
  • Try ignoring his repeated questions and reminding him that he had just asked the same question. You should engage him in productive activities such as helping you with a chore or singing. 
  • Provide comfort and reassurance in terms of touch and words. 
  • To remove uncertainty or anxiety about anticipated events, you can place a sign on the kitchen table saying “Dinner is at 8:00” or “XYZ will come home at 6:30 PM”. 
  • Distract him from a certain repetition with his favorite snack or activity. 

Restlessness/Sleeplessness

Restlessness, sleeplessness, or Sundowning, is another troubling behavior in people with dementia that often get worse at the end of the day. Experts believe that sundowning can be a result of several reasons such as changes in a person’s biological clock, exhaustion from the day’s events, etc. 

Here are some things that you can do to minimize the effects of sundowning:

  • Ensure that the house is safe. You can block off stairs with gates, lock the kitchen door, and put away the hazardous items from the senior with dementia. 
  • You should turn on all the lights before sunset and close the curtains at dusk to minimize the shadows – it will help diminish confusion. 
  • Put away dietary culprits such as sugar, caffeine, and junk foods. You should restrict such types of foods and beverages too early in the day. 
  • Motivate the person with dementia to perform daytime activities, especially physical activities. 
  • You can consider talking to a doctor about the person’s condition and medication to help him sleep with comfort. However, sleeping pills might solve one problem but create another. 

Agitation

Agitation is a state of anxiety and nervous excitement that is associated with dementia. It includes verbal/physical aggression, irritability, and sleeplessness. Agitation may be triggered by several things, such as fatigue, fear, and environmental factors. In most cases, agitation is triggered in a person with dementia when he feels that the control is being taken from him. 

Here are some things that you can do to minimize agitation:

  • Put away all the hazardous items from the person. 
  • Try to reduce noise, clutter, or the number of people from the room.
  • If the person is behaving anxious and depressed, you can distract him with a snack or an activity so that he can forget the troubling incident. 
  • Keep household furniture and different objects in the same places. Familiar objects such as photos can help suggest pleasant memories and offer a sense of security to the person with dementia. 
  • To quell agitation, you should take the senior to a walk, try a gentle touch, and make him listen to soothing music.
  • Reduce the intake of sugar, caffeine, and other foods that can cause energy spikes. 
  • Allow the person to do for himself as much as possible – it will create a sense of responsibility that he can take care of himself. 

Eating/Nutrition

Ensuring that a person with dementia would keep up with a healthy diet, including nutritious foods and fluids, is a big challenge. As dementia progresses, the person forgets that he needs to eat and drink as well. The complications of the lack of nutritious food include weight loss, sleeplessness, irritability, disorientation, and bladder/bowel problems. 

Here are some things that you can do to ensure that the senior eats well without creating any problem:

  • Making mealtimes a special time may help the person with dementia to eat well. To make everything more appealing, you can try flowers or soft music. Make sure to turn off the TV or loud music while having a meal. 
  • If the senior doesn’t like to eat the food alone, you should join him. It will allow him to mimic your actions and make the food pleasant as well.
  • If the senior is having a hard time eating, swallowing, or chewing food due to dentures or any other reason, you should use soft foods or cut them into small, bite-size pieces. 
  • Schedule the meal and snack times around the same time every day. You should decrease the portion of the meals but increase the meals. For example, instead of three big meals, you should go for six smaller meals a day.
  • If weight loss is a problem, you should give him high-calorie foods between meals. However, if weight gain is a problem, you should keep high-calorie foods out of sight. 

For more information on helping a senior with dementia eat, you can read our article on Tips to help someone with Dementia to eat more.

Bathing

Dementia affects brain’s ability to think and reason – this is why people with dementia often have a hard time remembering that “good hygiene” such as brushing teeth, bathing, regularly changing their clothes, or toileting is even a thing. We are taught from our childhood that one should do all these things by himself rather than depending on anyone. So, it might feel embarrassing or frightening to be undressed or cleaned by someone else. 

Bathing a person with dementia, due to the problems mentioned above, might cause distress for both caregiver and the senior. 

Here are some things you can do to avoid this frustration:

  • If you don’t know much about the person, you should ask his family members about his hygiene routine – like if she preferred baths or showers? What was his favorite shampoo, body wash, scent, etc.? – ensuring that you know all these things and adopting his past routine as much as possible will provide some comfort to both caregiver and the person. 
  • You should never leave the person with dementia unattended in the shower. It is better to assist him in taking a shower so he can bathe without falling or getting hurt. 
  • If the person you are caring for has always been modest and shy, you should respect this thing and care for his privacy by making sure that the doors and curtains are closed. You can keep a towel on his private parts while you bathe him. Have a bathrobe or a towel ready when he gets out.
  • You should be mindful of the environment in the restroom such as the temperature of bathwater and adequacy of lighting. You can install safety features in the restroom like grab-bars, bath or shower seats, and non-slip floor bath mats.

Conclusion

People with dementia are sensitive, and they forget how they used to be in the past. The only way to make good chemistry with the person with dementia is to understand dementia behaviors and do everything according to those. We hope that you are familiar with most dementia behaviors by now. You should keep these in mind, embrace them, and change your behavior according to them so you can treat the person well. 

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