15th April, 2019

Author: Viji Varghese, Facility Manager, Monet House


For people who have lived as a dementia caregiver for sometime, it is a commonly known fact that the condition is often accompanied by challenging behaviours. Some of the most common challenging behaviours and personality changes which I have noticed in my past experiences, have taught me that we can’t completely eliminate these behaviours or changes as the disease progresses. However, as the disease progresses there are several better ways to understand and deal with it, one of them being - focus on prevention. Some commonly observed behaviours are restlessness, physical acting out (hitting), pacing, wandering, night time walking, mood swings, following another person around the house all day, communication problems, changes in personality, disinterest, issues with eating and feeding, repetitive speech and the most challenging issue could be increase in agitation and aggression.

As we spend more and more time with our residents, we have new learnings every single day. At Epoch we try to accommodate the behaviour instead of controlling it, we have also learnt to be flexible because what works today may not work tomorrow.

I always inform my team members to report any behavioural symptoms as soon as noticed, for it can be a trigger for any physical problem which we would want to rule out first. The senior may be expressing it in form of anger or aggression. The best way to handle challenging behaviours are to do something different or change our perspective, and, we develop coping strategies. For example a person who is bored, we redirect their attention to help with simple house chores (with supervision, of course). We realize that when you try to control the person’s behaviour, it will often be met with resistance. All  behaviours are motivated with something  although it may not seem like it. A person with dementia is usually making a statement, even when performing repetitive actions (such as taking all the dishes out of the cupboard). He/she may be acting out of a sense of needing to do something meaningful or productive.

There are several potential sources of agitation and anxiety in people with dementia, including confusion, fatigue and overstimulation.

Couple of useful tips for handling agitation include:

  • Address any chaos in the environment by reducing noise level and the number of people around

  • Avoid moving household objects around often (familiar objects located in the same places can provide a sense of security)

  • Change the immediate environment when the person with dementia becomes agitated

  • Play soothing music

  • Safety-proof the environment to allow for as much autonomy as possible with the least number of hazards around

Many people with dementia have challenges in communication problems, which includes forgetting words, using repetitive phrases and more.

  • Give reassurance (try using touch if verbal support isn’t working)

  • Limit external distractions when attempting to communicate (turn off the radio and television)

  • Listen for the meaning of the feelings behind the words

  • Speak clearly and loud enough to be heard

  • Use non-verbal means of communication (such as positive body language, facial expressions and touch)

  • Be specific in what you say - avoid the usage of pronouns. Use short sentences

Apart from anxiety, delusions, hallucinations and paranoia are common behavioural issues in people with dementia, which may occur as a result of changes in the physical health of the brain.

Tips for handling delusions, hallucinations and paranoia include:

  • Avoid arguing or trying to impose a sense of truth or reality into the person with dementia.

  • Consult with a psychiatrist or neurologist to find out if medication is needed “to handle symptoms that may get distressing for the senior. Understand the basic emotions behind a paranoid episode, for eg., when a senior suspects that his money has been stolen - the underlying emotion would be fear or the feeling of being cheated. Address this emotion rather than focusing on the situation.

  • Reassure the person by saying things like, “I am sorry you are getting upset by this”.

  • Redirect the person with dementia to divert their attention to something more appropriate

Insomnia, sleeplessness, sundowning are common behavioural symptoms in people with dementia. It occurs due to a combination of factors and can be worsened by being exhausted after a day’s events.

Tips on how to handle sleeplessness and sundowning include:

  • Avoid giving alcohol, caffeine or sugar to your loved one

  • Consider hiring help at night so you can get enough sleep without having to leave your loved one with dementia unattended

  • Discourage napping during the daytime and ensure they are sufficiently active during the day.

  • Talk to a health care provider about natural sleep-inducing medication, such as melatonin

  • Turn the lights on and close the curtains well before sunset to eliminate confusion about the time, particularly in the winter months

  • Play soothing music during night time to have a calming effect on the senior

 

It’s not always easy to find out why a person with dementia is wandering, but caregivers can use these insights to help them more effectively deal with the problem.

 Tips on how to handle wandering include:

  • Don’t constantly prevent them from wandering, if possible walk with them

  • Add “elder-safe” plastic covers to camouflage door knobs or locks

  • Consider a GPS tracking device only if the senior is comfortable with a wearable”

  • Take safety measures in case of emergencies. Have a current photo of the senior on file, just in case the person with dementia goes missing

  • Install door alarms and set them to go off if the door is opened

  • Install locks that require a key (keeping safety issues in mind for all people in the home)

Caregivers to parents and senior loved ones with dementia already know that it can be difficult to care for a loved one as the disease progresses but we need to keep in mind that although you cannot change your loved one’s behaviour, you can always change your own.