Dementia often causes difficult behaviors in those we love due to confusion or memory issues. Your loved one may also become more easily agitated, have mood swings, wander, try to manipulate the situation, or show poor judgment. These dementia behaviors—and several others—are normal. But, for caregivers, they create unique challenges. While you can’t take these behaviors away, you can use tools to manage them. 

Agitation is the most common reason Americans place loved ones with dementia in nursing homes. There are more than 5 million Americans with dementia,1 and 80% of them may develop behavioral symptoms such as aggression, hallucinations, or delusions at some point..

As the geriatric population grows, health care practitioners will increasingly encounter distressed caregivers of dementia patients asking for help in handling difficult behaviors. Though most agitation is probably a result of deteriorative changes, health care professionals can influence behaviors.

Here are ways to manage difficult dementia behaviors:

REASSURE the person. Put the person with dementia’s feelings first. He or she cannot change; YOU have to change, or you have to change the immediate environment.

Collect yourself (no matter how irritated you are). People with dementia are sensitive to others’ moods and will pick yours up and mirror it. So take a deep breath. Count to 3. Or do a silent scream in the bathroom. Remind yourself, “It’s not him/her. It’s the dementia!” 

Avoid making the mistake of assuming they’ll forget your angry moment. Although it’s true that people with dementia tend to quickly forget what was said, the emotional impact of an encounter (negative OR positive) lasts much longer! 

Do: 

Approach slowly and from the front. You’re less apt to startle, confuse, or provoke. 

Play back the person’s emotions and ask questions: “You sound upset.” “You look sad. Can I help?” “I know this bothers you. Let’s see what I can do.” 

Try developing a go-to mantra for soothing: “I’m here.” “Everything’s OK.” “Not to worry, love.” 

Make your body language match your words. Avoid sighing or rolling your eyes. Smile, nod, use a friendly tone, relax your posture. Unspoken factors convey more than half of any message. Try touching an arm or shoulder. 

Don’t: 

Say things like “Calm down!” This has the opposite effect — it raises anxiety. 

Ask, “What’s wrong?” When someone doesn’t know or can’t answer, it’s irritating. 

Try to reason with the person (no matter how tempting). Logic and argument will not work. Period.

Things to Keep in Mind When Dealing With Difficult Behaviors

What’s not okay? People with Alzheimer's or dementia often exhibit behaviors that are unpredictable and may be outside the bounds of what others consider “normal” or socially acceptable. It may be tough to know when to worry and when to be flexible.

In general, try to remember that these behaviors do not define the person, they are just a product of the disease. If your loved one had the ability, they would probably choose to act differently.

Also, remember to practice patience and forgiveness. The disease, not the person, is likely causing these things to occur. Try to let things go and avoid holding a grudge over something they may not have meant to do or say, or even remember doing. The exception is if your loved one becomes a physical danger to themselves or others. Physically abusive behavior is not okay. Even a one-time occurrence should be communicated to your physician or other healthcare or mental health provider immediately to ensure your loved one’s safety as well as your own.

Finally, there are so many more behavior interventions, treatments and specialty care providers now than ever before. Don’t be afraid to reach out.

Wandering – How to Manage Wandering & Roaming

A stressful or over-stimulating environment can cause an individual with dementia to leave home or place of care without anyone noticing.

Stress can trigger disorientation and fear which may prompt a wandering episode.

Below are our strategies for management of dementia-induced wandering behavior:

• Reduce noise in the home, including loud TVs, computers, or exhaust fans can prevent increased levels of stress and anxiety.

• If they are able, encourage your loved one to engage in physical activity – exercise, dancing, or movement games – to reduce restlessness and promote restful sleep.

• If your loved one begins pacing or appears distressed, offer reassurance he or she is secure and in a safe place.

• Remove items commonly taken when leaving the home, such as keys, wallets, jewelry, and purses.

• Talk to the doctor about pain treatment options. A dementia patient may be wandering in an attempt to escape pain and discomfort.

About Dementia & Wandering Behavior

As dementia progresses, it can be difficult for your loved one to remember major environmental and life changes.

They may mistakenly engage in old routines, such as leaving the house to go to work at a job they have long since retired from or to visit a store no longer in business.

In addition, wandering can be caused by pain and discomfort, a lack of physical activity or simply by searching for locations related to normal, daily activities, such as the bathroom or kitchen.

Considering the rapid rise in the rate of dementia and the toll it takes on individuals, families, caregivers and healthcare systems, it’s not surprising that experts are intent on exploring and testing new treatments and therapies. Non-drug approaches not only avoid the side effects of medication, there is increasing evidence that they help reduce challenging behaviours associated with dementia, making life a bit easier for people with dementia and their caregivers.

Change with Your Loved One

Every person’s progression with dementia is different. You may have to try several tactics or change your approach as your loved one changes. Keep a journal of behaviors to help you track triggers and resolutions. This may help you see the bigger picture and know when it’s time to adjust.