Dementia Behaviors

Agitation

Persons with dementia often become anxious, upset, or restless. When you fill out the person’s behavior chart, you should consider using specific, concrete words clearly describing what your loved one is doing to help you truly determine whether the changes you have implemented work to decrease the behavior.

To reduce the agitation, listen to the individual as he/she expresses frustration to get a clue about the kind of antecedent that’s acting as a trigger and then try either reducing or eliminating the triggers as much as possible. Discomfort, pain, overstimulation, and frustration are all common triggers of agitation.

You should also examine your behavior in response to the individual. If you aren’t doing so already, reassure the individual that you are there not only to assist but also to comfort. If it appears as though the individual needs something to do, you should try redirecting them to an activity they find enjoyable. Help with dementia is readily available for both patients and carers.

Aggression

Aggressive behavior may include raising a hand to somebody, cornering somebody, shouting, or actually hitting or pushing. The unfortunate reality is that aggression in people with dementia may happen suddenly and probably without any warning.

Try identifying what triggered the aggression so as to modify or eliminate the antecedent without delay. As challenging as it might be, react calmly and reassuringly focusing on the feelings of the individual.

Reduce the environmental distractions to the best of your ability, such as potentially frightening movements or shadows or even loud noises. Redirecting the aggressive individual to an enjoyable activity can be incredibly effective.

Repetition

People with dementia usually repeat an action, word, or question repeatedly (e.g., saying “What do we have planned today” over and over again). Such behavior is generally harmless, but it can be annoying and unnerving for the people caring for the person with dementia.

Repetitive behavior is often a sign of insecurity because people with dementia are usually looking for something familiar and comfortable – something over which they have some level of control.

To address repetition, try looking for a specific reason or antecedent for the repetition along with the emotion behind it. This approach will make it less likely for you to respond impatiently with the individual.

If the repetition is an action, you can look for ways to turn it into an activity that helps make the individual feel useful. For instance, if the individual is constantly fidgeting with their hands, you can give them some knick-knacks to clean or some socks to sort out.

Hallucinations

A hallucination is a sensory experience that seems real, but it isn’t. The most common hallucinations are auditory (hearing something that isn’t really there) and visual (seeing something that isn’t really there). However, hallucinations may also occur in regard to touch, smell, and taste.

Since the hallucination appears real to the person with dementia, it isn’t helpful to try convincing them that they are imagining things. A better idea would be to recognize their feelings, reassure them that you are there to help, and redirect them to a pleasant activity.

It is also important to consider whether the hallucination is actually bothersome. If it is a “nice” hallucination such as seeing a beautiful orchard outside that isn’t really there, there may be no benefit in attempting to discourage such behavior.

Suspicion

People with dementia tend to perceive situations inaccurately due to memory loss and disorientation. They are often suspicious of others – even the people closest to them- and may accuse them of infidelity, theft, or other offenses.

It is obviously hurtful to be accused of something that you didn’t do, but it is important not to become offended. Try imagining what it would be like to continuously think that your possessions are being hidden or taken since you can’t remember where you put them.

Avoid arguing with the individual or even trying to convince them of your innocence. Instead, you should share a simple response with the individual (e.g., I see that you are upset that your wallet is missing; I will try my best to find it).

It can also be a good idea to avoid giving complicated explanations. In such situations, it can be effective to use redirection. The other option would be storing “back-ups” of commonly misplaced items such as wallets, hats, etc.

Apathy

Apathy refers to the lack of motivation or interest to take part in activities. While it might not seem like a serious behavioral problem, it simply is not healthy for a person with dementia to just sit around passively.

Try finding out what could be the trigger for the apathy along with the kind of consequences that could be reinforcing it. While the individual might be ill, you still need to keep them moving and as active as possible to maintain their physical health and prevent depression.

You can try to adapt the person’s previously pleasurable activities so that they may participate at a level that’s not only comfortable but also not overwhelming. Even a small level of activity is better than none at all.

Confusion

Dementia usually causes confusion about time, place, and person. Simply put, while the individual might still know who he/she is, he/she may fail to recognize others and/or the current time, location, year, or date.

A person with dementia may also become confuse about the purpose of objects such as pens or forks. While this can obviously be frustrating for caregivers, the ideal way to respond is remaining calm and providing clear, simple, positive answers when asked for help by the person.

For instance, if the person with dementia appears confused about the purpose of a fork, you can just say, “Here is your fork for eating your food.” You could also calmly show the individual how to properly use the utensil (e.g. by saying “watch how I do it”). You must never scold a person with dementia or talk to him/her in a condescending way for being confused.

Sundowning

Sundowning is a term used for describing behaviors that usually intensify (e.g. increased agitation and confusion) in the late afternoon and early evening. It is most commonly observed in people with Alzheimer’s disease.

Several theories have been advanced aimed at explaining why sundowning occurs, such as increased fatigue (and as a result, the reduced ability to tolerate stressful situations such a rushed bedtime routine or chaotic dinnertime) or increasing confusion because of shadows and darkness.

The best way for you to approach sundowning is making late afternoons and evenings as relaxing and simple as possible. Reduce the number of distractions, unscheduled activities, along with behaviors that can be done at a different time of the day (e.g. switch to morning baths) and don’t forget to keep rooms properly lit until it is bedtime.

Wandering

Wandering is one of the considerably dangerous behaviors among persons with dementia, but it may be goal-oriented (e.g. the person thinks that they are going to a job or going “home” to their childhood home) or non-goal-directed where the person wanders aimlessly.

To reduce the frequency of wandering, ensure that the individual has plenty of supervised activity to channel their energy. Redirecting the individual to a different activity can also be an effective strategy.

Interestingly, dementia affects perception at times in such a way that environmental approaches may help reduce wandering. For example, a black doormat or a black square painted on the floor in front of a doorway can be perceived as a hole that may prevent the individual from leaving.