Understanding Behaviors
Behavior problems are common in persons with dementia as they may be the only means of effective communication. As the disease progresses, day-to-day living becomes increasingly challenging and frustrating. What was once done independently will eventually require total assistance from a caregiver. Due to increasing confusion and paranoia, the person may misinterpret the caregiver's assistance and strike out verbally or physically. If you encounter behavioral issues, remember to stay relaxed, and think about what might be causing the problem. Identify and address the underlying issue, such as common unmet needs. You may also try to pleasurably distract the person by singing a favorite song, reciting a familiar prayer, offering a soft stuffed animal to hold, or providing other comfort measures identified through the About Me form.
Common unmet physical needs include:
- hunger/thirst
- toilet/brief change
- body positioning
- pain
- room temperature
- noise level
Identify and address the underlying issue. Consider the following:
Fatigue is one of the biggest enemies of the person with dementia, as the brain tires more easily. Late afternoon or evening can be particularly challenging. Excess fatigue caused by the demands of the day, along with memory difficulties and inability to recognize and effectively communicate basic needs, often results in what is called "sundowning." The person usually displays increased physical and/or verbal agitation. A common theme is the person wanting to "go home."
Boredom may lead to disruptive behaviors as the person searches for something meaningful to do.
Over-stimulation also may cause behaviors to occur. The most common causes include exposure to large groups of people, overwhelming or complex tasks, or noisy environments (unnecessary use of television and radio). Avoid these triggers and make sure the person gets enough rest during the day.
Change can be stressful and disruptive for persons with dementia. For example, changing environments, such as a move from home to assisted living, may cause anxiety and fear. Establishing calm, predictable and familiar surroundings is extremely beneficial for persons with dementia.
Also consider emotional needs. If there is continued or prolonged sadness and/or crying, the person may be depressed and may benefit from an antidepressant medication. Consider discussing with the person's healthcare provider.
Communication is another issue. The person with dementia may be unable to express basic needs or concerns, and may not understand what is being asked or said. Agitated behavior is often the person's way to communicate that something is wrong. Caregivers should respond to behaviors by considering and anticipating what the person may need.