Did You Know?

Alzheimer's disease sometimes causes people to see or hear things that are not there (hallucinations) or believe things that are not true (delusions). They look or sound very real to the person who is experiencing them.

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Coping With Difficult Behavior

People with Alzheimer's disease or other types of dementia behave in ways that others find odd or difficult to handle. The person you are caring for is not being deliberately difficult. Due to memory loss they are unable to understand or make themselves understood. They are confused, frightened and frustrated. Caregivers often report that persons with dementia seem to be lost. They wander and pace through the house. They rummage through drawers and closets as if looking for something. They may become suspicious or overreact and become extremely agitated over seemingly little problems. In some cases the individual may exhibit sexually inappropriate behavior.

These types of problem behavior do not occur in all persons with dementia. Some people may never experience problems with sleeping or show signs of agitation. Some may only experience these problems for a short time and others may experience severe difficulties in these areas for long periods of time.

Behaviors tend to change with time. This unpredictability adds to the challenge that caregivers face. As the disease progresses and different parts of the brain are affected, a behavior may change or new behavior may begin.

Meeting the individual's physical needs will contribute to avoiding problem behaviors. It is important to assess if a physical illness, constipation or perhaps side effects from medications are increasing or worsening a negative behavior.

Distracting the individual by changing the subject, changing the environment, altering the caregiver tone of voice, or offering food, liquid or other object, may help reduce the severity of a problem behavior.

Pacing and Wandering

People with Alzheimer's disease or similar dementia may pace or wander for many reasons:

• They may be hungry, thirsty or need to go to the bathroom and unable to tell you.
• They may feel ill or be experiencing negative side effects from a medication. If you suspect this contact their physician.
• They may be bored or have excess energy. Try to find appropriate activities or exercises.
• A noisy or overstimulated room may increase pacing. Reduce the noise or redirect the person to a quiet area.
• They may be angry or distressed. Explore how they are feeling, reassure them.
• They may be in pain and cannot tell you. Often, they cannot express the feeling of pain even when questioned.
• They may feel lost, disoriented, or confused. Reassure the person that they are safe.
  

Sundowning

People with Alzheimer's and other dementia often display increased agitation and restlessness during the late afternoon and evening hours. This condition is referred to as "sundowning." The cause is unknown however, certain individuals are affected more than others. To reduce the effects of sundowning, caregivers may want to try the following:

• Follow a daily schedule that includes exercise during the day.
• Turn on lights and reduce glare and shadows in late afternoon by closing curtains.
• Reduce noise level, turn on soft music and have a quiet environment.

Rummaging

During the first and middle stages of Alzheimer's disease, rummaging is a very common behavior. Individuals handle things, search for things and mistakenly take things that don't belong to them. Hoarding objects may also occur.

The object of the search may not even exist, may be something from the past or the search could be legitimate. Coping ideas for rummaging could include the following:

• Look for possible causes.
• Provide a dresser, box and/or closet for the person to rummage in.
• Be aware of regular "hiding places" and return items later if necessary.
• If you must remove an item, have something to replace it or to "trade."
• Help the person look.
• Put important documents in a secure location.
• Limit the number of "hiding" places by locking rooms, closets and drawers that are not regularly used.

Paranoia and Suspicion

Because of memory loss, individuals with dementia may become suspicious of those around them and accuse them of theft, infidelity or other improper behaviors. At times they may misinterpret what they see and hear.

Suggestions for coping with paranoia and suspicions:

• Do not personalize accusations, recognize this is part of the disease process.
• Request a medical and medication evaluation.
• Remain calm, do not argue or try to reason with the person.
• Investigate suspicions, they may be true.
• Try to engage the individual in another activity, or ask them to assist with a chore.
• Use touch to reassure (if the person is willing to accept it).

Physical Restraints

Studies have shown the use of restraints have caused more serious injury to those trying to get out of the restraint, may contribute to falls and actually increase negative behavior. The use of restraints for protection or behavior modification is inappropriate for someone with memory loss and impaired judgment.

Sleep Disturbance

Lack of sleep can cause health problems for both the caregiver and the impaired person. The inability to get adequate sleep is part of the disease process. Consider the following suggestions to promote rest:

• Make a part of the house safe so the person can pace while the caregiver sleeps.
• Seek assistance from family members or community services to provide supervision at night.
• Evaluate the physical comfort of the person. Are they hungry, thirsty, too hot or cold or having pain?
• Monitor the effects of too much caffeine, environmental stresses or the side-effects of medication.
• Establish a regular sleeping schedule.
• Place a night light in the person's room and leave a hall light on.

Helpful Hint...

Exercise helps with sleep. It relieves tension and restlessness, regulates appetite, helps digestion, and improves strength, coordination and flexibility.

Anger and Aggressive Behavior

A sudden outburst of anger or agitation presents special concerns to the caregiver. It may take the form of angry shouting, accusing others of wrongdoing or physical violence. Although this behavior is not a frequent symptom of Alzheimer's disease, it may appear as a phase of the disease. People who have not been violent before may become so for the first time.

It is hard to know exactly what triggers a violent or catastrophic reaction. In many cases, the person is overloaded with too much noise, activity, people or requests. A startling touch may cause the person to react strongly. If a violent reaction occurs, try the following responses:

• Remain calm and do not show any anxiety, avoid confrontation.
• Try to identify the cause.
• If the person is physically aggressive, you may need to leave the room, respect the person's personal space.
• Try a relaxing or favorite activity.
• Do not take personal offense.
• Do not ridicule or tease the person.
• If aggressive incidents are frequent have a medication and medical evaluation.
• Provide reassurance that the aggressor won't be harmed.

Although any form of aggression is very upsetting it is important to remember it is not deliberate, the person cannot help themselves, and they are likely to forget the incident.

Socially Inappropriate Behavior

Sometimes a person with Alzheimer's disease and other dementia may begin to act in "socially improper" ways. The individual may undress in public. They may go to the bathroom in odd places. They may make unreasonable sexual demands. The following suggestions may assist you:

• Check the comfort of clothes.
• Assess if the person is too warm.
• Explore the need for toileting.
• Substitute other physical contact in place of sexual contact such as a doll, overstuffed pillow or hand holding (if permitted).

Keep in mind that the person does not intentionally try to make others feel uncomfortable. They are really not aware that their actions are inappropriate.

Some of the suggestions will work immediately. Others may never work. Caregivers are the best judges of what will and will not be successful.

When you are faced with a difficult behavior, try to understand why this behavior is occurring. It is important to recognize contributing factors such as fear, fatigue or discomfort. Problem solving is a process of trial and error. Be flexible and take a "whatever works" approach.

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