New Approaches for Dealing with Difficult Dementia Behaviors

When most people think of someone with Alzheimer’s disease or dementia, they picture a senior with a benign, slightly confused demeanor who repeats themselves. But, there is a whole spectrum of other types of behaviors associated with the disease that most of us wouldn’t describe as slightly or “pleasantly confused” by any stretch of the imagination.New Approaches for Dealing with Difficult Dementia Behaviors

From angry outbursts to more physical manifestations of behavior, understanding and dealing with our loved one’s dementia behaviors may be one of the most stressful parts of being a caregiver.  Fortunately, these tips listed below can help you get through the moment.

New Approaches to Difficult Dementia Behaviors

When dealing with difficult behaviors from someone with dementia, it’s important to remember that they are not deliberately being difficult.

Our loved one’s sense of reality may now be different from ours, but it is still very real to him or her. As caregivers, we can’t change the person with dementia, but we can employ strategies to better accommodate any problem behaviors. Both the environment you create at home and the way you communicate with your loved one can make a significant difference.

These tips may help get you through some difficult moments using the “What, When, Where, Why, How” technique shared in: “When Caring Takes Courage: A Compassionate and Interactive Guide for Alzheimer’s and Dementia Caregivers.”

What

Identify the causes of Alzheimer’s or dementia behavior problems.

  1. Examine the behavior objectively. Are your loved one’s actions truly a problem behavior? Problem behaviors are typically those that can result in an adverse outcome for your loved one or others. For example: can they result in harm to self or others?
  2. Some behavior can be embarrassing, disruptive or uncomfortable to be around, but may not actually be harmful. Avoid correcting, intervening or unintentionally escalating situations by knowing when to let some things go. If Mom would rather wear four layers of pants at a time and rummage through her closet non-stop, let her. Protect your loved one from harm and then allow some sense of freedom and control by creating space for your loved one to make their own choices when possible.

When

Look for patterns that help you predict and prevent problem behaviors.

  1. Ask yourself what happened just before the problem behavior started. Did something specific trigger that behavior?
  2. Is there a certain time of day that seems to be more difficult on your loved one? Sundown for example? Or bath/shower time?
  3. Are certain times of the year more difficult? Winter, when days are darker and nights longer, for instance?

Where

What effects are environmental changes having on your loved one?

  1. What did the environment look, smell or sound like? What did they see?
  2. Were there new or different stimuli introduced? Noise, people, places or even your requests of them?
  3. Does changing their atmosphere or environment help to comfort your loved one?

Why

Identify the causes of Alzheimer’s and dementia behavior problems.

  1. Remember to focus on the “why” when approaching someone with dementia. Seek first to understand why your loved one may be behaving this way, rather than what it is they are actually doing. For example, a person who disrobes may be feeling that their clothing is too tight, too hot or too itchy, or may need to use the bathroom.
  2. Understand that your loved one’s behavior can often be a reaction to stress or a frustrated attempt to communicate. If you can establish why they’re stressed or what is triggering the discomfort, you should be able to resolve the problem behavior with greater ease.
  3. Try to put yourself in your loved one’s place. Look at their body language and imagine what he or she might be thinking and what they might be feeling or trying to express.
  4. Are all of your loved one’s basic human needs being met? Could they be tired, need to use the bathroom? Be hungry, thirsty, or in pain? Meeting an unmet need can quickly resolve the reason for the behavior in the first place.

How

Okay, you’re in the thick of it now. This is definitely a problem behavior… now what? Here’s how to get through some difficult moments:

  1. Validate your loved one’s feelings. If I have dementia and I’m upset, I have likely lost the ability to reason. The more you try to explain to me why my thinking is “wrong” or I don’t need to be worried, the more agitated I’m going to be, because it feels like you are not listening to me. Let your loved one know you understand that they’re upset and that you want to help.
  2. Remember, your loved one responds to your body language, facial expression and tone of voice far more than the words you choose. Use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. Try not to take problem behaviors personally and do your best to maintain your sense of calm.
  3. Be accepting instead of contradicting. Instead of correcting or arguing, look for opportunities to agree. If your loved one is insisting on the keys, instead of saying “No” for example, try: “Yes, I’ll make sure you get your keys as soon as the mechanic is done with the car. Where should we go first?”
  4. Introduce pleasant stimuli into the situation: a favorite song, food, drink, photo, texture, scent, collectible or other items that you know they enjoy.
  5. Use familiar music, favorite scents and items that evoke positive feelings. Often caregivers will gather these things ahead of time and keep a “behavior bucket” full of needed items on hand, so you can grab them the moment you need them.
  6. Try to engage your loved one in a favorite hobby or interest, or try looking at photographs of familiar people and places.
  7. Use a cooling off period if needed, when possible. If safe to do so, give your loved one some space or breathing room.

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.

Telling someone what’s really happening at home doesn’t mean a one-way ticket for your loved one into a behavioral unit or a “no questions asked” prescription for more medications. It’s just the start of a needed conversation with professional providers who may be able to add some value by identifying more ways of helping you and your loved one have better days.

What approaches do you use when dealing with difficult dementia behaviors? Share your story with us in the comments below.

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Please leave your thoughts and comments

  • kathy fry

    My brother has early stage dementia and he also has downs syndrome making his situation all the more difficult is there an organization that covers this type of problem?

  • Lisa

    I do I keep him for taking my clothes?

  • cat

    my hubby and a friend both say they have nothing wrong and I think because they are so smart in many ways . but the cracks get bigger but they are ok it is me

  • Naomi Saint Cilien

    Have you thought about a group home? The staff are trained to redirect ahs support all sorts of ailments.

  • Vicky Ruppert

    I agree that validating your loved one’s feelings, reassuring them, letting them know you are going to solve the problem together, all in as few words as possible is the best approach to try first. However, as the brain becomes more and more compromised this approach will not always work. My husband’s final stage that made me place him was a stage of worrying about his body with delusions of what was happening. For instance, if his nose was running because of allergies, he was sure that blood was running down the back of his throat. He thought he was dying. In this case agreeing with him didn’t work because he wanted to go see our doctor at 4am, and he couldn’t understand why I wasn’t as alarmed as he. No explanations of what was really happening were accepted by him, and he became very paranoid, including when I tried to administer Flonase to help his problem. The delusional thinking was taking over.

    It was at this point in his Alzheimer’s that he viewed me as a threat, or someone not aligned with his way of thinking, and he wanted to move back to New Jersey….to be with his childhood friends. He said our marriage wasn’t working, thus I couldn’t come. He left to walk to New Jersey from New York, with no wallet, one slipper, and one shoe. I could not keep him safe, so I instituted a mental health arrest by the county sheriff. They were wonderful and skillfully asked him to ride in an ambulance to the hospital to be checked out first, because his eyes didn’t “look right”. Then they would release him and he could go on his way.

    From there to assisted living, and on down the path…. from these experiences I co-wrote “Singing In The Rain: Weathering The Storm Of Dementia With Humor, Love, & Patience with Ann Henderberg.

    • Sandra

      Thank you for this comment. I just ordered your book because I choose to deal with my husband’s dementia with love and humor and need all the support I can get 🙂 Bless you!

  • EBart

    I love these articles that tell you to try and “sooth” the agitated dementia patient. It seems like the people writing these articles have never ever actually cared for someone with aggressive behaviors. None of the techniques above work. NONE. And most medications don’t work. Doctors don’t want to overmedicate because they are afraid of getting sued. No assisted living facility wants a patient that poses a threat. It’s impossible to care for your loved ones yourself because you have a job and it literally drains the life out of you.

    There are literally no real resources out there for caregivers dealing with a relative with aggressive behavior and dementia. I have tried everything. Dozens of facilities. Scores of doctors. Lawyers. Geriatric care managers. Geri psych units. I’ve never felt so helpless and alone. I pray every night my mom progresses past this stage of her disease – the spitting, cursing, yelling, grabbing, scratching, hitting.

    • caitlinburm

      Hi EBart,

      We appreciate your comments and are sorry to hear how you feel about this blog content. This blog was written by an Alzheimer’s caregiver, and many of us here at Alzheimers.net, myself included, have been impacted by this terrible disease.

      My Grandmother with dementia who my family could no longer care for, has now gone through various medications, two memory care communities and is now in a geriatric psych unit for her increasingly aggressive dementia behavior, which includes cursing, screaming and hitting. I can understand what you’re going through, as can many of us here at Alzheimers.net.

      I invite you to continue to share with us and vent on this blog when needed. We strive to be a social network that is a respite, resource and a way to connect with others who share the common bond of dementia.

    • CTB

      I understand where you are coming from. If anyone comes to visit my mother with or without my knowledge, she is nice to their face and as soon as they leave she is demanding to know what I meant by bringing those people in there. She thinks because I am not there 24 hours a day I have abandoned her and don’t love her. I am afraid to be alone with her for fear she will try to harm me because she thinks I am out to get her. I do not know how I will get through this.

    • Sheryl Dever

      Wow I totally get what you are saying. I just went through one of my Mom’s meltdowns a week ago. Took her to a local hospital where they were going to release her. I had to beg and ask them to reconsider because of her behavior at home. He said and I quote “next time it happens just call the police of her”. Yeah I will call the police on a 70 year old dementia patient. OMG why can’t they help dementia patients? Not even the Alz./Dementia foundation had any suggestions except to send her to a behavior hospital with other VIOLENT people. I had her there for 1 day had to pull her out. It was to dangerous and even they were not doing anything. In fact they were not even giving her, her medicine. She had a UTI, which I guess can cause a lot off behavioral issues in dementia patients like agitation, violence, rage, delusions, just to name the ones I can remember. You would think that would be one to give Mom. Anyway there is not one place to help me with Mom. It is ridiculous, they have all kinds of places for aids/HIV, cancer, Kidney disease, Drug addition but not one for dementia. It is a very sad place to be, as a caregiver of a dementia patient I am totally all alone on my own.

    • guest

      I feel for you so much and am so sorry. There are articles, organizations, doctors, care centers (if you can afford it) etc.. but when it comes right down to it… its up to us alone. Draining, totally losing yourself and your own life becoming unimportant is an understatement. What to do if there are no other family members to help or they just ‘don’t have time’? I don’t know. Someone told me there is a special place in heaven for those who care enough to hang in there but to what end ? I am also pretty much alone, loving my husband so much but feeling like I have given all I have left and will it ever end for him? For me? Feeling scared, alone, uncertain of the future and knowing I have lost him to dementia. If nothing is left of me in the end I will know I did everything and gave everything to him that I could……….. but the cost was myself.

    • Roe Dones

      I totally agree with you. They are not writing from experience it seems! I am exhausted from it all. It’s been 6 years of hell. When does it ever end?

    • CalGal

      I’m going through exactly the same thing with my 86 year old mom. Unless you’ve dealt with it you have NO idea what it’s like. When she gets aggressive it’s like a scene from the Exorcist….and she never remembers a thing. There is NOTHING that you can do during an episode. She’s in a nursing home and they call me asking for my help when it happens but by the time I get there 99.9% of the time she’s calmed down. They’re trying to get her moved to a place that handles geri psych patients. I’m praying it helps or that God intervenes…

      • christine

        God may intervene,,but is this for your sake..be caring loving trusting…yes im in your shoes too, its not their fault…it could be you one day… life is to short..

    • Tan Mom’s Suspicious Mole

      I agree. These platitudes are insulting.

    • Melanie

      My mom has dementia and physically abuses my dad every day. I don’t know how he can still stand by her. She is so very very mean. I know it’s the disease but I have a hard time being around her. She calls and stops by all the time. If I don’t answer the phone, she screams at me and says what if there was an emergency. I calmly told her the other night she hadn’t been calling me for hours. She had called me twice I was in the shower and it had only been 15 minutes. It’s like so hard because she is so aggressive and only wants to fight. I’m considering moving about an hour away because I know she wouldn’t drive that far to come see me. She used to live about an hour away and never visited. She moved into a smaller cheaper apartment that is literally 2 minutes from where I live. My dads a saint, if I ever get this disease, I hope my kids put me in a home and everyone just forgets about me. I know that is mean but it is so hard, I feel like I can’t escape.

      • Dee Dee

        Hmm,this is sad to think this way about your mother .I dealt with this same issue with my grandmother and now my mother.I’m sure she wouldn’t have given up on you so easily.

  • Guest

    I Care for Parkinson’s spouse alone. No family. Demands and attentions are constant and without end. The worst thing has now become being required to be present or near by 24/7 to a person who

    • Shellie Griffith

      I’m not sure if you’ve tried a homecare company for respite or a break but it might allow you to have some time just for you. Many companies will do just a few hours.

  • Pat

    My husband has begun to masturbate in bed mostly as he is waking up but sometimes in the middle of the night. This makes me want to flee the bedroom so I can get some undisturbed rest. Should I try to talk to him about it? He still understands conversations and is a sweet man. But it’s disturbing to me.

  • Trying hard

    I and my four brothers and sisters have been “caring” for my father at home for going on three years. He has dementia and parkinsons disease.

    I say “caring” because none of us are really equiped to deal with this, but several of my siblings still think “it is simple, just abc/xyz”. Of course that isnt realistic

    Caring for someone in my father’s situation is extremely stressful and on top of the day to day stresses of all the other aspects of our lives, as painful as it is to say it and as selfish as it may SOUND, it is an extremely heavy burden.

    As someone who never had a close relationship although we all lived with him (army mentality dad – work, discipline, few pats on the back) with my father, it was difficult to mentally adjust to him being so “needy”, demanding, and picky – he didnt raise us that way and we now had to turn around and give him a level of attention that was far from the treatment we recieved.

    I am not trying to complain – I am stating what feelings I and others may possibly go through.

    The demented behavior, accusations of stealing/lying, confusion, sundowning, etc from a person you love can be – will be – very trying and very stressful!

    It is important to remdmber that you have to take care of yourself, your mental, and your feelings just as much or more than you do for your loved one.

    While this may sound selfish, it is far from that. For the first two years, i put my life on hold and focused on caring for my dad. Understand that I am a young 30 something throughout this – in the prime of getting my life together.

    As a result of all the stress, pressure, etc. i got burned out – i began to despise the situation and even developed ill feelings for my father – i would also get physically sick.

    Caring for someone with dementia is totally different from caring for a different type of elderly person. You watch the person who was once strong and smart become weak and confused…the person who loved to work struggle with boredom and anxiety…the person who once seemed to not let anything affect them, be depressed and emotionsl all the time.

    Then you have to deal with family and friends who rarely understand.

    You try to develop some normacy – cleaning up, taking them out, setting up visits – only to have them mess areas up and then complain about how junky it is, have episodes that prevent you from bringing them out or having company.

    It is the most challeging situation I have ever faced.

    Yet, I look at my dad and know that what I am going through pales greatly in comparison to what he is dealing with.

    Offen times people feel like “sending their loved ones off” is being selfish or not showing them the love they showed you growing up – the huge expense of nursing homes and care centers doesn’t help either.

    The reality though is that we are being selfish when we arent giving /able to provide our loved ones with the level of care they need.

    I came to that realization 2 years ago, unfortunately my siblings did not agree.

  • I have spent the entire day making sure my mother is well taken care of, it is now midnight, and she just got up and accused me of taking her potato chips away. That is all she cares about.

    I do not know what to do.

  • Susan Butterfield

    My husband has just tried to break someone’s arm. He’s 6′ and 15 stone. I’m 5’5″and 9 stones. I have no idea why I should be forced to manage this or other people expected to excuse it. It is assault Bottom line he should not be out in society but we can’t afford £6,000 a month for a care home.
    Alzheimers society – address the Govt who will not fund care and get real about the impossibility of family members trying to deal with a complex illness that needs to be handled by experts in the nhs.

  • Dianne Elizabeth

    My mother with dementia has obsessions. Picking her scalp, nose, etc. the latest is constantly moving her mouth and sucking on her dentures, scraping her false teeth, etc. it is so loud and nerve racking to be around. I have taken her to the dentist to get her dentures checked, etc and dentists agreed it is the dementia. I am at my wits end. I trying to be gentle & compassionate. I don’t know how to help her with this compulsion.

    • Sarah

      There is a grinding bite guard you can sleep with to help. Don’t know if this will help at all but maybe take the dentures out when she’s not eating?

  • betty holmes

    How to handle a love one that constant walk and move causing them to fall at times

  • betty holmes

    My husband has dementia for 10 years now and I am his only caregiver
    he only take naps and up at 5am each morning

    • Gary Smith

      My wife from what I am gathering has dementia. This year was very rough. She started to have hyper sexual problems which caused her to have what she says was an affair. I did not realize it but when asked she cried and then got up a business as usual. After have five psychotic episodes along with two months of delusions she is calming down. What I have noticed in the last six-eight month, extreme mood changes, happy, bitter, loving, mad and back. Took her to a counseling and psychology place they treated it as a normal person with no cognitive disorder. But the last month has been getting pretty messy. She has consent memory lapses, goes from one persona to another and today she went from loving me to saying she was in love with the person she had the affair with to bashing me verbally, saying she wants to be like she was in high school, saying she has lied about a lot of different things over the years to back to loving me. All this was in front of our marriage counselor who I think was astonished. Monday she and I went to the neurologist who within less than twenty minutes figured it was frontal lobe dementia. She is to get a mri and a three hour test for memory. After leaving today my wife said this is very difficult for her, she is trying very hard and said she never would have cheated if her mom was still around. Unfortunately until a diagnose is made I have no recourse for help or resources, I have zero support from her family who see her maybe 1-2 times yearly. When they see her she is normal to them but living with her 24×7 is different. I am in a situation were I am lost at what to do. .

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