The Key to Understanding the Challenging Behaviors of Dementia

Sherry Christiansen
By Sherry ChristiansenMarch 4, 2019

Caregivers to parents and senior loved ones with dementia already know that it can be difficult to care for a loved one as the disease progresses. Dementia can make a person exhibit challenging behaviors and psychological symptoms that are upsetting for everyone involved.

Although we can’t prevent these behaviors or changes, there are ways to better understand and deal with them. Read our tips for handling the challenging behaviors associated with dementia.

The Challenging Behaviors Associated With Dementia

Some of the most common challenging behaviors and personality changes that dementia brings include:

  • Aggression
  • Anger
  • Apathy or disinterest
  • Changes in personality
  • Communication problems
  • Following another person around the house all day
  • Mood swings
  • Night time waking
  • Pacing
  • Physical acting out (hitting)
  • Restlessness
  • Verbal Abuse

Tips on Handling and Understanding Challenging Dementia Behaviors

Fortunately, the following tips have been proven to help caregivers handle the challenging behaviors associated with dementia:

How to Handle Challenging Dementia Behaviors

  1. Ask for help from others. Getting input from others can help caregivers see a new solution, take a new course of action or understand the underlying cause of challenging behaviors.
  2. Attempt to accommodate the behavior if possible, instead of controlling it.
  3. Be aware that the underlying cause of some symptoms can be a physical problem. Always report behavioral symptoms to a health care provider.
  4. Be prepared to be flexible because what works today may not work tomorrow.
  5. Change your perspective. The best way to do something different is to first attempt to see it differently. Changing how you see a situation will oftentimes enable the person with dementia to exhibit different behavior.
  6. Develop coping strategies in advance for dealing with bad days.
  7. Disrupt patterns which can help to change negative behavior. For example, try a different approach to how you ask a person with dementia to do something.
  8. Employ compassion, flexibility and patience.
  9. Keep in mind that although you cannot change your loved one’s behavior, you can always change your own.
  10. Realize that when you try to control the person’s behavior, it will most often be met with resistance.
  11. Remember that behaviors are motivated by something. Although it may not seem like it, a person with dementia is usually making a statement, even when performing repetitive actions (such as taking all the dishes out of the cupboard). He/she may be acting out of a sense of needing to do something meaningful or productive.
  12. Try to anticipate the person with dementia’s underlying needs. This will allow caregivers to redirect many negative behaviors. For example, a person who is bored can be redirected to help with simple house chores (with supervision, of course).

How to Handle Agitation and Anxiety

There are several potential sources of agitation and anxiety in people with dementia, including confusion, fatigue and overstimulation.

Tips for handling agitation include:

  • Address any chaos in the environment by reducing noise level and the number of other people
  • Avoid moving household objects around whenever possible (familiar objects located in the same places can provide a sense of security)
  • Change the immediate environment when the person with dementia becomes agitated
  • Play soothing music
  • Safety-proof the environment to allow for as much autonomy as possible with the least number of hazards

How to Handle Communication Problems

Many people with dementia have communication problems, including forgetting words, using repetitive phrases and more.

Tips for handling communication problems include:

  • Give reassurance (try using touch if verbal support isn’t working)
  • Limit outside distractions when attempting to communicate (turn off the radio and television)
  • Listen for the meaning of the feelings behind the words
  • Speak clearly and loud enough to be heard
  • Use non-verbal means of communication (such as body language, facial expressions and touch)

How to Handle Delusions, Hallucinations and Paranoia

Along with anxiety, delusions, hallucinations and paranoia are common behavioral issues in people with dementia, which may occur as a result of changes in the physical health of the brain.

Tips for handling delusions, hallucinations and paranoia include:

  • Avoid arguing or trying to impose a sense of truth or reality into the person with dementia
  • Consult with a health care provider to find out if medication is needed
  • Don’t feel the need to play into the lie; you can be honest, while still providing dignity and respect
  • Reassure the person by saying things like: I am sorry you are getting upset by this.
  • Redirect the person with dementia to divert their attention to something more appropriate

How to Handle Sleeplessness and Sundowning

Insomnia and sleeplessness, also known as sundowning, are common behaviors in people with dementia. It occurs due to a combination of factors and can be worsened by being exhausted after a day’s events.

Tips on how to handle sleeplessness and sundowning include:

  • Avoid giving your loved one alcohol, caffeine or sugar
  • Consider hiring help at night so you can get enough sleep without having to leave your loved one with dementia unattended
  • Discourage napping during the daytime
  • Talk to a health care provider about natural sleep-inducing medication, such as melatonin
  • Turn the lights on and close the curtains well before sunset to eliminate confusion about the time, particularly in the winter months

How to Handle Wandering

It’s not always easy to find out why a person with dementia is wandering, but caregivers can use these insights to help them more effectively deal with the problem.

Tips on how to handle wandering include:

  • Add “child-safe” plastic covers to doorknobs
  • Consider a GPS tracking device
  • Have a current photo on file, just in case the person with dementia goes missing
  • Install door alarms and set them to go off if the door is opened
  • Install locks that require a key (keeping safety issues in mind for all people in the home)

You can learn more about handling other behaviors of dementia, like issues eating, repetitive speech and more, at the Family Caregiver Alliance, National Center on Caregiving website.

Are you a caregiver? Do you have any other tips for handling and understanding the challenging behaviors of dementia? We’d like to hear them in the comments below.

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Sherry Christiansen

Sherry Christiansen

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