Dealing with Difficult Behaviors

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Day to day caregiving is difficult enough. However when dealing with Alzheimer’s, the very nature of this disease and the way it affects the brain frequently have added frustrations and difficulties, which make Caregiver’s lives just that much more difficult.
I start a series today that I hope will help caregivers with ‘Difficult Behaviors’. Difficult behaviors are fairly common conditions that we (Alzheimer’s professionals) see frequently and cause added difficulty for caregivers. For example: Angry, agitated behavior, Incontinence problems, and problems with dressing, bathing, eating and sleeping. There are also problems with Paranoia, wandering, repetitive actions, and ever frequent “wanting to go home”, and in the very late stages screaming and verbal noise.
With each of these problems, no matter how random they seem there is a cause. Therefore, the solution will be found in thinking about possible causes and addressing it. They might be physical, mental, medical, environmental, or circumstantial. When you notice a reoccurring problem in a loved one first start by trying to figure out the cause, for example:
Lets start with Anger and Agitation.
Physical, Mental, Environmental and Medical Causes:
Fatigue at time of request, activity or event.
Disruption of sleep pattern (day and night reversal) causing sleep deprivation.
Physical discomfort, such as pain, fever, illness, constipation, fecal impaction, bladder infection, expressed as anger.
Loss of control over behaviors due to physical changes in the brain.
Adverse side effects of medication such as psychotropics, sedatives or tranquilizers.
Impaired vision or hearing causing person to misinterpret sights and sounds.
Hallucinations.
Sensory overload – too much noise, activity, or clutter, or too many people in immediate environment.
Unfamiliar people, place or sounds.
Sudden movements, startling noises.
Feeling lost, insecure, forgotten. When familiar person is out of sight, impaired person may feel abandoned.
Difficulty adjusting to darkness from well lighted area and vice versa.
Being asked to respond to several questions or statements at once.
Responding to arguments between other people.
Response to caregiver’s impatience, stress, irritability,
Person scolded, confronted, contradicted.
Surprised by unexpected physical contact.
Inability to perform what was once a simple task, e.g., buttoning clothes.
Instructions unclear or too complicated.
Change in schedule or routine.
Attention span too short for task.
Task not broken down into manageable steps.
Activity perceived as too childlike, insulting.
How to Cope
Begin with a medical evaluation to rule out physical and/or medication problems, always ask about bladder infection as a possible cause. You would be surprised at how often it’s the case.
Discuss possible adverse side effects of current medications with their doctor.
Have vision and hearing checked.
Alternate quiet times with more active periods.
Plan outings, activities when person is rested.
Make sure person is comfortable – clothes are not too tight, perons is not too hot or too cold.
Simplify environment by reducing noise, number of people, and clutter.
Keep daily routine as consistent as possible. Avoid changes and surprises. For some people with dementia, the slightest change may lead ot confusion and disorientation. Try scheduling meal, bathing, and walks, at the same time every day.
Keep furniture and objects in the same place at all times.
Make sure the person is protected from hurting him/herself. Remove sharp utensils, tools, and objects from environment.
Remove the person from stressful situation, persons, or place. Gently guided the person from environment while speaking in a calm and reassuring voice.
Distract the person with a favorite food or activity. This may reduce agitated feelings. Distraction and avoidance are often the most useful approaches to handling agitated or angry behaviors.
Rules of Thumb
Try these communication techniques:
Avoid asking questions that rely on memory
Try not to reason with the person as they no longer have the ability to think logically.
Reasoning or rationalizing with the person frequently leads to frustration and anger.
Try not to express your anger or impatience verbally or with physical movements, like wagging your finger at the person.
Speak slowly and clearly, and use short sentences.
Allow adequate time for persons to respond and/or process information.
Limit choices. For example, never say “what do you want to eat” rather say “do want the chicken or the fish”.
That’s a pretty long list, for now. However, if you have ideas that you find work well, please add your comments here so we can share it with some other caregivers. I have found over the years that there is nothing better than someone giving advice based on their actual experience.

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