Manage Dementia Behaviors: The Who, What, When and Where

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There are a few important tips to keep in mind when a dementia-related behavior occurs.

As a caregiver, you need to examine and track the who, what, when, where, how and to what extent the behavior occurs to figure out the best plan of action to manage a dementia-fueled behavior:

  1. Who is around when your loved one acts out? The mere entrance or exit of a person in the general vicinity of someone with dementia can cause them to respond positively or negatively. Certain friends and family members may interact with your loved one in a way that triggers a negative response. Or, perhaps the aide who looks after your loved one in skilled nursing resembles someone who's caused them frustration or anxiety in the past. Whenever that particular aide is around your loved one, these feelings (and subsequent behavioral outbursts) may resurface, regardless of what the aide does.
  2. What is going on when the undesirable behavior occurs? Environments that are too loud, too quiet, too cold or too hot can all cause an elder with dementia to become agitated.
  3. When do the behaviors happen? There may be a time-related component to certain dementia behaviors. See what the time(s) of day seem to provoke outbursts in your loved one and determine whether there's a pattern. Sometimes it's helpful to develop a daily routine for people with dementia.
  4. Where do the behaviors happen? Ask yourself whether there's a correlation between certain locations and you loved one's behavior. This can help narrow down the potential cause. For example: Is the behavior occurring while in the living room more or in the bathroom?
  5. How does the behavior affect me? This question can help you gauge whether the current behavior is truly one that needs to be addressed for the sake of your loved one, or if you are being fueled to stop the behavior because of the emotional stress it's personally causing for you. This can help you decide whether to seek a solution to the behavior, look for ways to help you better cope with the stress the behavior causes, or both.
  6. What are the consequences of the behavior? Determining the physical and emotional impact of behavior on your loved one and those they interact with (including you, their caregiver) is vital for coming up with effective interventions.

Using the above questions, create a journal to help you chronicle your loved one's behaviors. This will enable you to establish a baseline for your loved one's reactions. Plus, writing down and processing the answers to these questions will help you make a logical, rational decision about the behaviors being exhibited.

The main driver of dementia behavior

Caregivers should also consider the "being" of their loved one and how it impacts behavior—essentially, what makes your loved one who they are?

What are the factors that have shaped your loved one throughout the course of his or her life? What makes them tick? What quirky traits have they always had?What level of anxiety has been considered normal for them in their day-to-day life? What have been their daily habits over the years?

All of this is important to keep in mind because, as caregivers, we can become so stressed that we may fixate on stopping a behavior that is truly not causing them (or those around them) any harm.

What can a caregiver do to ensure that his or her stress level is not encouraging the behavior and/or intensifying the desire to "fix it?"

Check for local support and resources in your area. Reach out to family and friends. Realize it is okay to be overwhelmed and stressed, and don't beat yourself up even more than you already are. Take "time-outs" often—even if it's only for a moment.

For example, say you walk into your loved one's room after getting yourself ready for a doctor's appointment that you have scheduled for them. You may discover that they have undressed, gotten back in bed, had an incontinent episode in the bed and are becoming agitated. This is a classic example of an opportunity to take a "time out." Walk out of the room, take a few breaths, compose yourself and then walk back in and help your loved one get ready for the doctor's appointment in a calm way. Rushing them, or explaining that they need to hurry will not help speed things up or stop the agitation they are experiencing. The best way to approach the situation is to go in after your time out and act like you are there to help them get ready for a fun-filled day. Bring up something they like to do while out. Talk about grabbing an ice cream or a burger. Then, after the doctor's appointment, take a moment and actually stop for that ice cream or burger, and enjoy your time together.

Keep in mind that not all behaviors need to be fixed. Instead, we as the caregivers need to find a way to work with and around the behavior that is being exhibited. If the behavior truly is causing harm (or potential harm) to your loved one or those around them, let their doctor know so that clinical help can be given. Talk with their doctor about medication options to help ease anxiety, agitation and pain.

Deanna Lueckenotte is the author of "Alzheimer's Days Gone By: For Those Caring for Their Loved Ones." She plans to continue publishing books related to Alzheimer's and caregivers. She would also like to continue her education by obtaining her doctorate in geriatrics.

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2 Comments

Great article - needs to be read daily as a reminder that there are others dealing with similar issues. Caregiving can be so isolating and lonely, and rarely does the 'patient' give encouragement or thanks!
Me, my sister, and wife have a problem with mom not believing us and telling. She cannot find things like money she got at the bank. I think this article is right on. I have POA, both financial and medical. We are going to follow your plan. Thanks for the help.