ALZHEIMER’S DISEASE AND DEMENTIAS

Memory loss diseases can cause people to act in unpredictable ways. As the changes can progress over time, it can be difficult for family members and caregivers to know what each day will bring.

Some people with Alzheimer’s say they have noises playing in their heads.

Can you imagine listening to a constant stream of loud noise in your head and trying to accomplish tasks? Even simple tasks become very difficult.

BEHAVIORS

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Aggressive Behavior

This can be shouting, name-calling, mean remarks or physical like hitting, shoving, or smacking.

PINPOINT BEHAVIORS

  • Was it harmful?

  • Can you figure out a trigger?

  • What happened next?

  • Could the person be in pain?

  • Could it be related to a medication?

  • Are their needs being met?

  • Are they comfortable?

  • Can you change your reaction?

CALM RESPONSE

  • Focus on feelings

  • Be positive

  • Speak slowly and in a soft tone

  • Be “all in”—avoid distractions and focus attention

  • Create a relaxing environment with music, massage or exercise

  • Take a break if the person is safe

IF THE PERSON IS UNABLE TO CALM DOWN, seek help.

If you do need to call 911, it is important to tell the first responder the person has dementia and can become agitated and aggressive.

Remember, aggressive behavior can be a response to:

  • Pain or discomfort

  • Medication

  • Hunger or thirst

  • Loud or busy environment

Confusion and Forgetfulness

Remember, patients can forget the purpose of common items like a pen, glasses, fork, spoon.

They can forget a person, even their most beloved, which can be difficult for everyone.

Stay Calm

  • Don’t overwhelm with a long answer—clarify with the most simple and short explanation

  • Instead of correcting, suggest “I think it is used to eat your food” instead of “You use this every day to eat your food, it is a fork”

  • Show photos of the person with the loved one to “jog” their memory

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Repetitive Questions

Many times someone with Alzheimer’s disease will repeat the same question over and over again. Sometimes there will be a recurring theme that they are concerned about such as worrying about if they paid a bill or if their daughter or son will be visiting on Sunday.

Tips for repetitive questions include guiding them to focus on what they are able to understand and giving them the tools to easily see reminders for their daily schedule.

Watch Video on how to Respond to Repetitive Questions:

Repetitive Actions

It can be difficult and slightly annoying when a person repeats something over and over again.

  • This can be verbally or physically

  • Repeating a phrase or repeating an action

  • They may pace back and forth endlessly

  • They may undo something you just did

This can cause stress for you as the caregiver.

As long as the action is not harmful, keep calm and look for the reason why the person is doing the behavior—the trigger. Most times repetitive behaviors are a calming response to something.

Watch Video on Repetitive Behaviors:

Turn the action into positive behavior. For example, if they are rubbing a surface, provide a cloth for dusting.

If they are wringing their hands provide a wet cloth for them to wring out.

If they are pacing, take them on a walk.

Suspicions and Accusations

No one likes to be accused of something, especially when you didn’t do anything to deserve it. Even if you are accused of something you find horrible or offensive—DON’T take offense.

Be reassuring—still, respond to the person and acknowledge their feelings.

Do not argue or be defensive.

Offer a very simple answer, then quickly focus their attention on something else, a new activity for example.

Aggressive behavior can also be due to:

  • Lack of a consistent daily, evening, and nightly routine

  • Communication issues with loved ones who don’t accept or understand the disease

Steps for Caregiving when Aggressive Behavior Occurs

  • Approach them in a friendly manner

  • Meet them where they are (where they think they are)

  • Talk at eye level

  • Use their name

  • Gently touch (on the shoulder, for instance)

  • Talk about a non-threatening topic for a couple of minutes

  • Once comfortable, suggest they take a walk with you or suggest another activity

Use REMISSION to get them to focus on a subject that makes them feel good.

For instance, if they are still able to communicate, they may enjoy talking about their spouse or their first car or a child. Once they are talking, the caregiver can begin assisting with the care needs.

Break tasks down into manageable steps.

Never say “no” or argue with a person with dementia. It is much better to divert their attention elsewhere. Learn about what they like or a person they love and talk about that when they are being aggressive.

Remember that their aggression is something that is not caused by you. Do not take it personally.

Watch Video on Dementia and Aggression:

Catastrophic Behaviors

Catastrophic reactions are an overreaction to a seemingly normal, non-threatening situation. The word catastrophic implies that there is a catastrophe or some terrible event that occurred.

Catastrophic Reactions are more likely to occur in the middle stages of Alzheimer’s.

Examples of Catastrophic Reactions:

• Physical Aggression such as hitting, kicking, or pulling hair

• Emotional outbursts such as shouting, yelling or crying uncontrollably

Why Do Catastrophic Reactions Occur in Dementia? What Causes Them?

Dementia can distort the way a person interprets reality.

The University of Rochester study found that the most common trigger for a catastrophic reaction is assistance with personal hygiene tasks, and the evening dinner time is the most frequent time of day that catastrophic reactions are experienced.

Can Catastrophic Reactions Be Prevented?

Often, the way you interact with others can affect their reaction to you.

  • Approach the person from the front, rather than the back or side which may startle them.

  • Don’t appear rushed or frustrated or upset.

  • Know the person’s preferences. For example, some people respond very positively to touch and others bristle even if someone is near them.

  • Explain clearly what you would like to have the person do before attempting to do it. (“It's bath time. Let’s walk together to the bathroom.”)

  • Don’t argue, criticize or disagree with a person who has dementia.

  • Avoid over-fatigue if possible.

  • Avoid sudden changes in routine.

How Should You Respond to Catastrophic Reactions?

  • Give the person physical space.

  • Don’t attempt to continue whatever it was that triggered the reaction unless it is absolutely necessary to accomplish that particular task at that specific time.

  • Don’t use force.

  • Be respectful, not patronizing.

  • Use the person’s name.

  • Allow him extra time to calm down.

  • Reassure her. Perhaps she has a favorite stuffed animal. Let her hold the item and be comforted by it.

  • Divert him as he’s calming down. Catastrophic reactions are traumatic for those experiencing them, so encouraging him to focus on something else can help.

  • If the person has experienced a catastrophic reaction previously, you should always take note of what appeared to trigger the reaction before and avoid that behavior if at all possible. Note this in their care plan.

  • If a catastrophic reaction is unusual for this person, you will also want to consider if she has any health changes that might be causing her to have pain, such as a fall or other injury, or delirium. Delirium is usually caused by an infection or other illness. It can cause a sudden change in cognition and/or behavior, and it can show up as increased confusion or aggressive behavior.

Modesty Garments

Seniors from the Silent Generation who are age 60 and above, were raised in a time when nudity was considered more shocking than it is today. Remember that even public schools had dress codes requiring skirts below the knee and colleges had curfews for women. These earlier generations considered public nudity more unacceptable and this may be escalated when a senior has memory loss. This is why bathing and personal care can become a battle. The senior associates this as behaving badly. This strong resistance to bathing and toileting often is because of their modesty.

Modesty garments are available to allow the caregiver to cover the senior's private areas while still allowing the caregiver easy access for bathing and toileting. They will often help solve the senior’s resistance.

Watch Video on How to Respond to Dementia Behaviors:

💡 Tip Sheet

Be Calm and Reassuring, Alzheimer’s and Dementia Cause Unpredictable Behavior, Confusion, and Forgetfulness Can Be Frustrating, Break Down Tasks into Manageable Steps