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New Approaches for Dealing With Difficult Dementia Behaviors
Written by OurParents Staff
about the author
7 minute readLast updated April 21, 2023
Some people may think of Alzheimer’s disease or other types of dementia as a benign level of confusion, repetitive speech, or forgetfulness. But there’s a whole spectrum of other types of behaviors associated with these diseases that most of us wouldn’t describe as “slightly confused” by any stretch of the imagination. From angry outbursts to more physical manifestations of behavior, understanding and dealing with a loved one’s dementia behaviors may be one of the most stressful parts of being a caregiver. Fortunately, the tips below can help you get through the moment.
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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 them. 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, a book penned by Maria Botonis, a dementia education advocate who also contributed to this article.
Read more:12 Tips for Managing Sundowners Syndrome
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The what, when, where, why, and how of dealing with dementia behaviors
When you wish to address a particular dementia behavior, it can be helpful to consider the emotions your loved one is feeling and how they got to that point. Ask yourself the following questions to better understand your relative’s behaviors.
What?
Identify the causes of Alzheimer’s or dementia behavior problems.- 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?
- Determine if the behavior is harmful. 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.- Ask yourself what happened just before the problem behavior started. Did something specific trigger that behavior?
- Is there a certain time of day that seems to be more difficulton your loved one? Sundown for example? Or bath/shower time?
- 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? Does their agitation lead to wandering or trying to get away from certain situations?- What did the environment look, smell or sound like? What did they see?
- Were there new or different stimuli introduced? Noise, people, places or even your requests of them?
- Does changing their atmosphere or environment help? Would your loved one be more comfortable in a different location or around different people?
Why?
Identify the causes of Alzheimer’s and dementia behavior problems.- Remember to focus on the why. 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.
- Understand that your loved one’s behavior can often be a reaction. Outbursts may be in response 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.
- 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.
- 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:- 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.
- Consider your actions, not just your words. 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.
- 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?”
- Introduce pleasant stimuli into the situation. Consider a favorite song, food, drink, photo, texture, scent, collectible or other items that you know they enjoy.
- Use favorite scents, items, and familiar music to 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.
- Try to engage your loved one in a favorite hobby or interest. Or, try looking at photographs of familiar people and places.
- Use a cooling off period if needed. If safe to do so, give your loved one some space or breathing room.
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Things to keep in mind when dealing with difficult behaviors
What’s not okay? People with Alzheimer’s or another type of 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.
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