How to Manage the Unpredictable Behaviors of Dementia

Dementia can be as challenging for the senior’s caregiver as it is for someone living with the disorder. Unpredictable and sometimes dangerous behaviors can try the patience and understanding of the most devoted loved one or friend.

Dementia is a group of symptoms involving a decline in mental abilities, such as reasoning and remembering, that significantly interferes with daily life. Alzheimer’s is the most common form of dementia.

It is important to remember that a person with dementia is not trying to be difficult when they exhibit behaviors as a side effect of dementia. They may be extremely frustrated as they live their lives in a confusing and uncertain world.

However, there are ways that caregivers can cope with the unpredictable behaviors of seniors with dementia and help diminish some of the conflict and frustration the senior is experiencing.

Examine the Behaviors Dementia Can Cause

Because dementia is progressive, caregivers will need to continually evaluate the behavior of the person for whom they are caring. The Alzheimer’s Association offers some basic questions to put the behaviors in context:

• Was the senior’s change in behavior harmful?
• Did something trigger it?
• Was it caused by another illness or medication?
• Can the senior’s surroundings be made more comforting?
• Do you as the caregiver need to change your reactions?

Grace LeRoux, RN, former Nurse Manager of a memory support neighborhood at one of Bethesda’s skilled nursing communities, also has some suggestions tips for dealing with these changing behaviors.

1. Anger and Aggression

Aggressive behavior can be verbal or physical. People who have never been physically abusive or used profanity in their lives may employ both at unexpected moments when suffering from dementia. According to Grace, most aggressive behaviors are a way of communicating pain. “What we perceive as a negative behavior may be the person’s way of expressing a need,” she says.

2. Anxiety and Agitation

Many things can trigger anxiety and agitation in people with dementia, including confusion over the time of day. Pain, hunger, and the need for sleep also can contribute. Grace suggests a change of scenery or an activity (offered daily in the memory support communities throughout Bethesda) can provide a distraction.

“Anxiety is a constant struggle for seniors with dementia,” she says. “Their brains always try to find context for what is going on around them.” Routine and a calm approach help to relieve symptoms.

3. Forgetfulness and Confusion

Early on, people with dementia may be able to compensate for some forgetfulness with lists and calendars. As the disease progresses, even once familiar people and items may be unrecognizable. A person’s home may become foreign to them, and the town they knew so well becomes a confusing maze. Even the purpose of basic household items like silverware may be forgotten.

According to Grace, even in these later stages of dementia, caregivers may be able tap into memories to provide assistance and comfort. For example, a person living with dementia who has forgotten how to brush his or her teeth may be able to recall that basic skill if the toothbrush is placed in their hand or the brush is placed to their lips.

4. Repetitive Actions

Caregivers must be prepared to repeatedly answer the same questions or provide the same information to their senior loved ones living with dementia. It does no good to tell them that you just answered the question a few minutes ago.

“Patience is so important,” says Grace. “If someone can still read, sometimes notes to refer to can help.” She also says it might be necessary to “read between the lines” to determine intent. “If someone is repeatedly asking to ‘go home,’ it may mean they want or need something they would find at home, like rest, comfort, or food.”

5. New Suspicions

A person with dementia may be suspicious of others and accuse them of wrongdoing. Also, they may misinterpret what they have heard. “These suspicions are often a way to compensate for missing memories,” Grace says. “They may believe an item has been stolen from them, when in reality they’ve misplaced it.” She encourages caregivers to consider the person’s life history, because past trauma also can be a factor.

6. Wandering and Getting Lost

One of the most frightening dementia-related behaviors for caregivers is wandering and/or getting lost. “Understanding when a person is most at risk for wandering is vital,” Grace says. “When a person is traveling, in the hospital, or newly admitted to a nursing home, they are at the highest risk of wandering.” She suggests familiar surroundings and exercise for managing wandering behaviors.

7. Trouble with Sleep

People with dementia may experience sleep pattern changes or the inability to fall asleep. Grace stresses the importance of exercise during the day and peaceful surroundings at night. It might help to open the curtains during the day and encourage the person to spend some time outdoors. Understanding past sleep routines is also important. “A person who worked night shift may fall back on old habits,” Grace says.

8. Changes in Ability to Communicate

Dementia also diminishes a person’s ability to communicate. They may struggle to find the right words, describing familiar objects, completing a thought, or organizing their words logically. They may also use more gestures and fewer words to communicate. Again, patience is key for the caregiver: “Be comfortable with periods of silence,” says Grace. She notes that a person with dementia may take 20 to 30 seconds to process a question and create a response.

How to Respond to the Unpredictable Behaviors of Dementia

It is important to for caregivers and loved ones to respond to these challenging behaviors as follows:

• Stay calm.
• Be patient.
• Be positive.
• Look for a root cause.
• Reassure and explain.
• Modify the environment if necessary.
• Look for ways to redirect focus.

The Alzheimer’s Association provides more specific responses that address the individual dementia behaviors listed above, along with resources for caregivers of seniors with dementia.

One other important thing for caregivers to remember: take care of yourself. Caring for someone with dementia can take its toll. You may need to seek help from a professional or reach out to your support system.

If you need assistance caring for a senior with dementia, Alzheimer’s, or any form of memory loss, contact Bethesda. Our memory support neighborhoods in the St. Louis area provide support to caregivers and families of seniors. Contact us or schedule a tour to learn more.