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Behavior Changes: Causes and Techniques

Yolanda Wright, MSWEarly Stage/ Support Group Coordinator

Alzheimer’s Association- Greater Maryland Chapter

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Communication

• Communication is so much more than just the exchange of words

• When we communicate a message to others, it consists of three parts:

• Words 7% Voice 38%

Body Language 55%

• 93% is conveyed NON VERBALLY

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Communication Challenges

Speech

- Word finding

- Repeating words

Reading and Writing

- Reading small print

- Comprehending groups of words

Language

- Vocabulary skills, may revert to native language

- Ability to convey ideas

- Ability to understand

- Ability to speak, use words correctly

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Expressive Methods Used to Communicate

• Screaming• Repetition• Nonsensical verbal noises• Confabulation

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Strategies: Verbal & Non-Verbal

• Volume of voice, soft pleasant• Word choices• Identify yourself• One-step directions• Don’t argue• Non-threatening body language• Eye contact• Front approach• Stoop, squat or sit• Slow movement• Cueing, pointing, demonstrating• Touch

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Strategies: Verbal & Non Verbal

• Provide the solution rather than the question• Avoid confusing expressions• Avoid vague words• Always try to turn negatives into positives• Avoid quizzing• Use simple written reminders• Use pictures to replace written reminders• Refrain from discussing plans until just prior to

event

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Understanding Behavior

• Changing caregiver behaviors to better meet the needs of the person with dementia

• Treat the CAUSE of the behavior, NOT the behavior

• Correctly identifying what has triggered agitated behavior can help in selecting the best intervention

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Triggers

• Environment - Change in living arrangements

- Travel

- Hospitalization

- Presence of houseguests

- Bathing

- Being asked to change clothes

- Noise

- Boredom

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Additional Triggers

Medical Conditions

- Poor sensory functions

- Impaired mobility or pain

- Infections

- Dehydration

- Toxic effects of medications

Human Factors

- Caregiver approach

- Communication challenges

- Fail to understand the person’s habits, likes, dislikes and routines

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Goals in Behavior Management

• Decrease stress in patient and family• Increase patient’s self-esteem• Tap into individual’s talents and strengths• Maximize independencies• Improve quality of life• Validate behaviors• Increase sense of fellowship with other people• Maintain social skills

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Catastrophic Reaction

Definition:

Overreaction to a minor problem

Cause:

The patient feels…• Overwhelmed• Frightened• Frustrated• Over stimulated

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When is behavior a problem?

• If it violates the rights of others

• If it poses a threat to someone’s health and safety (including their own)

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Common Challenging Behaviors

• Aggression• Anxiety or agitation• Confusion• Repetition• Suspicion/delusions/paranoia/

hallucinations• Wandering and getting lost• Trouble with sleep• Sundowning

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Aggression

Aggressive behaviors may be verbal (shouting, name calling) or physical (hitting, pushing). These behaviors can result suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is important to understand what is causing the person to become angry or upset.

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How to respond

• Try to identify the immediate cause• Rule out pain as a source of stress• Explore environmental changes• Focus on feelings, not facts• Don’t get upset• Limit distractions• Try a relaxing activity• Shift the focus to another activity/redirect

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Anxiety or Agitation

A person with Alzheimer’s or another dementia may feel anxious or agitated. He or she may become restless and need to move around or pace. Or, the person may become upset in certain places or focused on specific details.

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How to respond

• Listen to the frustration• Provide reassurance• Involve the person in activities• Modify the environment• Find outlets for energy

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Confusion

• A person with Alzheimer’s or another dementia may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The purpose of common items, such as a pen or fork may also be forgotten. The situations are difficult and require patience and understanding.

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How to respond

• Stay calm• Respond with a brief explanation• Show photos or other reminders• Offer corrections as suggestions• Try not to take it personally

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Repetition

A person may do or say something over and over again- like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity

They may also pace or undo what has just been done. These actions are harmless yet stressful for caregiver.

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How to respond

• Look for a reason behind the repetition• Remove things in the environment that may trigger repetitive

questions• Focus on the emotion, not the behavior• Turn the action or behavior into an activity• Stay calm and be patient• Provide an answer• Distract the person with a favorite activity• Use memory aids- reminder notes or pictures

Accept the behavior. Work with it. If it isn’t harmful, don’t worry about it. Find ways to work with it.

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Suspicion/delusions/paranoia/hallucinations

Memory loss and confusion may cause a person to perceive things in new, unusual ways. Individuals may experience false ideas (delusions) and become suspicious of those around them, accusing others of theft, infidelity, and other improper behavior. Sometimes a person may misinterpret what he or she sees and hears; see and hear things that are not real (hallucinations).

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How to respond

• Rule out physical/medication problems• Provide bright, evenly-lit living spaces• Don’t take offense• Don’t argue or try to convince• Offer a simple answer• Switch the focus to another activity• Duplicate any lost items

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Wandering and getting lost

It’s common for a person with dementia to wander and/or become lost. In fact more than 60% of individuals with Alzheimer’s will wander at some point. They may try to go home when already there or attempt to recreate a familiar routine such as going to school or work.

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How to respond

• Encourage activity• Inform others• Make the home safe• Sign up for Alzheimer’s Association

Medic Alert + Safe Return and Comfort Zone

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Trouble with sleep

People with dementia may have trouble sleeping or experience changes in their sleep schedule. Scientists don’t completely understand why these sleep disturbances occur. As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer’s on the brain.

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How to respond

• Make a comfortable environment• Maintain a set bedtime and waking routine• Get the person up earlier or keep them up

later• Talk to a doctor• Avoid stimulants• Consider accommodating the person’s

need to be up at night

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Sundowning

Sundowning occurs in the afternoon/evening. Disorientation, confusion, anxiety, pacing and agitation are common problems. Causes can include mental and physical exhaustion, increased noise and busyness at home, and reduced lighting and increased shadows.

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How to respond

• Reduce noise and activity levels• Have the person engaged in appropriate physical activities

during the day• Monitor your exhaustion• Plan ahead for calm evenings• Identify triggers• Plan for light dinners• Keep the home well lit in the early evening• Don’t physically restrain• Channel restlessness• Plan a medication schedule• Use pharmaceutical intervention as a last resort

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10 Quick Tips: Responding to Behaviors

• 1. Remain flexible, patient and calm• 2. Explore pain as a trigger• 3. Respond to the emotion, not the behavior• 4. Don’t argue or try to convince• 5. Use memory aids• 6. Acknowledge requests, and respond to them• 7. Look for the reasons behind behavior• 8. Consult MD to identify causes related to meds or

illness• 9. Don’t take the behavior personally• 10. Share your experience with others

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