Caregiver life can be wonderfully meaningful and fulfilling. But this doesn’t mean it’s not without its share of difficulties. The key to managing these challenges? Understanding them. Here’s a closer look at common dementia behaviors, their causes, and coping mechanisms for caregivers.
About Dementia Behaviors
Dementia is not a specific disease, but rather an umbrella term used to describe a wide range of symptoms associated with cognitive decline.
These symptoms impact both aging adults and their loved ones. According to the Mayo Clinic, “Behavioral disturbances such as apathy, physical or verbal aggression, and agitation are among the most challenging aspects of dementia and are likely to affect most patients at some point in the course of their illness. Immensely distressing to both patients and caregivers, negative behaviors greatly diminish quality of life and often lead to caregiver burnout, early institutionalization, and acute hospitalizations.”
While psychotropic medications and hospitalizations are often used to manage these behavioral disturbances, they may ultimately do more harm than good. Instead, experts recommend treating the “organic, psychosocial and environmental factors contributing to challenging behaviors.”
This approach begins with evaluating the dementia symptoms within the context of the progression of the disease. For example, “In those with mild cognitive impairment, agitation may reflect boredom and a need for stimulation, whereas people who are lower functioning may be overstimulated by, say, the noise and congestion of a dining room and need a quieter, more intimate environment,” says neuropsychologist Glenn E. Smith, Ph.D., L.P., a member of the Mayo Clinic Dementia-Behavioral Assessment and Response Team (D-BART).
It’s also crucial to address who the person was before the onset of dementia. Dr. Smith shares the example of a former power plant manager who was upsetting residents at his senior living community by touching their plates and silverware during meal times. "He once had a very challenging job and was accustomed to being in charge, so we asked him to set out plates and silverware that weren't actually used and to write out operating procedures for setting the table. By knowing what he had done for a living and the kind of person he had been, we were able to give him back a sense of control and stop behavior that resulted from its loss,” Dr. Smith explains.
Coping with Dementia Behaviors
Many of the more challenging dementia symptoms occur during the mid-to-late stage of the disease. These include aggressive words and actions; confusion over time and place; poor judgment; and obvious cognitive issues. Common triggers, meanwhile, include biological factors like physical discomfort and social factors like meeting unfamiliar people.
The good news is there are several things caregivers can do to support their aging loved one while simultaneously mitigating their difficult behaviors, including the following:
- Improve communication by minimizing distractions and sticking to one subject at a time. This approach allows aging loved ones to focus and increases the chances that they’ll behave in the desired way.
- Speak clearly, calmly, and positively when talking to your aging loved one. Use his/her name whenever possible, and avoid baby talk and condescending language. An affectionate response is reassuring and soothing, while a frustrated response can escalate the situation.
- Manage your own—and others’—expectations. You’re dealing with a declining condition. Not only are these difficulties to be expected, but they’ll also likely increase over time. Familiarize other people with the situation, what to expect, and how they can help, as well.
- Plan accordingly. Some dementia tendencies, such as sundowning, are tied to a certain time of day. Others are triggered by specific situations. Acknowledge these particulars as much as possible while planning activities for your aging loved one.
- Stick to a schedule. Older adults with dementia do best with a routine, so be consistent with meal times and other activities. Breaking larger tasks into smaller steps, meanwhile, can help prevent your aging loved one from becoming overwhelmed.
- Mix things up. When dealing with an upset or agitated loved one, sometimes all that’s needed is a change of subject or scenery. For many seniors, a trip down memory lane can be soothing and affirming. For others, a walk outside can bring comfort and a new mindset.
- Change your own behavior—and attitude. The person for whom you’re caring has a brain disorder which is responsible for his/her behavior. While you can’t control your loved one’s behavior, you can control your own. Accommodating dementia behaviors is the goal, not controlling them. “Listen with your ears, eyes, and heart,” recommends the Family Caregiver Alliance.
"We are so often oriented toward what we don't want people to do that we end up trying to get them to do nothing. What we should be doing is finding positive activities that will compete with the behaviors we don't want to see. The key is finding when a person is most content and doing more of that—shifting the focus to what the person is doing when things are going well,” concludes Dr. Smith. Caregivers who keep this advice in mind can hope for the best outcomes when dealing with difficult dementia behaviors.
Another invaluable resource for people with dementia and the people who love them? Memory care. Learn more about the Episcopal Church Home community and our Memory Care Center of Excellence here.