A monthly article brought to you by Senior Services Memory Support Programs
Behavioral expressions can be a common symptom of someone living with dementia. Once you understand that these new and unusual behaviors are symptoms of the disease, it will require patience and creativity to manage and work through these challenges.
What are some types of behavioral expressions that a person living with dementia might exhibit?
Agitation is an unpleasant state of extreme emotional disturbance or an increase in tension. Some specific examples could be anger, hostility, aggression, combativeness, cursing, screaming and hitting. Another type is called psychomotor agitation, which is a series of unintentional and purposeless motions. This could be pacing, wringing hands, ripping, tearing or chewing at one’s fingernails or lips.
Anxiety is a feeling of apprehension, nervousness, fear or the inability to sit still, rest or relax. Some signs of anxiety may include restlessness, clinging/shadowing, fidgeting, always moving around in one’s seat and getting up and sitting down. Elopement (unattended wandering) is often coupled with anxiety or frantic behavior.
Apathy is a lack of enthusiasm or energy or lack of interest in doing anything. Many people with dementia may begin to withdraw from social settings or once enjoyed activities. Oftentimes, apathy will look like depression, a personality trait or fatigue.
Delusions are a false belief that remains fixed or persistent despite all evidence to the contrary. Some examples may include a person believing your car has been stolen or thinking that someone is coming into your home at night.
Fixations are when an individual becomes obsessed with an attachment to another human, animal or inanimate object. It could also be viewed as an irrational preoccupation and obsessions. Some examples might be someone that is fixated on their purse or wallet, a pet that has passed away, stuffed animal or physical/sexual touching.
Hallucinations are sensory experiences created by the mind that cannot be verified by anyone other than the person experiencing them. Any sense may be involved, but seeing and hearing are the most common. Some hallucinations are pleasant, while others can be frightening. These can be very vivid and seemingly real to the individual experiencing this. This can include seeing a person, animal, objects, etc.
Hoarding is the behavior of putting many or inappropriate objects in a purse, pocket or clothing. This also may include putting objects out of sight or keeping too many of a particular item. Some specific examples of hoarding may include hiding, rummaging and stealing.
A person with dementia may be resistant to care. There is a difference between the person’s ability and right to refuse versus resistance and self-neglect. The individual may have resistance to taking medications, toileting, dressing, bathing or eating.
A person with dementia may ask to “go home” because they are no longer able to recognize their home. This term may refer to their childhood home, a time in their life when they felt more comfortable or a feeling of security.
Now that we have identified some possible challenging behaviors, what can we do next?
- Keep in mind that we cannot change the person
Remember the person you are caring for has a brain disorder that shapes who they have become.
Try to accommodate the behavior.
For example, let them rummage through papers if this is what they want to do. Place non-important items out for them to look through.
- Check with the doctor first
Behavioral problems may have an underlying medical reason (pain, UTI, pneumonia, medication side effect)
In some cases, there may be medication that can assist in managing the problem
- Behavior has a purpose
Often, people with dementia cannot tell us what they want or need
Always consider what need the person might be trying to meet with their behavior and when possible, try to accommodate them
- Behavior is triggered
It is very important to understand that all behavior is triggered (doesn’t occur out of the blue)
Common triggers include:
Physical health needs
Emotional health needs
Tasks being too complicated.
- Our responses and/or interventions with the person can contribute to or trigger the behavior seen:
Be mindful of:
Your pitch, volume, speed of speech
Complexity of words, message, request
Non-verbal signals: hand gestures, body language, tension, frustration, eye contact
Your approach: Try a soft approach from the front and moving down to their eye level
Timing of a request
Argumentative, confrontational and negative interaction can create drastic challenges
- What works today, may not work tomorrow
The multiple factors that influence behavior and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow.
Be creative and flexible in your strategies and employ patience and compassion.
Be prepared and open-minded by being self-reflective and look back at challenging scenarios.
It also helps to not take things personally and maintain your sense of humor.When you start to notice memory changes, seeking early detection is key. Senior Services offers an array of memory support programs including confidential memory screenings to obtain a cognitive baseline, educational classes as well as support from Seasons Adult Day Health Services. If you or someone you know is experiencing increasing changes with their memory and could benefit from additional services, please contact Amy Sheridan, Family Support and Activity Manager at 989-633-3764.
Check out our section, Our Mind Matters, next month as we dive more into therapeutic interventions for managing behaviors.