Duration
1 Hour
Dementia - Handling Difficult Behaviors and Best Practices
Core Philosophy: Behavior is Communication
People with dementia lose the ability to express needs clearly (e.g., "I'm scared," "I'm cold," "This noise hurts my ears"). Their behaviors—wandering, agitation, repeating questions—become their language. The caregiver's role is to act like a detective to decipher the underlying cause.
Behavior 1: Repetitive Questioning or Actions ("Perseveration")
The client asks the same question every five minutes ("When are we eating?") or performs the same action repeatedly.
Why it Happens:
Memory Loss: They genuinely forget they just asked the question.
Anxiety: Seeking reassurance or predictability.
Unmet Need: Hunger, boredom, or the need to use the restroom.
Best Practices for Handling:
Acknowledge and Reassure: Instead of saying, "You just asked that," respond with warmth: "We are eating soon, right after this TV show."
Use Visual Cues: Use a whiteboard to write down the answer (e.g., "Lunch at 12:00 PM"). They can refer to it without repeatedly asking you.
Distraction and Redirection: Gently shift their attention. Start a new activity, offer a snack, or move to a different room.
Avoid Logic: Logic and reasoning won't work; their short-term memory can't retain the information you provide.
Behavior 2: Wandering and Pacing
The client attempts to leave the house or paces the same path constantly.
Why it Happens:
Disorientation: They may be looking for a former home, job, or a deceased relative.
Physical Need: Restlessness, need for exercise, or discomfort from sitting too long.
Boredom: Lack of stimulation.
Anxiety/Stress: A physical way to burn off nervous energy.
Best Practices for Handling:
Ensure Safety First: Lock outside doors (consider safety locks that require a sequence to open). Use motion sensors or bells on doors.
Address the Need: Are they hungry? Do they need to use the bathroom?
Provide Purposeful Activity: Engage them in a simple task like folding laundry, walking in a safe area (like the garden), or doing chair exercises.
Create a "Wandering Path": Clear a safe, circular path within the home so they can pace without encountering obstacles or dead ends.
Avoid Confrontation: Don't block their path forcefully. Instead, walk with them and gently redirect them back indoors using distraction (e.g., "Let's stop in the kitchen for some water first").
Behavior 3: Agitation, Aggression, or Sundowning
Increased confusion, anxiety, and restlessness often occurring in the late afternoon or evening (known as "sundowning").
Why it Happens:
Fatigue: Exhaustion at the end of the day.
Reduced Lighting/Shadows: Increased fear and confusion due to visual misinterpretations.
Internal Clocks Disruption: Difficulty distinguishing between day and night.
Overstimulation or Understimulation: Too much noise during the day, or too little to do in the evening.
Best Practices for Handling:
Maintain Routine: A predictable daily schedule helps minimize uncertainty and anxiety.
Enhance Lighting: Ensure rooms are well-lit in the afternoon and evening to reduce shadows.
Stay Calm: Your anxiety will transfer to them. Use a soft, reassuring tone of voice.
Validate Feelings: Acknowledge their distress: "I see you're feeling restless right now. Let's sit here for a minute."
Offer Comfort: Soft music, a favorite blanket, or a warm drink can provide comfort.
Behavior 4: Delusions and Hallucinations (e.g., "Mom thinks her purse is stolen")
The client believes things that aren't true or sees/hears things that aren't there.
Why it Happens:
Brain Changes: Dementia affects perception and logic.
Fear: False beliefs are often rooted in a feeling of insecurity or loss of control.
Best Practices for Handling:
Don't Argue: Arguing reinforces the delusion and causes distress. You cannot use facts to convince them otherwise.
Validate the Feeling, Not the Fact: Acknowledge their emotion: "You are worried about your purse. I understand you feel anxious when you can't see it."
Offer Reassurance and a Solution: "I’ll help you find it; we can look together." Or, if they see something scary, "I can see how that would worry you. We are safe here, I am here with you."
Check the Environment: Is a shadow on the wall making them see a person? Can you remove or adjust the item causing the misperception?
Quick Reference: The "Dementia Caregiver's Checklist"
Stop, Step Back, Breathe: Your immediate reaction matters most. Stay calm.
Act Like a Detective: What is the unmet need? (Hunger? Pain? Boredom? Fear? Bathroom?)
Validate the Feeling: Address the emotion they are experiencing, not the literal behavior.
Redirect and Distract: Gently move the focus to something positive or neutral.