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8 Dementia-Related Behaviors and Ways to Manage Them

Finding the right solution requires systematic sleuthing and calm compassion

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Fabio Camandona

Ordinary activities such as bathing or sleeping can quickly turn into a battle of wills for caregivers and people with dementia. In those exasperating moments, your loved one is trying to tell you something, experts say.

“Dementia-related behaviors are a form of communication,” says Monica Moreno, senior director for Care and Support at the Alzheimer’s Association.

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Needs, emotions or surroundings can trigger troublesome behaviors. As the person with dementia loses the ability to communicate, the caregiver has to become a detective to understand what’s really going on, Moreno says. That sleuthing requires briefly hitting the pause button when a loved one is resisting, rather than plowing ahead with a task.

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“It’s not that the caregiver’s agenda isn’t important. It’s that it can’t come first,” says Vicki de Klerk-Rubin, author of Validation Techniques for Dementia Care and executive director of the Validation Training Institute. The Oregon-based nonprofit has short YouTube videos to educate dementia caregivers on the best ways to handle specific situations.

Here’s how to assess and address eight common dementia-related behaviors.

1. Repeating the same questions

A loved one who asks the same question every few minutes doesn’t remember asking it, let alone your answer. But the person may remember that something is on the agenda, which can produce anxiety. Have the answers in written form to minimize questions.

“Keep a calendar or whiteboard, and write things down so that the person can refer to that,” says Helen C. Kales, M.D., a geriatric psychiatrist and chair of the Department of Psychiatry and Behavioral Sciences at the University of California Davis Health. “Say to them, ‘We’ve talked about this and whenever you have a question, look right here.’ ”

Don’t tell the person about events days in advance because that “gives someone a lot of runway to be conscious about it,” Kales says. A structured daily routine can also help. Because boredom may be a factor, Kales suggests giving the person simple tasks like folding laundry, tearing the lettuce for a salad or setting the table.

2. Wandering

The urge to wander often occurs later in the day because of sundowning. But the reasons for wandering are generally a change in location or an unmet need, says Ardeshir Hashmi, M.D., section chief of Cleveland Clinic’s Center for Geriatric Medicine.

Visiting another person in their home or staying somewhere new can be disorienting, triggering agitation. Bring familiar objects or favorite possessions to reassure and anchor the person in a new place.

Most people with dementia can answer yes-or-no questions, so ask them what they need. Is it the toilet? Maybe they’re hungry or in pain. To keep the person safe, lock doors and use tracking devices that alert you by phone when the person ventures too far, Hashmi says.

3. Resistance to bathing

Struggles over bathing are often about privacy and preserving dignity, Kales says. Close the bathroom door and have towels handy to wrap the person in as soon as they get out.

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“Give them a soapy washcloth to wipe themselves so they can maintain some independence,” Moreno says. Maybe the caregiver’s gender is the problem. For instance, a woman may prefer her daughter to bathe her instead of a male relative.

Poor depth perception or a fear of falling can also trigger resistance, so consider installing a shower seat and hand shower for easier bathing. Family caregivers have the benefit of knowing the person’s past habits. If the person always bathed at night, preferred showers over baths and liked cooler water temperatures, try those options first.

“Bathing doesn’t have to be daily,” Hashmi says. A few times a week is fine, and they can even be sponge baths.

Managing Incontinence

4. Incontinence

Someone in the middle or late stages of dementia may not know where to find the bathroom or even recognize the need to go. Proactively staying out of trouble is better than automatically using incontinence products, Hashmi says. Instead, take the person to the bathroom every few hours and have them wear easy-to-remove clothes.

If your loved one needs incontinence undergarments and resists wearing them, investigate potential causes. Is the disposable underwear causing discomfort?

“Maybe it’s rubbing up against their leg, or they don’t know how to use this undergarment,” Moreno says. “Sometimes it’s addressing their feelings about loss of independence.”

Have everything ready if they need to be changed, to keep the exercise as short as possible, and “connect to the next activity” so they know what to look forward to, Hashmi says.

5. Insomnia

Because dementia can disrupt the sleep-wake cycle, allow one short nap a day, eliminate electronic devices before bedtime and put the person to bed at the same time each night. Natural light helps regulate circadian rhythms, so make sure they get outside during the day, preferably in the morning, Kales says. Don’t overlook obvious culprits, like medications or caffeine, and avoid sleeping pills because they worsen confusion and sundowning in dementia patients, Hashmi says.

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6. Delusions, hallucinations and paranoia

Dementia often affects a person’s reality. They may have false beliefs contradicted by reality (delusions), hear or see things that aren’t real (hallucinations) or suspect someone is harming them (paranoia).

If the person’s reality isn’t hurting or upsetting them, move with it. “You don’t have to say it’s true, but don’t confront the person,” Kales says. If the thoughts are upsetting or harmful, see if something in the surroundings might be setting your loved one off.

Moreno recalls one woman who was frightened because she kept seeing someone in the house. The family realized it was her own reflection. When the mirrors were removed, the behavior stopped.

If the behavior endangers your loved one or anyone else, get it evaluated. Medications may be contributing factors and so can poor vision or hearing problems, says Eilon Caspi, founder, owner and director of Dementia Behavior Consulting.

When the dementia is the cause, an antipsychotic medication may be needed, Hashmi says. But the drugs can raise the risk of stroke or mortality.

7. Sexual inhibitions

Lack of inhibitions can accompany dementia, and a person’s confused state of mind often makes matters worse. They may be unaware of their surroundings or confuse the caregiver for someone else.

Protecting the caregiver from harassment is paramount. Finding a caregiver whose gender doesn't attract the person being cared for is one solution, Hashmi says. Antidepressants, which can reduce that sexuality, are another.

“Sometimes, caregivers feel squeamish about sexual behavior,” Kales says. Ask yourself who is it affecting. If someone is masturbating and not harming anyone, steer them to a room to be alone. If that’s not possible, redirect attention with a fun activity, like a walk or a car ride.

Helping to Feed Persons with Dementia

8. Loss of appetite

Chewing and swallowing become more difficult as dementia progresses. But taste buds can also change so that even favorite dishes are rejected.

  • Rule out a dental problem, like a painful tooth.
  • Make mealtimes an activity and a way to connect with other people, Moreno says. Someone with dementia shouldn’t eat alone.
  • Experiment with texture. Choose softer foods or those that can be cut into smaller bites.

As with managing all dementia behaviors, Kales says, “trial and error is the way to go.”

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