How To Deal With Challenging Behaviors That Can Come With Alzheimer’s Disease
Caring for someone with Alzheimer’s disease can pose many challenges. Not only is it difficult to handle the emotions that go with seeing a loved one go through such a difficult disease, but there are several out of character behaviors that may come with it.
Accepting and understanding that these behaviors are not coming from your loved one, but coming from the disease can help. Even knowing this, it can still be frustrating, particularly if you don’t have the tools to deal with it.
Even with the proper tools and knowledge, it is important that you squeeze in self-care and health habits to keep yourself as well as possible. People caring for someone with Alzheimer’s disease have a higher disease and mortality rate than other caregivers.
Understanding Triggers in Alzheimer’s Disease
A trigger is an event that causes other events or behaviors. They can be environmental, physical or emotional. Some common emotional triggers include reactions to loss, depression, frustration, past life events, personality differences or boredom. Physical and environmental triggers may include rearrangement of furniture, too many people in the room, changes to the daily schedule, over-stimulation from noise, clutter or activities, new medications, infections or pain.
It may be difficult to identify a trigger. Some tips to identify a trigger include determining when the behavior occurs (time of day, location, etc.), who was present and what conversations were taking place at the time. It may take you some time to figure it out, so don’t expect to magically figure this out. Once you’ve identified a possible trigger, you can try adapting the environment to control the trigger or providing physical comfort (rest, food, quiet environment).
Common Challenging Alzheimer’s Disease Behaviors
There are many challenging behaviors that you may experience with your family member. As verbal skills diminish, their behavior becomes the primary communication method. They may become disoriented, easily frustrated, repeat speech or actions, withdraw, become paranoid or suspicious, have delusions or hallucinations, become depressed or use insulting or profane speech.
They may also experience one of the following behaviors that can be more difficult to manage.
Agitation or Aggressive Behavior
Agitation or aggressive behavior can be a response to an unmet physical need such as hunger, thirst, pain or the need to use the bathroom. Finding the cause and offering a simple solution can help reduce their agitation.
For example, someone may resist bathing because they don’t want to feel cold. Adding a small bathroom heater or running hot water to warm the bathroom before they enter may help. You may not figure out the cause right away. Be patient and get creative to find out what is causing the negative behavior and how to either distract or solve the problem.
You can also reduce agitation by doing the following:
- Avoid crowding your loved one
- Ask for permission to approach or touch them
- Maintain a normal, calm voice
- Slow down and be patient with your loved one – don’t rush them
- Limit stimulation (loud music/TV, clutter, crowds, etc)
- Speak slowly and clearly
- Redirect attention
I wrote an entire post on wandering because it can be a very difficult behavior to manage and can also affect your loved one’s safety. The Alzheimer’s Association reports that more than 60% of elders with Alzheimer’s disease will wander at some point.
If you are experiencing this challenging behavior, there are things that you can do to help your loved one stay safe:
- Establish regular routes
- Accompany your loved one (if possible)
- Provide easy access to food and fluids
- Camouflage the door or doorknob leading outside
- Install slide locks out of lines of vision and consider child safety doorknob covers for doors leading outside
- Install monitoring devices that signal when an outside door is open
- Purchase a medical alert bracelet with a phone number and address and any medical conditions
- Provide neighbors and emergency responders with a picture of your loved one and information about their condition
Sundowning is a symptom that refers to increased agitation, confusion and hyperactivity that begins in the late afternoon and continues throughout the evening.
There isn’t a known cause of sundowning, however, some doctors suspect it could be related to exhaustion or a disturbed biological clock.
There are some things you can do to help manage sundowning. Here are suggestions:
- Encourage rest throughout the day
- Plan the majority of activities for the morning hours, including physical activity
- Schedule quiet, less energetic activities in the afternoon
- Keep the environment well lit as it gets dark outside
Be kind to yourself. These are very difficult behaviors to manage. And in many cases, they are completely out of character. I remember working with a woman who became very physically aggressive when she transitioned activities. Her husband would assure me that she really wasn’t an aggressive person. She used to hit her caregivers who would bathe her. It was such a difficult thing for her family to watch. This formerly quiet, reserved woman became violent in difficult situations.
Separating the behaviors from the person may help you accept them and move forward. Hopefully these techniques can help your family.