It’s easy to think of dementia as simply an issue of poor memory and confusion. However, if you or a loved one have been diagnosed with dementia, you may be surprised to find that new, challenging behaviors and personality changes are also a common part of this condition.
There are some helpful approaches you can try to reduce or better manage these behaviors. Understanding dementia-related behaviors and the ways to manage them offers dignity to loved ones with the diagnosis. It also reduces stress and worry for caregivers.
Understanding the basics and what is behind behaviors
Anywhere from 30%-90% of people diagnosed with dementia experience behavior disturbances.1 A key fact to remember is that dementia is the result of a progressive brain disorder. The behaviors are out of the person’s control and do not reflect any bad feelings or ill intent toward family or caregivers.
We’ll first discuss behaviors that can result from dementia, and then we’ll consider ways to help reduce or improve some of these difficulties. As you read, keep in mind that some of these behaviors can happen not only because of confusion but due to the inability to communicate needs. Is the person hungry, exhausted, or in pain? Looking for patterns and underlying problems can help relieve any discomfort that is contributing to disruptive behaviors.
Behavior difficulties common with dementia
You may recognize several or only a few of the behaviors common to dementia. In the early stages of Alzheimer’s disease, there may be little or no behavior changes. As dementia related to Alzheimer’s or other conditions progresses, however, these behaviors can all be common:
Agitation
Anxiety and restlessness due to confusion, discomfort, fear, medication side effects, and more are very common with dementia. Because of the inability to identify what is upsetting or to communicate needs, the person with dementia can become overwhelmed and irritable.
Aggression & verbal outbursts
Confusion and agitation sometimes lead to escalating anger and aggression. Yelling, cursing, or becoming physically aggressive can happen suddenly at times and without warning.
Repetitive speech
Asking a question over and over again, or repeating a word or statement many times, can happen when a confused person fixates on an idea. While it’s a harmless behavior, it can be very frustrating for caregivers and sometimes escalate to agitation for the person with dementia.
Wandering
Up to 60% of people with dementia wander. 2 Walking around constantly, sometimes even at night, can turn into a safety hazard if the person starts leaving the home to wander. Sometimes it can seem as if the person is looking for something, or going somewhere meaningful. Other times, there is no clear reason for the wandering.
Paranoia or hallucinations
As the brain problems worsen in conditions like Alzheimer’s, people can experience seeing things that are not there (hallucinations). Or, they may believe things that are not true (delusions), leading to suspicion and paranoia of others.
Sleep issues and “sundowning”
With dementia, it is very common for the brain to have trouble regulating sleep. Increased confusion, agitation, and restless behaviors that begin at dusk are called “sundowning” and frequently happen with Alzheimer’s disease. In addition, a person’s circadian rhythm, or internal clock, can be disrupted.
Depression
As many as 41% of people with dementia also suffer from depression. 3 Some of the symptoms of depression– social withdrawal, trouble concentrating, lack of interest in hobbies and activities, and difficulty thinking– can also be early symptoms of dementia, so it’s easy to miss.
Problems with hygiene and dressing
Confusion and forgetfulness can often lead to difficulties with dressing, bathing, and tending to other personal hygiene like brushing teeth. Even simple tasks like choosing the correct outfit can be a challenge. The person may resist important personal hygiene. Incontinence due to confusion about how or when to use the toilet can add to these challenges.
Sexually inappropriate behavior
As shocking or upsetting as sexually inappropriate behaviors may be, this is not unusual when dementia is present. These behaviors can include inappropriate verbal comments, inappropriate physical touch, or public sexual behaviors.
Some practical tips for approaching behavior concerns
As we’ve discussed, some of the behaviors above may be an expression of other underlying problems that the person can’t communicate clearly. Investigating further and offering food or drink, or tending to personal hygiene can sometimes improve behavior.
Sometimes, medications prescribed for other conditions can cause increased confusion, hallucinations, or agitation. So can urinary tract infections. And problems like incontinence and pain can be addressed with medication. It’s good to visit a healthcare provider especially if changes in behavior have been sudden.
Let’s go over some practical suggestions for how to handle these behaviors when they occur:
How to reduce agitation
While it may not be possible to eliminate all agitation, there are ways you can reduce it and de-escalate it once it happens:
- Express empathy– “I can see you are very frustrated/upset/scared, how can I help?”
- Offer distractions- food, drink, or a preferred activity can redirect a person.
- Follow routines- the fewer changes a person with dementia has to face, the less upsetting, confusing, and frustrating things will be. Keep everyday expectations the same, and avoid big changes like moving, or rearranging furniture if possible.
- Avoid overstimulation- too much noise, activity, or even conversation or multiple visitors, can overwhelm a person with dementia. Keep the environment calm and quiet.
- Don’t argue- disagreeing, even if you are right, will only escalate frustration and confusion.
Allow extra time- sometimes, a little patience goes a long way in calming an upset person. Often agitation can result from loss of control. Allowing the person time to do things on their own can give them a sense of control over their life.
Reacting to aggression and verbal outbursts
Aggression that becomes physical can lead to injury. Verbal aggression is upsetting and overwhelming for caregivers. The same tips that help with agitation can aid with aggression as well. Here are some additional approaches that can help calm these episodes:
- Address confusion- re-orient the person to their surroundings with simple reminders and reassurance. “We’re at home and I’m here to help you.”
- Find sources of frustration- Ask simple questions that call for a yes or no answer. “Are you hungry right now? Is anything hurting?”
- Try to focus on a happy memory- while short-term memory may be a struggle for someone with dementia, they often retain long-term memories. It is sometimes possible to calm a person who is focused on anger by redirecting them to a conversation about a better time.
How to redirect repetitive speech
This behavior can be a result of anxiety and confusion, or even due to boredom. There are some ways you can “change the subject,” so to speak:
- Give the person a purposeful activity- redirect them to a task they enjoy doing, go for a walk, put on music, or offer to read a book together. This can occupy their mind with something else.
- Calm anxiety- offer reassurance with comforting words and hugs or touch, if appropriate.
- Use visual reminders- if the speech involves questioning a future event constantly, such as when a family member might arrive home, you can help by hanging written signs that remind the person what time to expect something. Having a clock available and showing it to them can help too, depending on how advanced their dementia is.
Tips for wandering
Because wandering is a safety concern, it’s important to address this problem immediately. There are several approaches you can use:
- Install safety locks on doors- placing these above eye level can stop someone from opening doors. There are different styles available, including hinge locks that easily flip open and closed for fire safety. These are not likely to be opened by a person with dementia. Child safety door knob covers may also work.
- Install door alarms- simple alarms mounted on the door and frame will alert you to doors being opened.
- Have your loved one wear ID- a safety alert bracelet or tags sewn into clothes can help them return home safely if they do wander outside of the home. There are also digital trackers with GPS that can be used.
- Alert neighbors- if the community is aware that seeing your loved one unsupervised means they are likely lost, they can act faster
- Put away coats, shoes, etc.- sometimes, not being able to find essential items to leave the house will deter wandering outside
- Use a 24-hour caregiver- supervising wandering that may potentially happen overnight is exhausting. If the above tips are not preventing the person from leaving the house unexpectedly, an overnight professional home caregiver can help.
Managing paranoia and hallucinations
To the person experiencing hallucinations, delusions, and paranoia, their experience is real. Some strategies that help redirect these issues are:
- Don’t argue- trying to convince the person of reality leads to agitation. Instead, offer solutions, like helping them look for missing items they believe have been stolen, and distracting them with other tasks
- Visit the doctor- especially if this is a new symptom, sometimes underlying medical problems can trigger it.
- Reassure the person- hallucinations can be frightening if they involve threats that aren’t real, like seeing bugs crawling. Let your loved one know you are there and will help them.
- Change the environment- make sure there is enough lighting to reduce shadows that might be seen as something else. Cover mirrors if they are causing the person to believe they are seeing a stranger.
Helping sleep issues and sundowning
Problems with sleeping and settling down in the evening can lead to other issues like agitation, wandering, and sleepless nights for caregivers. Here are some ways to help this concern:
- Restrict caffeine, alcohol, and sugar- because these substances can disrupt sleep hours after ingestion, limit them to early in the day
- Encourage activity and reduce naps- staying active and doing things like taking walks can make a person more likely to fall asleep in the evening. It can also discourage napping. Taking too many naps or long naps can further disrupt sleep at night.
- Establish a routine- make sure bedtime is at the same time every night, and try to follow the same routine for getting ready for bed. Dim lights, comfortable pj’s, soft music, or whatever is calming to the person will serve as a cue that it will be time to go to bed soon.
- Keep the lights on- both daylight exposure and having indoor lights bright until it’s time for bedtime can help reduce night and day confusion and loss of bedtime routines.
What to do about depression
Because depression can make other dementia symptoms worse, and affect quality of life, it’s important to address it. Here are some things to do if you’re concerned about depression:
- Talk to your doctor- medications to treat depression can be used by people with dementia. It’s also important for a doctor to diagnose whether depression is truly present.
- Offer companionship- loneliness due to isolation, and friends pulling away after a dementia diagnosis can lead to depression. Providing social activities or involving a home caregiver for regular visits can help the person feel less isolated.
- Prioritize fun- what kinds of activities is your loved one happiest doing? Make sure these are offered and encouraged regularly.
Improving challenges in hygiene and dressing
You can make some simple changes that improve these self-care activities for a person with dementia:
- Choose simple outfits- avoid buttons and zippers and opt for clothes with elastic waistbands that are easy to pull on, for example.
- Break tasks into steps- just reminding someone to take a bath or get dressed may not help them if they are confused. You may need to tell them each step involved, from getting undressed to washing and then drying off.
- Offer help- as dementia worsens, hands-on assistance may be necessary for all tasks.
- Set a routine- regular bathroom breaks can reduce episodes of incontinence, and serve as a reminder to tend to personal hygiene.
Addressing sexually inappropriate behavior
This can be upsetting and embarrassing for family, but it’s important to remember that the person cannot control the behavior. As many as 25% of people with dementia display these inappropriate behaviors.4 There are some ways you can redirect this issue:
- Reduce boredom- keeping a person occupied in other meaningful ways can reduce sexual behaviors. Snacks, activities, exercise, and social interaction are good distractions.
- Keep hands busy- this can reduce inappropriate touching. Crafts, folding towels, and other “chores” can help.
- Ask about medication- although caution must be taken with medications and dementia, your healthcare provider can make recommendations about treatment that could reduce this behavior.
It’s important to be adaptable as dementia progresses
Keep in mind that trying to change or control behaviors is not going to improve the brain condition that is causing them. Over time brain function will worsen– and the behaviors will change, or new behaviors may develop.
Because of this, your approach to behaviors may need to change as well. What works today, may not work tomorrow. You may find it helpful to review this guide from time to time to help you create solutions that ease some of the stress of managing disruptive behaviors.
In addition to the strategies we’ve mentioned, sometimes having professional home care, even for respite visits, can give family caregivers a much-needed break to rest. This helps caregivers to feel better prepared for difficult behaviors that are beyond their loved ones’ control. If you’d like to learn more, or are ready to take the next step to hire a home caregiver, Caresify’s team is available to help. You can read more here, or call 888-799-5007.
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