Anyone who has an elder with Alzheimers Disease knows that the hardest part of
caring for the individual comes from the problem behaviors that can occur as a result of
the disease. In some people, problems begin in the early stages of the disease and last
until they die. Others seem to live in their own little world and are passive and easy to
deal with. Sometimes "problem" behaviors are in the eye of the beholder. A
behavior that may be problematic for one caregiver may not concern another. The key for
dealing with behavior problems is for caregivers to have a positive attitude and be
flexible.This article focuses on reducing or eliminating problem behaviors once they
occur.
Alzheimers Disease is not just a disease of memory loss. People with
Alzheimers Disease also show symptoms of:
- Language problems;
- Problems with judgement, reasoning, sequencing and planning;
- Problems with perception;
- Loss of motor skills;
- Inability to carry out daily activities;
- Personality changes
All of these deficits lead to changes in behavior that can range from simple repetitive
behaviors and lack of interest in past hobbies to extreme agitation and violence. Some of
the problem behaviors seen in people with Alzheimers Disease include:
- Anxiety;
- Wandering;
- Stealing others property;
- Pacing;
- Inability to remain quiet;
- Disorientation to time, place and/or person;
- Constant demand for attention;
- Repetitive speech and/or actions;
- Restlessness and fidgeting;
- Inappropriate toileting;
- Undressing;
- Feeding problems;
- Inappropriate sexual behavior;
- Emotional outbursts;
- Combativeness;
- Screaming;
- Cursing;
- Lack of interest in surroundings/activities;
- Disturbance of sleep/wake cycle;
- Sundowning;
- Hostility;
- Being uncooperative;
- Easy frustration;
- Hitting, kicking and biting;
- Paranoid ideas;
- Resisting care or refusing care;
- Sadness, hopelessness or despondency;
- Mood swings;
- Catastrophic reactions (when a demented person has an extreme reaction, often due to
sensory overload);
- Hallucinations;
- Delusional ideas;
- Rummaging
Understanding Problem Behaviors
Difficult behaviors can be more easily understood if caregivers remember that:
- All behavior has meaning: It is most important to remember that all behavior has
meaning, even if its sometimes hard to determine what that meaning is. Caregivers
cant think like a person who has Alzheimers Disease because caregivers are
capable of logically thinking through their own behaviors. People with Alzheimers
Disease dont follow logic and can be very difficult to understand.
- There is always a cause for a behavior and a result of the behavior: Behavior always has
a cause and a result. For instance, a person may start to pace for multiple reasons. He
may have a generalized feeling of anxiety or he may be searching for something. The
behaviors result can be anything from a decrease in the feeling of anxiety to
finding a way out of the house in order to search further.
- Behavior does not occur in a vacuum: There are always outside influences that modify
behavior. They can come from people or from the environment. For instance, a person with
Alzheimers Disease who is a resident of a nursing facility might become agitated
when a message from a staff member is heard over the loudspeaker. Since these influences
change from moment to moment, behavior also may change from moment to moment.
Stage One: Early
Behavioral problems often occur early in the disease, before a caregiver is even aware
that the person is afflicted. For instance, the person may become easily angered when a
mistake is made due to memory loss. One person may lash out verbally at the caregiver when
it is pointed out that she forgot to pay a bill. Another may become very angry when he
asks why a favorite relative hasnt visited lately and is told she was just there the
day before.
Stage Two: Middle
As the disease progresses, behavioral problems may become more frequent and severe.
Some people in Stage Two become very paranoid and suspicious, accusing their caregivers of
stealing things or being unfaithful. Some people have sleep disturbances and begin to
wander from home.
Stage Three: Late
The person may scream or yell inappropriately and may resist a caregivers
attempts to help with bathing, dressing or other personal care.
Guidelines for Dealing With Behavior Problems
- Everything surrounding a person could contribute to the behavior problem;
- A thorough assessment of the elder, the environment and the caregiver by a trained
professional is necessary in order to plan for intervention;
- Think ahead and plan for situations that could result in problem behaviors;
- Trying to argue or reason with a person who has Alzheimers Disease only results in
frustration for both the caregiver and the elder. It is not possible to win an argument
with a person who has Alzheimers Disease;
- Distract and divert whenever possible;
- Keep the routine the same. Changes in routine are upsetting to people with
Alzheimers Disease and can cause behavior problems;
- Promote a sense of security and comfort when problem behaviors occur. Problem behaviors
often happen because a person is frightened and unable to make sense out of the
environment;
- Use positive reinforcement such as food, smiles, a gentle touch, personal attention and
lots of praise. These tools are more effective than negative reactions;
- Allow a person with Alzheimers Disease some sense of control. Being able to save
face is important even in a person who is very confused;
- Maintain a calm manner when confronted with threatening behaviors. This can defuse a
very tense situation and help a person become less fearful;
- Keep things simple. Complex situations only cause frustration and can escalate behavior
problems;
- If a caregiver becomes frustrated and angry, it is best to find someone else to handle
the problem and have the caregiver leave the immediate area or take a break (respite). An
angry caregiver will only intensify problem behaviors;
- Caregivers should practice ways to reduce stress when they become frustrated and angry.
Deep breathing or talking to someone can be helpful. Remember that stress comes from many
sources, including personal life;
- Behavioral problems result from the disease. Dont take things that the person says
and does personally. It is the disease speaking;
- Be creative when seeking solutions to difficult behaviors;
- Use good common sense when attempting to solve problem behaviors;
- Keep a sense of humor even in the most difficult situations. Humor will help you cope
with the frustrations of caring for a loved one with Alzheimers Disease.