Alzheimer's Behaviors

Alzheimer's clients can display a wide variety of behaviors. Their actions and reactions can be random and unpredictable. These are not behaviors that they can control and they aren't "doing it on purpose". As caregivers all we can do is try our best to keep them safe, healthy and comfortable. It's not always easy but there are suggestions and tips to follow.

I've added some links and suggestions from various sources below:

Alzheimer's Association Behaviors - What causes dementia-related behavior like aggresion and how to respond ...


Alzheimer's Society - Unusual Behaviors - Repetition, Restlessness, Shouting, Lack of Inhibition, Night time waking, Trailing and Checking, Hiding and Losing things and being Suspicious.


Information Obtained From the Alzheimer's Association:

Repetition:

Introduction:

The person with Alzheimer's may do or say something over and over again – like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity.

The person may also pace or undo what has just been finished. These actions are rarely harmful to the person with Alzheimer's but can be stressful for the caregiver.

How to Respond:

• Look for a reason behind the repetition. Try to find out if there is a specific cause for the behavior.


• Focus on the emotion, not the behavior. Rather than reacting to what the person is doing, think about how he or she is feeling.
  
• Turn the action or behavior into an activity. If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
  
• Stay calm, and be patient. Reassure the person with a calm voice and gentle touch.
  
• Provide an answer. Give the person the answer that he or she is looking for, even if you have to repeat it several times.
  
• Engage the person in an activity. The individual may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.
  
• Use memory aids. If the person asks the same questions over and over again, offer reminders by using notes, clocks, calendars or photographs, if these items are still meaningful to the individual.
  
• Accept the behavior, and work with it. If it isn’t harmful, let it be. Find ways to work with it.
  
  

Aggression

Introduction
Aggressive behaviors may be verbal (shouting, name-calling) or physical (hitting, pushing). These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is try to understand what is causing the person to become angry or upset.

Possible causes
Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. If the person is aggressive, consider the following:

Physical discomfort
Is the person tired because of inadequate rest or sleep?

• Are medications causing side effects?
  
• Is the person unable to let you know he or she is experiencing pain?
  

Environmental factors

• Is the person overstimulated by loud noises, an overactive environment or physical clutter?
  
• Does the person feel lost ?
  

Poor communication

• Are you asking too may questions or making too many statements at once?
  
• Are your instructions simple and easy to understand?
  
• Is the person picking up on your own stress and irritability?
  
• Are you being negative or critical?
  

How to respond

• Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
  
• Focus on feelings, not the facts. Try not to concentrate on specific details; rather, consider the person's emotions. look for the feelings behind the words.
  
• Don't get angry or upset. Don’t take the behavior personally. The person isn’t necessarily angry with you. Be positive and reassuring. Speak slowly in a soft tone.
  
• Limit distractions. Examine the person's surroundings, and adapt them to avoid similar situations.
  
• Try a relaxing activity. Use music, massage or exercise to help soothe the problem.
  
• Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.
  
• Decrease level of danger. Assess the level of danger — for yourself and the person with Alzheimer’s. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.
  
• Avoid using restraint or force. Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.
  

Agitation

Introduction
A person with Alzheimer's may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places or focused on specific details. He or she may become over-reliant on a certain caregiver for attention and direction.

Causes of agitation
Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person’s ability to think. Situations that may lead to agitation include:

• Moving to a new residence or nursing home
  
• Changes in the environment or change in caregiver
  
• Misperceived threats
  
• Fear and fatigue resulting from trying to make sense out of a confusing world
  

Treating agitation

A person with agitation should receive a thorough medical checkup, especially when it comes on suddenly. The treatment of agitation depends on a careful diagnosis, determining the possible causes and the types of agitated behavior the person is experiencing. With proper treatment and intervention, the agitation symptoms can be reduced.

There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral treatments should be tried first. In general, steps to managing agitation include (1) identifying the behavior (2) understanding its cause and (3) knowing how to respond.


Preventing agitation
To prevent or reduce agitation:

• Create a calm environment. Remove stressors, triggers or danger; move person to a safer or quieter place; offer rest or privacy; limit caffeine use; provide opportunity for exercise; develop soothing rituals; and use gentle reminders.
  
• Avoid environmental triggers. Noise, glare, insecure space and too much background distraction, including television.
  
• Monitor personal comfort: Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation; ensure a comfortable temperature; be sensitive to fears, misperceived threats and frustration with expressing what is wanted.
  
• Simplify tasks and routines.
  

Identify triggers

Identifying what has triggered agitation can often help in choosing the best response to the behavior. Often the trigger is a change in the person’s environment:

• change in caregiver
  
• change in living arrangements
  
• travel
  
• hospitalization
  
• presence of houseguests
  
• bathing
  
• being asked to change clothing
  

How to respond

• Listen to the frustration. Find out what may be causing the agitation, and try to understand
  
• Provide reassurance. Use calming phrases such "You’re safe here." "I’m sorry that you are upset." "I will stay until you feel better."
  
• Involve the person in activities. Try using art, music or other activities to help the person relax.
  
• Modify the environment. Decrease noise and distractions, or move to another place.
  
• Find outlets for the person's energy. The person may be looking for something to do. Take a walk, or go for a car ride.
  
• Check yourself. If the person is agitated, do not raise your voice, and do not corner, restrain, criticize, ignore, argue with or shame the person.
  

Confusion

Introduction
The person with Alzheimer's may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The person may also forget the purpose of common items, such as a pen or a fork. These situations are extremely difficult for caregivers and families and require patience and understanding.

How to respond

• Stay calm. Although being called by a different name or not being recognized can be painful, try not to make your hurt apparent.
  
• Respond with a brief explanation. Don't overwhelm the person with lengthy statements or reasons. Instead, clarify with a simple explanation.
  
• Show photos and other reminders. Use photographs and other thought-provoking items to remind the person of important relationships and places.
  
• Offer corrections as suggestions. Avoid explanations that sound like scolding. Try "I thought it was a fork, " or "I think she is your granddaughter Julie."
  
• Try not to take it personally. Alzheimer's disease causes your loved one to forget, but your support and understanding will continue to be appreciated.

Hallucinations


Introduction

A hallucination is a false perception of objects or events involving the senses. When individuals Alzheimer’s disease have a hallucination, they see, hear, smell, taste or feel something that isn’t there. The person may see the face of a former friend in a curtain or may hear people talking.

If the hallucination doesn’t cause problems for you, the person or other family members, you may want to ignore it. However, if they happen continuously, consult a physician to determine if there is an underlying physical cause. Also, have the person’s eyesight and hearing checked, and make sure the person wears his or her glasses and hearing aid on a regular basis.

• Offer reassurance
  
• Respond in a calm, supportive manner.
  
• A gentle tap on the shoulder may turn the person’s attention toward you.
  
• Look for the feelings behind the hallucinations. You might want to say, “It sounds as if you’re worried” or “I know this is frightening for you.”
  
• Avoid arguing with the person about what he or she sees.
  
• Use distractions
  
• Suggest that you take a walk or sit in another room. Frightening hallucinations often subside in well-lit areas where other people are present.
  
• Try to turn the person’s attention to music, conversation or activities you enjoy together.
  
• Modify the environment
  
• Check for noises that might be misinterpreted, such as noise from a television or an air conditioner. Look for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls and furniture.
  
• Cover mirrors with a cloth or remove them if the person thinks that he or she is looking at a stranger.
  

Sleeplessness and Sundowning

Sleeping problems experienced by individuals with Alzheimer’s and caregiver exhaustion are two of the most common reasons people with Alzheimer’s are eventually placed in nursing homes. Some studies indicate that as many as 20 percent of persons with Alzheimer’s will, at some point, experience periods of increased confusion, anxiety, agitation and disorientation beginning at dusk and continuing throughout the night.

While experts are not certain how or why these behaviors occur, many attribute them to late-day confusion, or “sundowning,” caused by the following factors:

• end-of-day exhaustion (mental and physical)
  
• an upset in the “internal body clock,” causing a biological mix-up between day and night
  
• reduced lighting and increased shadows
  
• disorientation due to the inability to separate dreams from reality when sleeping
  
• less need for sleep, which is common among older adults
  

Tips for reducing evening agitation and nighttime sleeplessness

• Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.
  
• Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
  
• Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the person relax at night.
  
• Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.
  
• Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages, then diminishes as the disease progresses. In the meantime, caregivers should make sure their home is safe and secure, especially if the person with Alzheimer’s wanders. Restrict access to certain rooms or levels by closing and locking doors, and install tall safety gates between rooms. Door sensors and motion detectors can be used to alert family members when a person is wandering.
  

Once the person is awake and upset, experts suggest that caregivers:

• approach their loved one in a calm manner
  
• find out if there is something he or she needs
  
• gently remind him or her of the time
  
• avoid arguing or asking for explanations
  
• offer reassurance that everything is all right and everyone is safe
  

Suspicion

Introduction
Memory loss and confusion may cause the person with Alzheimer’s to perceive things in new, unusual ways. Individuals may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior. Sometimes the person may also misinterpret what he or she sees and hears.

How to respond

• Don't take offense. Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
  
• Don’t argue or try to convince. Allow the individual to express ideas. Acknowledge his or her opinions.
  
• Offer a simple answer. Share your thoughts with the individual, but keep it simple. Don’t overwhelm the person with lengthy explanations or reasons.
  
• Switch the focus to another activity. Engage the individual in an activity, or ask for help with a chore.
  
• Duplicate any lost item. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.
  

Unpredictable Situations

Introduction
People with Alzheimer’s disease can act in different and unpredictable ways. It is important to remember that the person is not acting this way on purpose. Whatever the behavior, try to identify the cause and possible solution.

Bold behavior
Individuals with Alzheimer’s disease may forget that they are married and begin to flirt or make inappropriate advances toward others.

When there is unusual, inappropriate behavior, try to distract the person with another activity or lead him or her into a private place. Avoid getting angry or laughing at the person.

Inappropriate dressing
The person may forget how to dress or take clothes off at inappropriate times and in unusual settings. For example, a woman may remove a blouse or skirt simply because it is too tight or uncomfortable.

Help the person dress by laying out clothes in the order they need to be put on. Choose clothing that is simple and comfortable.

Shoplifting
The person with Alzheimer’s may not understand or remember that merchandise must be paid for. He or she may casually walk out of the store without paying — unaware of any wrongdoing.

Have your loved one carry a wallet-size card that states that he or she is memory-impaired. This may prevent the person with Alzheimer’s disease from feeling embarrassed.

Wandering

Introduction
It is common for a person with dementia to wander and become lost; many do repeatedly. In fact, over 60 percent of those with dementia will wander at some point.

Wandering can be dangerous - even life threatening - for the person who wanders. The stress can weigh heavily on caregivers and family.

Keep your loved one safe by knowing the risk factors for wandering and enrolling in MedicAlert® + Alzheimer's Association Safe Return®, our 24-hour nationwide emergency response service for individuals with Alzheimer’s or related dementia that wander or who have a medical emergency. You can't know when wandering will happen, but you'll know what to do when it does.


What is wandering?
Many people with dementia do not fit the textbook definition of wandering, "To move about without a definite destination or purpose."

People with dementia who wander often have a purpose or goal in mind. They may be searching for something that is lost or trying to fulfill a former job responsibility.


Who's at risk?
Everyone is at risk for wandering. However, a person may be at risk for wandering if he or she:

• Returns from a regular walk or drive later than usual
  
• Tries to fulfill former obligations, such as going to work
  
• Tries or wants to "go home" even when at home
  
• Is restless, paces or makes repetitive movements
  
• Has difficulty locating familiar places like the bathroom, bedroom or dining room
  
• Checks the whereabouts of familiar people
  
• Acts as if doing a hobby or chore, but nothing gets done (moves around pots and dirt without actually planting anything)
  
• Appears lost in a new or changed environment
  

Causes

• Wandering can be caused by several factors, including:
  
• Medication side effects
  
• Stress
  
• Confusion related to time
  
• Restlessness
  
• Agitation
  
• Anxiety
  
• Inability to recognize familiar people, places and objects
  
• Fear arising from the misinterpretation of sights and sounds
  
• Desire to fulfill former obligations, such as going to work or looking after a child
  

Tips to reduce wandering

• Encourage movement and exercise to reduce anxiety, agitation and restlessness
  
• Ensure all basic needs are met (toileting, nutrition, thirst)
  
• Involve the person in daily activities, such as folding laundry or preparing dinner
  
• Place color-matching cloth over doorknobs to camouflage
  
• Redirect pacing or restless behavior
  
• Place a mirror near doorways. The reflection of a person's own face will often stop him or her from exiting the door.
  
• Reassure the person if he or she feels lost, abandoned or disoriented
  

Tips to protect a loved one from wandering and getting lost

• Enroll the person in MedicAlert + Safe Return.
  
• Inform your neighbors and local emergency responders of the person’s condition and keep a list of their names and telephone numbers.
  
• Keep your home safe and secure by installing deadbolt or slide-bolt locks on exterior doors and limiting access to potentially dangerous areas. Never lock the person with dementia in a home without supervision.
  
• Be aware that the person may not only wander by foot but also by car or by other modes of transportation.
  

Tips for preparing for emergencies

• Keep a list of emergency phone numbers and addresses of the local police and fire departments, hospitals, and poison control as well as the MedicAlert + Safe Return emergency response number.
  
• Keep a list of physicians phone numbers and current medications (with dosages)
  
• Keep copies of legal documents (living will, power of attorney, etc.)
  
• Check fire extinguishers and smoke alarms