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Managing Problem Behaviors in Dementia

By Vivienne Campbell, FTJ Resident Care Manager

Individuals dealing with dementia often display inappropriate or unpleasant behaviors as part of their illness.  In general, it is helpful to identify the causes of problem behaviors so that triggers and be avoided and the reaction averted.

1. Observe the body language and try to figure out what the person is trying to communicate non-verbally.
2. What happened immediately before the behavior started? Can you identify a trigger?
3. Are the person’s needs being met? Many behaviors are the result of unmet needs.  Are they hungry/thirsty?  In pain?  Need to use the bathroom?
4. Does a change to a calmer environment help to defuse the behavior? Playing soothing music, gently massaging hands, speaking in calm tones can help.
5. How does YOUR reaction influence behavior? Are you making things better or worse?

Below is a list of some common problem behaviors in Dementia and suggestions on how to deal with them.

Wandering. 

Tune into the person’s nonverbal cues (pacing, restlessness) and redirect that energy into productive activity.  Reassure the person if they appear disoriented.  Identify times/situations that lead to wandering and distract with another activity when noted.  Redirect the person to a calmer environment, reduce noise and other distractions.  In the home, make sure your loved one is safe.  Install door alarms. Consider providing your loved one with a tracking device so that if they wander away they can be found quickly.

Rummaging/Hiding Items

Use child safe devices on cupboards and doors that would present an issue, especially where toxic or dangerous items are kept.  Provide a special drawer or cupboard that c contains safe items that the person can safely play with when wanting to rummage.  Check wastebaskets/trashcans before emptying to check for objects hidden there.

Incontinence

Loss of bladder and bowel control is common in dementia.  Establish a toileting routine and assist the person to the bathroom on a regular schedule, about every two hours.  Make sure the person is well hydrated.  Use signs and other visual cues to remind them where the bathroom is.  Dress in easy to remove clothing )sweat pants, elastic waist, Velcro fasteners) to facilitate using the toilet.

Sundowning

Often people with dementia will exhibit increased symptoms or restlessness and agitation at the end of the day.  Some way to combat this is to have a “cooling down” period at the end of the day, with quiet structed activity such as taking a stroll outdoors or listening to soothing music. Turn the light down and close curtains but keep a nightlight on for safety.  Watch your intake of caffeine, sugar and junk food later in the day.

Resistance to bathing

Many folks with dementia forget the importance of good hygiene, and can be resistant to bathing, brushing teeth, changing clothes.  Try to remember or find out what the person’s routine was before dementia: time of day, preference for shower/bath, favorite scented soap or lotion.  Respect the person’s sense of privacy and dignity by keeping doors closed, curtain pulled and offer the person’s body with a towel to preserve modesty.  Make sure there is a safe environment with grab bars and non-slop pads in the shower.  Have everything ready BEOFRE you start to assist the person to bathe and never leave unattended in the shower or bath.

Agitation, Paranoia and Hallucinations

Provide a calm, clutter-free environment for the person.  Gentle touch, soothing music and speaking in a reassuring voice can reduce agitation.  Don’t take it personally if the person becomes suspicious or accusatory.  Don’t argue or disagree.  If the person is experiencing hallucinations and delusions, offer reassurance and state your perception of the situation in a calm manner but don’t try to convince the person that their perception is incorrect.  If acting out with verbal aggression, remain calm and reassuring, validate their feelings and try to re direct their attention.

Sexually inappropriate behavior

Understand that this, too, is part of the disease and try to understand what may trigger this behavior.  Do not scold the person, instead try to redirect them to a more appropriate activity.