- What is it?
- Caring at home
- Taking care of yourself
- Postural hygiene for carers
- Dependent person
- Communication with the dependent person
- Mobilising the dependent person
- Nutrition and the elderly
- Personal hygiene
- Urinary incontinence
- Changes in bowel movements
- Pressure sores
- Changes in behaviour
- The comunication
- Home environment and dementia
- Lack of appetite and dementia
- Changes in behaviour and dementia
- INFOSA project
Changes in Behaviour in People with Dementia
Agitation can mean various forms of behaviour associated with dementia, such as irritability, insomnia and becoming verbally or physically aggressive.
These behaviours may not always be present, and will tend to fluctuate, i.e. sometimes they will appear only for the person to show an improvement, and which may have a range of causes (such as environmental factors, fear or fatigue).
Agitation is most likely to appear when the person with dementia thinks that he or she is being denied the ability to manage his or her own life and independence.
Recommendations to avoid agitation
- Reduce the consumption of caffeine and sweet foods
- Reduce environmental noise, mess and the number of people who might upset the person
- Maintain a stable environment and fixed routines. Always place furniture in the same place. Photographs and other recognised objects help to create a sense of safety and can make it easier to remember happy memories
- Try to calm the person down with gentle caresses, calm music, reading or going for a walk. Always talk to the person using a gentle, comforting voice. Do not try to reason with someone when agitated
- Keep any dangerous objects out of reach
- Allow people with dementia to take charge as their own situation as much as possible, stimulating their sense of independence and the ability to look after themselves
- Use a snack or some other activity as a distraction. Allow the person to forget the incident that caused the problem
People with dementia tend to repeat certain words, sayings, questions or activities over and over.
This type of behaviour is for the most part inoffensive, but as a carer you may find it irritating or stressful. It can be due to anxiety, boredom, fear or environmental factors.
Recommendations for managing repetitive behaviour:
- Create feelings of security and wellbeing using words and physical contact
- Try to distract the person
- Do not feel resentful that he or she has just asked the same question
- Do not try to explain plans when he or she is in a state of confusion until just before carrying them out
- Remove any anxiety and uncertainty about future events. Place a sign on the table or in the kitchen that says “Lunch is at 1.30” or “Maria will be here at 8pm”
- Learn to interpret certain behaviours. A state of agitation, or tearing off clothes, for example, may indicate the need to go to the bathroom
If you suspect or notice hallucinatory behaviour, consult with the person’s doctor. When these symptoms are diagnosed and treated with medication, the attitude will be to maintain a calm, safe environment. Emotional support is basic, and should be reinforced, and it should be repeated that the person is not alone, is loved and will be helped. Positive reinforcement.
As the dementia progresses, hallucinations (seeing or hearing things that do not actually exist) and delusional ideas (false beliefs) can occur.
It is extremely disconcerting to see our loved one suddenly become suspicious, jealous or start making accusations. Remember that, from his or her point of view, those feelings are very real.
The best thing to do is not to argue or hit back at what is said. These behaviours form part of the dementia. It is important not to take it personally.
Recommendations for managing delusions or hallucinations
- If the person is in a state of confusion and insists that he or she “is missing money”, keep a small amount in his or her pocket or bag, so it can be taken out easily
- Help the person to look for the “lost” item, then try to distract him or her with a different activity. Try to discover where the person hides the things he or she thinks are “lost”. Avoid having an argument
- Explain to other relatives and home helps that the accusations and suspicions form part of the illness
- Use non-verbal means to strengthen the feeling of being safe, such as gentle caresses or a hug. You can try saying “I see you’re frightened. Stay by my side. I’m not going to let anything bad happen”
- Let the person know, simply and calmly, that other people cannot see or hear these things, but avoid arguing and trying to convince the person that his or her perception is wrong
- Keep the room well lit to reduce shadows
- If these symptoms worsen, consult a professional
Wandering is a behaviour that often appears in the intermediate stage of the illness.
Causes of wandering
- Confusion. While feeling disoriented, the person does not realise that he or she is at home, and sets off “to find it”, ending up somewhere else as a result
- Delusions. This relates to thinking things that are not really there, and the person may be trying to fulfil a past responsibility, such as going to work or going to look for a child
- Attempts to escape from a real or perceived threat. People with dementia can feel frightened by a noisy house, a stranger visiting or even by the belief that their carer is trying to harm them
- Due to this nervousness, people with dementia can become more anxious. Sometimes this anxiety and nervousness can be side effects of some medication, so check with a professional if the behaviour persists
- Restlessness, due to a lack of exercise and other forms of stimulation
- Searching from something or someone, a place or personal item that they have lost
If the person persists with this behaviour, he or she should never be left alone. Care providers should take certain measures to reduce the danger of the person with dementia leaving the home unaccompanied.
Recommendations for managing wandering
- Ensure the person takes regular exercise to reduce feelings of anxiety
- Obtain a medical ID bracelet and ensure it is worn at all times. They are often sold in pharmacies. Other options are also available, such as watch-type or key fob GPS locators
- Establish a clear and safe place in which to walk
- Give the person something repetitive to do
- Keep a few essential articles, such as the person’s overcoat, wallet or spectacles, in a safe place
- Keep the doors leading outside closed, and keep the keys in a safe place that cannot be accessed by the person with dementia
- Install safety devices on the windows
- Install bells or alarms that sound when a door leading outside is opened
- Inform the neighbours that your relative has dementia and ask them to tell you if they see him or her out in the street alone
- Try to use barriers to hide the doors. A sign saying “Stop” or “No access” might also work