Welcome to This is Getting Old: Moving Towards an Age-Friendly World, I’m your host Melissa Batchelor, and today I’ll be talking about Six Tips for Managing Behaviors in Alzheimer’s Disease.
In Alzheimer’s disease, a person may do very distressing things to you as a caregiver. These are often categorized as behavioral and emotional behaviors and may range from being irritable, having major mood swings of being angry or sad, or being agitated.
Alzheimer’s disease is, in a nutshell, brain failure. When your brain fails, it means you can’t think clearly or interpret information from the world around you correctly. This can be frightening and confusing to the person living with the disease. These feelings of anxiety or being scared may cause the person to behave in challenging ways to you as a caregiver, but please understand that it’s not personal. The person living with Alzheimer’s disease is doing the best they can, and we need to adjust to them.
Behaviors may include repetitive verbalizations – like saying “I want to go home” or “Help me! Help me!”. They may lash out in anger or resist care, like not wanting to take a shower or bath. They may accuse you of stealing from them or trying to poison them. These are just a few examples, but there are many other behaviors that you may see. The six tips I’m going to give you can serve as a problem-solving framework because you will have to be a detective and be reflective – as the person with the “big brain” – to manage these behaviors effectively.
So, let’s get to it. Here are the Six Tips for Managing Behaviors in Alzheimer’s Disease” …
#1: Restrict: This one is important if the behavior can harm the person living with dementia or others. Things that come to mind include access to firearms, managing their finances, or driving. Understand that restricting some things may be met with resistance by the person living with dementia, so involve other family or friends if they are. The main thing here is to maintain safety for everyone.
#2: Reassess: Think back to when the person wasn’t demonstrating a particular behavior? Has medication recently been changed? Anytime there’s a sudden behavior change, work with your healthcare providers to see if a new underlying health condition, like a bladder infection or constipation, could be driving the behavior.
If a different approach was used, might that result in a different – less challenging – interaction? If they have trouble with hearing or their vision, could they be misinterpreting what’s going on?
#3: Reconsider: Try to see the situation from the perspective of the person with dementia. Remember that Alzheimer’s disease causes a person to lose the ability to use and understand language, but they will pick up on your nonverbal behavior. If a person doesn’t understand what you are trying to do, they may become upset with you. Try using the Under Hand technique to provide a sensorimotor (or movement) cue when providing care, so you are doing with – instead of doing to – the person living with dementia.
#4: Rechannel: Look at what behavior the person is doing and see if you can channel it into something constructive rather than destructive. Does it have meaning for that person? For example, I cared for a resident who had been a mail carrier for the post office his entire life. He spent most of his day trying to deliver mail to all residents in our nursing home. Rather than making him sit in a chair or medicating him, we gave him a mailbag with “letters” so he could “deliver the mail.”
#5: Reassure: When someone is upset, anxious, or scared, they need reassurance – even with a normal brain! Reassure the person that they are safe, being taken care of, and that things are alright. Also, remember to reassure yourself. This is a HUGE job that is difficult and demanding. You are also doing the best you can, so pat yourself on the back to get through one more challenge.
#6: Review: It takes two to tango and two to tangle … if you experience a less than ideal interaction with your loved one, reflect on the event. Talk the situation over with a trusted friend or family member. Was there a trigger? At what point could you have intervened to minimize the conflict? Is there something you could have done differently? What could you try next time? And also, be mindful that you may need more help – or more rest. Look into Adult Day Care options and Respite Care to allow an opportunity for you to get some rest. If you don’t take care of yourself, you can’t take care of anyone else.
Unfortunately, there isn’t a rule book that says there’s one right way to respond to any behavior. I encourage you to be creative and engage other family members or friends to help to come up with ideas for how to best manage any behavior you find challenging. Multiple “big brains” are best for helping a person with a failing brain.
You can also check out my podcast titled “How to Manage Repetitive Behaviors” to learn about the C3P Problem-solving Framework. I also share more strategies for dealing with challenging behaviors.
Thank you for listening to this podcast or watching this video. I hope these six tips are helpful to you in managing behaviors in Alzheimer’s disease.
I earned my Bachelor of Science in Nursing (‘96) and Master of Science in Nursing (‘00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I truly enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home and office visits) then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer.
I obtained my PhD in Nursing and a post-Master’s Certificate in Nursing Education from the Medical University of South Carolina College of Nursing (2011) ) and then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 and led to me joining the faculty at George Washington University (GW) School of Nursing in 2018 as a (tenured) Associate Professor where I am also the Director of the GW Center for Aging, Health and Humanities.
Find out more about her work HERE.