Agitation - people with dementia frequently become restless, anxious, or upset.
Agitation – people with dementia frequently become restless, anxious, or upset. It can be helpful to listen to the person as they express their frustration as you may get a clue about what is upsetting them e.g. pain, discomfort, being too hot, too cold, hungry, needing to use the toilet. Frustration and overstimulation are all common triggers of agitation. Reassure the person that you are there to provide assistance and comfort. Quite often changing the subject or redirecting them to an enjoyable activity can help.
Aggression – Aggressive behaviour amongst people with dementia can happen suddenly and without warning. Try to find out what triggered the aggression so that steps can be taken to avoid the stimulus that triggered the situation. React in a calm way and reduce environmental distractions, such as loud noises or potentially frightening shadows or movements. Again, redirecting an aggressive person to an enjoyable activity or simply changing the subject, can be remarkably effective.
Repetition – People with dementia often repeat a word, question, or action over and over again (e.g., saying “What are we doing today?” repeatedly). This behaviour is usually harmless, but it can be unnerving and annoying for those who are caring for the person. Repetitive behaviour is usually a sign of some form of emotional stress, since people with dementia are often looking for something comfortable and familiar – something over which they have some degree of control. To address repetition, try to find a reason for the repetition as well as for the emotion behind it. This can reduce your chances of responding impatiently with the person. If the repetition is an action, try turning it into an activity that makes the person feel useful. For example, if the person is constantly fidgeting with their hands, try them giving them some socks to sort out.
Hallucinations – The most common hallucinations are visual i.e., seeing something that is not really there and auditory i.e., hearing something that is not really there but hallucinations can also occur in regard to taste, smell, and touch. Hallucinations are real to those with dementia, so do not try to convince the person that they are imagining things as you may make the situation worse. Instead, reassure the person that you are there to help and redirect them to a pleasant activity. Also consider whether the hallucination is problematic. If it is a “nice” hallucination, e.g., seeing a pretty orchard outside that is not really there, there may be no benefit in trying to discourage the behaviour.
Suspicion – Memory loss and disorientation can cause individuals with dementia to perceive situations inaccurately. They may become suspicious of others – even those close to them – and accuse them of theft, infidelity, or other offenses. Although hurtful, try not to be offended or take it personally, remember their behaviour is caused by the dementia. Do not argue with the person or try to convince them of your innocence. Instead, say, “I see that you’re upset that your purse is missing; I’ll do my best to find it for you,” and avoid giving complicated explanations. Redirection to another activity can also be effective in these situations. Another option is to store “back-ups” of commonly misplaced items (e.g., hats, wallets).
Apathy – Apathy is a lack of interest in or motivation to engage in activities. It is not healthy for someone with dementia to sit around passively. Try to find out what may be triggering the apathy (e.g., being ignored or becoming overwhelmed with a task. It is important to the person moving and as active as possible in order to maintain physical health and to prevent depression. Try simplifying activities they used to enjoy doing so they can participate at a level that is comfortable and not overwhelming. Even a small amount of activity is better than none at all.
Confusion – Dementia often causes confusion about people, places, and time. The person may still know who he or she is, but may not recognize others and/or the current location, time, date, or year. An individual with dementia may also become confused by everyday objects like knives and forks or pens. As frustrating as this can be for caregivers, the best way to respond is to stay calm and provide simple, clear, positive answers when the person asks for help. For example, if the person seems confused about the purpose of a spoon, simply say, “Here’s your spoon for eating your soup.” You could also calmly show the person how to use the utensil (e.g., by saying “watch me”). Never reprimand the person or talk to them in a belittling way for becoming confused.
Sundowning – Sundowning is a term used to describe behaviours that intensify (e.g. confusion and agitation) in the late afternoon and early evening, and is most common with Alzheimer’s disease. There are several theories about why sundowning occurs, such as increased fatigue or increasing confusion due to darkness and shadows. The best way to approach sundowning is to make late afternoons and evenings as simple and relaxing as possible. Reduce distractions and keep rooms well-lit until bedtime.
Wandering – wandering may be goal-directed e.g., the person thinks they are going to a job or going “home” to a childhood residence, or non-goal-directed i.e., the person wanders aimlessly. To reduce the frequency of wandering, make sure the person has plenty of supervised activity to channel their energy. People with dementia may also wander because of emotional stress or physical discomfort. Try to find out what may be triggering this behaviour by ascertaining person if the person is upset, worried or in pain.