When a loved one has dementia, managing their changing behaviors can be very challenging. In the early stages, common behaviors such as repeating a story or asking the same question several times may be annoying, but they aren’t harmful. However, as the disease progresses, behaviors can become dangerous. Behavior becomes a problem if it violates the rights of others; poses a threat to safety for themselves or others; or makes it difficult to provide care for them.

There are three levels of behavior—common, challenging, and potentially harmful

1. Common behaviors

Repetitive behaviors can be either verbal (repeats the same story, statement, or question over and over again) or physical (rummaging, rubbing hands, tapping, banging).

What can you do?

  • Distract them by changing the subject and redirecting the conversation.
  • Get them involved in a physical task such as a simple craft or household chore.
  • Respond to the emotion. Rather than reacting to what they are doing, respond to how they are feeling.
  • Use memory aids such as writing notes and reminders.
  • Respond with a brief explanation. Offer corrections as suggestions; don’t scold.
  • Don’t argue with their reality; it will probably only upset them. A helpful technique for handling confusion and memory loss is called “therapeutic fibbing.” For example, if they ask where their mother is (who passed away many years ago), you may want to say that that she is out right now. Reminding your loved one that their mother died many years ago may actually shock them and cause them to become very emotional. Afterwards, they will likely forget they asked.

Wandering can be dangerous, particularly if they want to get out of the house and it is not safe for them to do so, or if they are trying to get away from you or something else. 

What can you do?

  • Monitor their whereabouts so you know where they are at all times.
  • Make the home safe by installing deadbolt or slide-bolt locks on exterior doors and limiting access to potentially dangerous areas.
  • Make sure family, friends, and neighbors know that your loved one has dementia and wandering may occur.
  • Distract them with activity to reduce their anxiety and restlessness.
  • Have an action plan in case they wander away.
2. Challenging behaviors

Outbursts, yelling, and screaming often occur suddenly, with no apparent reason or can result from a frustrating situation.

What can you do?

  • Stay calm.
  • Assess the danger level.
  • Gently soothe and redirect to a relaxing activity.
  • Try to identify the cause and eliminate the triggers if possible.
  • Check them for pain or other health issue.
  • Take a break to give yourself a moment if it is safe to do so.

Hallucinations (seeing, feeling, hearing, smelling, or tasting things that cannot be verified by anyone else) and paranoia (unrealistic blaming belief or unreasonable suspicion) occur because the disease may cause them to perceive things in new and unusual ways.

What can you do?

  • Don’t argue.
  • Offer reassurance that they are safe.
  • Redirect to another topic.
  • Change the environment if possible.
3. Potentially harmful behaviors

Hitting, biting, and throwing things are just a few of the behaviors of a harmful or catastrophic reaction. A catastrophic reaction is an extreme emotional response that is out of proportion to the actual event and usually cannot be explained (eg, you say good morning, they throw something at you)

What can you do?

  • Remain calm.
  • Gently soothe or redirect them to another activity.
  • Allow them to express their feelings while maintaining safety for both of you.
  • Assess the event that caused the extreme reaction and try to avoid it in the future. Look out for:
    • Actions that frighten, annoy, threaten, or cause them pain
    • A physical environment that is uncomfortable, noisy, threatening, has too much or too little going on
    • Signs of increased confusion
    • Unmet physical or emotional needs (eg, too hot or too cold, hungry or thirsty)
    • Emotional responses to triggers such as an anniversary, a smell, a song, and others

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