Tips for Dealing with Specific Dementia Problematic Behaviors Continued

Rudolph C. Hatfield, PhD., edited by Kathryn Patricelli, MA

Repetition

Someone with dementia may repeat a word or activity over and over even after it has been finished. Often, they are simply trying to maintain a feeling of familiarity and security because of their cognitive issues. The main cause of repetition in people with dementia is the brain damage that occurs because of the nature of the disease. However, certain things in the environment may also lead to repetition. Understand that repetition may be the way that the person is expressing a need to cope, ease their anxiety or frustration, or ask for help. Repetition is often more annoying to caregivers than it is potentially harmful to anyone. It is important to check your own motivation for wanting to deal with repetition and how you deal with it.

Some tips to deal with repetition are:

Try and find the cause of the repetition. Is it limited to a certain place or situation?
Trying to focus on what the person is feeling as opposed to what they are repeating. Try and understand how the person feels:

if they are anxious, try to reduce their anxiety,
if they are depressed, try and deal with their depression,
if they are confused, try and deal with their confusion.

Get the person engaged in some activity. Using constructive distraction is often the best way to deal with many repetitive behaviors.
The use of memory aids may cut down on repetition in individuals with dementia.
Work with the person. Provide answers to the person's questions if they are repeating questions, have them repeat the answers, and then repeat answers with them.
Be patient and stay calm. Trying to use logic, chastising a person with dementia, etc. are not constructive strategies for people with cognitive impairment that is primarily fueled by memory loss and progressive brain damage. These people often mirror the impression that they get from their caregivers. Stay calm, be understanding, and work with the person.

Hallucinations and Delusions

Psychotic experiences such as hallucinations (seeing or hearing things that are not there) or delusions of the paranoid nature (extreme suspiciousness, acting as if people are out to get them, etc.) often represent the progressive nature of many different types of dementias. The most common forms of hallucinations are visual and auditory hallucinations. However, people can hallucinate in any of their senses including smelling things that are not there, feeling things that are not there, etc.

Delusions are very strong beliefs that are not true and may often be illogical, but the person strongly believes them. The most common forms of delusions are paranoid delusions as explained above. However, other types of delusions also exist such as thinking that someone is in love with them, that one is communicating with aliens, that one is royalty, etc.

Hallucinations and delusions are very commonly treated with medications, especially in people that have dementia. Caregivers can also help medical personnel to understand the cause of these issues. Some of the things to look for include:

Is the appearance of hallucinations and/or delusions sudden? This may represent a reaction to a new medication or a combination of medications, an infection (for example, urinary tract infection), getting too many medications or too much of a medication, not getting enough of the medication (for example, a thyroid medication), and many other factors that can be corrected. A thorough medical evaluation should be the first step in trying to deal with the appearance of hallucinations and/or delusions.
Check for problems with a person's hearing or vision as these often lead to suspiciousness and even hallucinations. One of the most common causes of suspiciousness in elderly people with dementia is hearing loss.
Determine the nature of the hallucination of delusion. If it is harmless, simply tolerate it and work with the person until a medical evaluation can be performed and a medical intervention can be used. Check your reaction.

Some suggestions for caregivers include:

Assuring the person in a calm and supportive manner that you understand that they may be seeing things that are frightening for them and you are there to help them.
Changing the environment may lessen the impact of hallucinations. Taking a walk, going to a room with better lighting, getting the person to concentrate on music or conversation, engaging the person in activity, etc. may be helpful.
Check the environment for noise, lighting that produces shadows that may appear to be moving, removing mirrors, etc.
A person who is very suspicious or even paranoid will not respond to logic. Do not logically try to explain things to them. Be reassuring, listen to them, and try to understand things from their point of view.
Offer simple answers and be supportive. Again, distraction can often be helpful by getting the person to help you with a chore, changing the environment, etc.
Limit the use of caffeine, tea, sugar, etc.
If the person is complaining about things being stolen from them make sure that the so-called missing objects are in full view of the person. In some cases, duplicating items such as having two of the same wallet, sunglasses, etc. can be useful.

Apathy

Apathy occurs when a person is not interested in doing things, lacks motivation, and may even be the result of depression. Like most of the other problematic behaviors that occur with dementia, it may represent the progression of the disease or may be related to some other issue. In some higher functioning people, it may represent the person simply giving up. Some of the signs of apathy include:

The person no longer appears motivated or has the energy to do everyday activities including maintaining their self-care such as bathing, brushing their teeth, etc.
A lack of concern about their problems.
Being totally unemotional.
Relying on others to do things for them when they used to do them themselves.

By definition, the person with apathy is not concerned about the way they are acting. This can result in frustration for caregivers. However, make sure you check your motivations before attempting to deal with these types of behaviors and others. Understand that many times people with dementia simply reflect the attitudes that others give to them. Dealing with apathy can include:

A medical evaluation to determine if there any changes in the person's metabolism or medications that may be contributing to apathy. This would include checking to see if the person has developed depression.
Setting up a routine with the person begins with tasks that they find enjoyable can help motivate them to do other tasks.
Breaking down tasks that have multiple steps in them into shorter easier to complete tasks is often very helpful.
Staying with the person and instructing the person will help motivate them.
Do not criticize people, but instead reassure them and keep them calm.
Check your reactions. If you show the person that you are frustrated or angry this may just make the whole situation worse.

Confusion, Wandering, and Sundowning

The majority of people with moderate to severe dementia become very confused. As dementia progresses many people often wander because of confusion. Sundowning occurs when the person's confusion (and other behaviors such as agitation, hallucinations, etc.) often becomes significantly worse in the latter part of the day. All of these behaviors may just be a result of the progression of the dementia, or may be the result of factors that can be changed to some extent. It is important to expect some level of confusion, anticipate wandering, and if an individual begins to experience sundowning, try and determine if there is a cause that can be changed this behavior. As always, caregivers should check their own behaviors and motivations and see of these behaviors are contributing to whatever issue is being experienced. To deal with these behaviors caregivers can:

Maintain a structured routine that is the same every day.
Provide reassurance to a person who is confused or feels lost.
Reduce stimulation in environments where there is a lot of noise, many people doing different things, etc.
Make sure that the person's needs are met. Make sure that the person is not hungry, thirsty, tired, needs to use the bathroom, uncomfortable, etc.
Limit the use of caffeine or remove caffeine from the person's diet altogether.
Keep environments supervised, simple, and escape proof.

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