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By Sandi McCann
Reviewed April 2019, by Sara Russell, RN

It’s never easy to watch a loved one progress into memory loss or deal with the difficult symptoms and behaviors of dementia or Alzheimer’s. You want to help, but the symptoms often change from day to day and it’s hard to know just what to do to provide comfort.

Yet, there are some care approaches that we teach our professional in-home caregivers in the HomeCare 100 Professional Caregiver Training Program that will help you too, as you care for your loved ones.

When we start by understanding what’s behind the difficult behaviors, then we can find ways to manage them.

Understanding Behavior

Alzheimer’s disease and other dementia-related illnesses can impair a person’s verbal ability making it hard for them to express their needs and feelings. Their behavior, then, becomes a way to communicate anxiety or discomfort, says Megan Carnarius, author of A Deeper Perspective on Alzheimer’s and other Dementias: Practical Tools with Spiritual Insights.  Carnarius is one of the care-industry experts who trains HomeCare of the Rockies’ caregivers in dementia care, one of many sessions in the HomeCare 100.

My sister Maureen McCann and I developed the HomeCare 100 to give caregivers the more advanced skills they wanted to meet the wide-range of complex care needs experienced by many of the seniors we care for throughout Boulder County. The training includes 100 hours of classroom education and hands-on practice where caregivers learn about the aging process, safe transfers and fall prevention, Alzheimer’s care and communication, end of life support, senior nutrition and hydration, and other specialized care topics.

What we know from our training and experience with working with older adults on a daily basis, is that it becomes harder for people with advancing dementia to initiate a conversation or say what they need. Their actions, then, become an important way for them to convey their feelings and needs.

When we can observe and understand what those behaviors are trying to tell us, we can help ease their anxiety, provide comfort, and meet their other needs.

Behavior Triggers

If an older adult feels overwhelmed, frightened or lonely, or the environment is too noisy or boring; if the senior is hungry or in pain, or needing to use the bathroom, then he may communicate those discomforts and frustrations through specific, or even disruptive behaviors.

If you see a disruptive behavior emerging, take a quick assessment of the situation.

Ask yourself these questions:

  • Who is around when the behavior takes place?
  • What triggers the behavior?
  • When do the behaviors appear?
  • Where do the behaviors occur?
  • What need is being expressed? (Bathroom, hunger, fear)

If you’ve noticed your loved one acting restless, for example, or fiddling with his belt or pacing around, you may discover the agitation resolves after a trip to the bathroom.

“A caregiver may notice the older adult doing a certain thing over and over again and the senior may seem almost stuck in the pattern of movement or activity,” Carnarias says. “But once you know how he shows his frustration and you see those signs emerge, you’ll be able to help and distract him with something else to do or focus on.”

Using Positive Distraction

A distraction can be anything that is interesting or pleasant for your loved one. Either meeting their identified need by offering food or taking them to the restroom, or shifting their focus to the weather, a piece of artwork, or a favorite memory, can help change the behavior pattern.

Start by validating whatever emotion they are expressing, offer reassurance, then provide the relief or distraction. For example, if they are expressing fear or anxiety, you could say: “I can tell you are upset but I love you. I remember those family dinners you cooked and can still smell your pot roast. What did you do to make it so tender?”

Here are six other behaviors you’ll probably encounter while caring for your loved one, and some helpful approaches for dealing with them. While dementia symptoms differ from client to client, we see these behaviors routinely while caring for our clients with dementia.

Wandering or Pacing

Is your loved one acting disoriented? Trying to “go home,” though she is already there? Having difficulty locating the bathroom or other familiar spaces, or continuously doing dishes or another household chore without making real progress? Then keep an eye out for emerging wandering or pacing behaviors.

According to the Alzheimer’s Association, 60 percent of those living with Alzheimer’s will wander or pace. It’s unlikely to pose a serious safety risk as long as they are in a controlled environment and not outside of the home.  Wanderers often experience impaired judgment and decision-making skills. If they become lost, they are prone to serious injury.

Helpful Care Strategies

  • Encourage daily activity to help quell evening restlessness.
  • Make sure doors and windows are locked and install devices that signal when a door or window is open. The Alzheimer’s Association recommends placing deadbolts high or low to make it difficult for individuals to wander out.
  • Enroll in a safety system like Safe Return® recommended by the Alzheimer’s Association, or install a GPS monitoring application. Have your loved one wear a medic alert bracelet with identification information and the GPS link if required, so that they can be found and reunited with family if they do become separated.

Rummaging or Pillaging

Many of those with Alzheimer’s will rifle through drawers or shelves, searching, looking, touching and even repeatedly moving items from one place to another or hiding them.

Helpful Care Strategies

  • Have the older adult help you “straighten up” and let him touch and sort items while supervised.
  • Put wallets, purses, watches and other jewelry or keepsakes out of sight or out of reach and lock up toxic items.

Catastrophic Reaction

People living with dementia-related illness and Alzheimer’s can have a hard time managing their moods. Your loved one may cry, become agitated, get angry, overreact to minor situations, and even become violent.

Helpful Care Strategies

  • Remember, these outbursts are symptoms of the disease, not a personal attack.
  • Anticipate possible stressors before they appear so you can offset the intense behavior.
  • Keep the environment calm.
  • Help your loved one eat regular nourishing meals and get plenty of fluids.
  • Stay calm and provide reassurance.

Screaming, Yelling, Calling Out

This kind of communication behavior can be a part of a catastrophic reaction or a self-soothing behavior for seniors who are feeling fearful and out of control. It often emerges when a senior can no longer see or hear well and she feels lonely and confused.

Helpful Care Strategies

  • Distract or divert your loved one’s attention by having him help with tasks he can perform successfully like sorting items, folding towels, or sweeping the floor.
  • Make sure you and your loved one have some quiet, one-on-one time together away from other people and noise.
  • Practice touch massage or help your loved one move or do physical therapy exercises to help them feel more in control and confident in their body.
  • Look for ways to help your loved one feel more connected in control by validating their feelings or having them assist with chores or simple tasks that they can complete successfully.

Repeated Movements

Have you noticed your loved one repeatedly kneading, pulling, wiping, clapping, chewing or exhibiting other repetitive actions throughout the day? That’s another common symptom.

Helpful Care Strategies

  • Try distracting your loved one with something they can safely push or pull apart.
  • Find another activity – like sorting socks, or folding towels – that can be a safe way for them to channel their energy.

Layering Stripping Clothes, Sexual Language

Your loved one may begin dressing or undressing in inappropriate places. A senior may also act with inappropriate sexual gestures, behaviors, and racy language.

Helpful Care Strategies

  • Stay calm.
  • Check the senior’s comfort level and clothing. Removing clothes can be an indication of dry skin, clothes not fitting properly, or tags or buttons that may be scratchy or irritating against the skin.
  • Do not argue, chide, demean if the older adult exposes himself, or uses sexually inappropriate language, gestures, or other behaviors.
  • Distract and divert while moving him to a private space. Then divert with another more positive activity.

No matter how knowledgeable or committed you are to caring for your loved one, we know caring for someone with dementia is never easy – and nobody can do it alone. We have an entire care team to back up our caregivers and our clients for this very reason and we are here to help you too.

Every day I talk to families who are dealing with the challenges of Alzheimer’s and I know these approaches, the ones used by our own trained, care professionals, can help you and your loved ones too.

And, we are here to help too. Give us a call at 720-204-6083. Our caregivers, trained in dementia care, can help your loved one live safely and comfortably at home.

Sandi McCann is the Founder and President of HomeCare of the Rockies, a provider of non-medical caregivers to older adults throughout Boulder County. McCann is also the creator of the HomeCare 100 Professional Caregiver Training Program, an innovative educational strategy that provides advanced training to non-medical caregivers.

Sara Russell, RN, is a registered nurse, senior care specialist, and caregiver educator.

Megan Carnarius, RN, is a registered nurse (RN), a licensed nursing home administrator, licensed massage therapist, a memory care expert and consultant, and a caregiver educator training professional care providers in approaches to dementia care. Her book, A Deeper Perspective on Alzheimer’s, is available through Amazon.

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