Dementia Behaviors: Expert Do’s and Don’ts (2023)

In this Article

01Dementia behavior: Confusion

02Dementia behavior: Aggression

03Dementia behavior: Sleep problems

04Dementia behavior: Wandering

05What are some other typical dementia behaviors?

(Video) Persons with Dementia: Skills for Addressing Challenging Behaviors (V16MIR)

06Remember: Your needs as a caregiver matter too

If this sounds familiar, know that “you are not alone,” says Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi. Behaviors like aggression, confusion, sleep problems, and wandering are common, but they can be managed, Hashmi says.

Read on to learn more about these common dementia behaviors in the elderly and to get Hashmi’s adviceon how best to handle them as a caregiver— foryour sake as much as that ofyour loved one.

Dementia behavior: Confusion

Memory loss and confusion become more common as dementia progresses.

Memory loss can lead to confusion and confusion often manifests as a senior asking the same questions over and over, not recognizing formerly familiar people or places, or becoming disoriented. Caregivers who spend many hours with their loved one may hear phrases and answer questions on repeat: “I want to go home!” “This isn’t my house.” “When are we leaving?” “Why are we here?”

Common causes of confusion

Like many dementia behaviors, confusion can have a number of triggers or root causes. Factors that may contribute to disorientation include the following:

  • Sundown syndromeor delirium.Up to two-thirds of dementia patients experience sundown syndrome, an evening behavioral shift characterized by increased memory loss, agitation, confusion, and anger. “It may not exactly happen at sundown, but there’s always this hour — the witching hour — where suddenly the same person may completely change,” Hashmi says.
  • An unexpected change.Did your senior loved one just move to a new place? Did their routine change?
  • Paranoia and hallucinations.Dementia leads to complex changes in the brain, which can result in delusion. Seniors may see things that aren’t really there, develop false beliefs, or become suspicious of caregivers and loved ones.

Tips for managing your loved one’s confusion

“Simplification is key here,” Hashmi says. To help minimize confusion, he suggests several ways to simplify both the home environment and your interactions:

Provide structure.

  • Keep familiar objects around to help reorient your loved one.
  • Label drawers and cabinets. This is especially helpful if confusion about where to find things is a common trigger.
  • Use tools such as alarms, calendars, and to-do lists to help them remember tasks.

Deliberately use simple, short sentences and ask yes/no questions.

  • Normalize their experience. Say, “You’re confused. It’s okay. We’ll figure it out together.”
  • Lead with what you think might be happening. For example: “It seems like you’re looking for something.”
  • It’s often much easier for your loved one to answer yes or no questions, instead of coming up with the words themselves. “Are you looking for your keys? Are you looking for your glasses?”

Lastly, Hashmi says, it helps if you can learn to accept the confusion. In the moment, he says, whatever your loved one thinks is real is in fact their reality. For example, they might think they’re at work when they’re really at home. If that belief isn’t hurting them or anyone else, it’s OK for you to play along a little bit. Confronting or trying to change the belief often leads to agitation and aggression.

“For us as caregivers, we have to be OK with that confusion,” Hashmi says.

Dementia behavior: Aggression

Verbal threats and physical aggression can be among the more serious of the dementia behaviors. These verbal or physical outbursts may occur seemingly out of nowhere. They tend to happen in the latter stage of dementia, when patients can’t communicate their needs.

One study found that more than a third of caregivers reported abuse from a patient in the three months prior.

“I hear very palpably how upsetting that is, how distraught they feel,” Hashmi says of caregivers. “They are trying to make sense of it — ‘Why me? I’m the one who’s here for you? Why are you angry at me? I’m trying to help.’”

Common causes of aggression

Aggression can stem from:

  • Confusion.When a senior is feeling disoriented and scared, they may act out with aggression.
  • Physical pain or another unmet need.When a senior can’t verbalize or address needs such as hunger, thirst, or pain, it’s common for frustration to build, Hashmi says.
  • Emotional pain.Sometimes, agitation can be a sign that someone with dementia feelslonely, depressed, or isolated.
  • Discomfort with a specific task.Does aggression come out specifically at bath time, bedtime, or while your loved one is getting dressed? These tasks may be triggers for aggressive behavior.
  • Reactions to medications.Has your loved one recently changed medications? Do they experience difficulties withmedication management? This might be interfering with their dementia diagnosis, leading to aggression.
  • Vision or hearing loss.Issues with vision or hearing can compound the typical disorientation of dementiaand can cause seniors to act out in confusion or as a cry for help.
  • Sundown syndrome.Does your loved one become aggressive around sunset in particular?
  • Fear.People often are confrontational when approached or touched by someone they don’t know. For seniors with dementia, who may not recognize caregivers, doctors, and community residents, many daily interactions can alert a “fight or flight” response.

Tips for handling a senior’s aggression

Most importantly, try not to take the aggressive behavior personally, Hashmi says.

(Video) Do’s and Don’ts for Discussing Dementia — Caregiver Webinar

“The classic line I always use is that this is the disease talking. It is not the person,” Hashmi says. “There is a lack of awareness in that moment. It’s not your mom or dad or spouse saying that. It’s the disease.”

When you are faced with a loved one’s aggression, Hashmi suggests employing these 4 Rs:

  1. Reassure.It can be difficult to do in the moment, but start by reassuring your loved one. For example, Hashmi suggests you might say something like, “I’m here for you. I’m still here for you. It’s OK.”
  2. Reorient.If they are disoriented, reorient them to their environment and with a familiar object. Say, “Look, we’re at home. Here’s a picture we have.”
  3. Redirect.Redirect your senior toward a familiar object, anything that gives them joy and comfort. “It may be family photos, it may be a keepsake, it may be something that has great meaning and value to them,” Hashmi says. “It helps redirect and also helps reorient them.”
  4. Reminisce.Help them connect to a long-term memory. E.g., “Remember when Joe was born?”

When they’re feeling calmer, Hashmi says, you can try asking yes/no questions to help determine whether an unmet need is causing the behavior. Ask: Are you hungry? Are you thirsty? Are you in pain?Are you tired?

Dementia behavior: Sleep problems

While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.

Common sleep issues may include:

(Video) How to Talk to Someone With Dementia

  • Difficulty getting and staying asleep
  • Agitation and restlessness when trying to sleep
  • Thinking it’s daytime when it’s night, going as far as getting up, getting dressed and wanting to start the day, Hashmi says

Sleep disturbances are hard on patients and caregivers alike, Hashmi says. “It’s physically and mentally exhausting to be up night after night.”

Common causes of sleep problems in dementia patients

Troubled sleep is thought to be a dementia risk factor as well as a behavioral symptom. Here are some factors that may contribute to your loved one’s sleep problems:

  • Brain changes.Dementia patients have steeper changes in their brain’s sleep architecture and theircircadian rhythms, causing sleep disturbances.
  • Over-the-counter medications.Some over-the-counter medications labeled “PM” can disrupt sleep by making patients sleep for a bit but then making them more confused or sleepy at the wrong time, Hashmi says.
  • Diet.Caffeine, excess sugar (especially before bed), and alcohol can disrupt sleep patterns, Hashmi says.
  • Electronic screens.The blue lightfrom acomputer, portable electronic devices, and television screens can delay sleep and disturb sleep patterns, Hashmi says.

Tips to help manage dementia sleep problems

There are ways to help your loved on get a better night’s sleep, Hashmi says.

Avoid things that disrupt sleep.

  • Limit caffeine, alcohol, and sugar near bedtime.
  • Avoid over-the-counter sleep aids. Instead, Hashmi suggests you talk to a doctor about whether melatonin might help your loved one sleep.
  • Remove electronics from the bedroom.

Create a routine that supports sleep.

  • Make sure your loved one gets enough daytime light to help with circadian rhythms.
  • Change into comfortable clothing, signaling nighttime.
  • Consider warm milk, a hot shower, relaxing music or reading before bed.
  • Pick a bedtime — not too late — and stick with it every night.

Dementia behavior: Wandering

Sixty percent of people who have dementia will wander. As their memory declines, they might leave a confusing situation or suddenly try to find someone and become disoriented and lost.

Suchwanderingcan be dangerous, even life-threatening, yet caregivers often feel guilty for putting in place measures that will keep their loved one safe.The classic quandary that caregivers express is: “I don’t want my mom or dad or spouse to be a prisoner in their own home, and yet this is what I feel I’m doing,” Hashmi says.

Tips for managing dementia wandering

The No. 1 priority is to keep your loved one safe, Hashmi says. He suggests the following actions:

  • Secure all doors.Be especially vigilant about doors that lead outside.
  • Use technology.Tracking devices and surveillance systems are widely available and affordable.
  • Enlista team.Neighborhood watch groups and local police are often happy to help keep an eye out for your loved one.

What are some other typical dementia behaviors?

In addition to aggression, confusion, sleep problems and wandering, symptoms of dementia can also include delusions, hallucinations, paranoia, depression, apathy and sexual inappropriateness. And, behavioral dementia symptoms tend to occur more frequently as the dementia progresses.

Up to 90% of patients have one or more of these symptoms during the course of their disease,studies show. It is important to discuss all dementia symptoms with your loved one’s physician to rule out or treat any medical conditions that could be causing the behavior.

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Dealing with dementia behaviors can quickly wear out a caregiver or family member,causingcaregiver burnout.

If your loved one’s dementia behaviors have progressed to the point where you cannot manage them alone, help is available. Senior care options like home care or memory care can help relieve some of the caregiving burden while also helping to keep your loved one safe.

If you are feeling resentment, anxiety, or depression, seek help. Acaregiver support group, counselor, friend, or family member can offer camaraderie and advice.

“Other families, other caregivers, are going through the same thing,” Hashmi says. “They have a lot of common challenges and common solutions to share. And often those are the most effective, because they’re going through exactly the same process.”

A Place for Mom and Cleveland Clinic: Supporting seniors and their families

This article was developed in conversation withArdeshir Hashmi, MD, section chief of theCleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.

Sources

Alzheimer’s Association.“Dementia-related behaviors.”

American Psychological Association.“Living Well With Dementia.”

Johns Hopkins Medicine.“Facing Dementia in the Family.”

National Institute on Aging.“Alzheimer’s and Hallucinations, Delusions, and Paranoia.”

UpToDate.“Management of neuropsychiatric symptoms of dementia”

UpToDate.“Sleep-wake disturbances and sleep disorders in patients with dementia”

UpToDate.“Recognition and management of behavioral disturbances in dementia”

UpToDate.“Safety and societal issues related to dementia”

FAQs

What are the three behavioral problems associated with dementia? ›

Behavioral disturbances in dementia are often globally described as “agitation” including verbal and physical aggression, wandering, and hoarding. These symptoms create patient and caregiver distress, and lead to nursing home placement.

What should a dementia patient not do? ›

I'm going to discuss five of the most basic ones here: 1) Don't tell them they are wrong about something, 2) Don't argue with them, 3) Don't ask if they remember something, 4) Don't remind them that their spouse, parent or other loved one is dead, and 5) Don't bring up topics that may upset them.

What is the best way to manage behaviors associated with dementia? ›

Person-centred care and communication, sensory stimulation and listening to music are three evidence-based therapies that can help reduce agitation and other challenging behaviours for people with dementia. Given that antipsychotic drugs have many side effects, effective non-drug strategies should be considered first.

What are 5 challenging Behaviours? ›

Examples of challenging behaviour include: Withdrawn behaviours such as shyness, rocking, staring, anxiety, school phobia, truancy, social isolation or hand flapping. Disruptive behaviours such as being out-of-seat, calling out in class, tantrums, swearing, screaming or refusing to follow instructions.

What are the most common Behavioural changes seen in dementia? ›

Behavioral symptoms like moodiness, apathy, changes in personality, unsocial behaviors and language difficulty can be part of the disease. Behavior and personality often change with dementia.

What are the two most common psychotic features in dementia? ›

Symptoms. As the term might suggest, people with dementia-related psychosis have the decline in thinking and problem-solving skills of dementia, as well as delusions or hallucinations of psychosis. (Delusions are more common.)

What are 3 types of behavior triggers? ›

Here, I'll discuss three types of trigger: external, internal, and synthetic. These each have different strengths and weaknesses, and each can be used to design great behaviors that form lasting habits.

What triggers challenging Behaviour in dementia? ›

Their behaviour may be a direct result of changes in their brain, or be caused by a general health problem, such as pain from an infection. These behaviours can also reflect problems related to the care the person is receiving, or their general environment or social interactions.

What is the most important thing in caring for dementia patients? ›

Allow the person with dementia to do as much as possible with the least amount of assistance. For example, he or she might be able to set the table with the help of visual cues or dress independently if you lay out clothes in the order they go on. Provide choices. Provide some, but not too many, choices every day.

What can calm a dementia patient? ›

To prevent or reduce agitation:
  1. Create a calm environment. Remove stressors. ...
  2. Avoid environmental triggers. Noise, glare and background distraction (such as having the television on) can act as triggers.
  3. Monitor personal comfort. ...
  4. Simplify tasks and routines.
  5. Provide an opportunity for exercise.

How do you make a dementia patient happy? ›

Do something personal.
  1. Give the person a hand massage with lotion.
  2. Brush his or her hair.
  3. Give the person a manicure.
  4. Take photos of the person and make a collage.
  5. Encourage the person to talk more about subjects they enjoy.
  6. Make a family tree posterboard.

What are the 5 R's of managing behavior? ›

The 5 R's: Refuse, Reduce, Reuse, Repurpose, Recycle.

How do you handle a patient with dementia who is having behavioral problems? ›

Immediately redirect pacing or restless behavior into productive activity or exercise. Reassure the person if they appear disoriented. Distract the person with another activity at the time of day when wandering most often occurs. Reduce noise levels and confusion.

What are 5 strategies you should use to communicate with people with dementia? ›

Tips for successful communication:
  • Engage the person in one-on-one conversation in a quiet space that has minimal distractions.
  • Speak slowly and clearly.
  • Maintain eye contact. ...
  • Give the person plenty of time to respond so he or she can think about what to say.
  • Be patient and offer reassurance. ...
  • Ask one question at a time.

What are the 7 principles in dealing with difficult behaviours? ›

These seven principles are described in this chapter: (1) goals of correction pro- cedures; (2) the role of teacher attention in correction procedures; (3) the nature of behavioral intensity, escalation, and defusion; (4) the nature of behavioral chains; (5) the role of behavioral extinction and extinction bursts; (6) ...

What are 3 things you can do to prevent a challenging behavior from occurring? ›

How to Prevent Challenging Behaviors
  1. Use words, hugs and kisses to recognize positive behaviors.
  2. Remove from your child's reach things that are not for children or are dangerous.
  3. Always have toys and fun things at home, in the car, in your bag and when you travel.

What are the four main roots of challenging behavior? ›

The 5 Root Causes of Challenging Behavior
  • Communication and Language. ...
  • Attention and Working Memory. ...
  • Emotion- and Self-regulation. ...
  • Cognitive Flexibility. ...
  • Social Thinking. ...
  • The Good News.
1 Dec 2018

What type of dementia causes manipulative behavior? ›

People with behavioral variant frontotemporal dementia (bvFTD) often have trouble controlling their behavior. They may say inappropriate things or ignore other peoples' feelings. bvFTD may affect how a person deals with everyday situations.

How do you handle unusual behaviour? ›

Distract the person with calming activities such as a hand massage, stroking a pet, a drive in the country or by playing their favourite music. Try to make sure that you have support for yourself and breaks when you need them. Some people find unusual behaviours, particularly a repetitive behaviour, very irritating.

Is lying part of dementia? ›

It's true that in the early stages of the disease, people with dementia might fib to cover for memory loss. But most examples of “lying” are dementia symptoms rather than intentional deception. “They're more like an unconscious defense mechanism,” says Kallmyer.

What stage of dementia is suspicion? ›

Suspicions and delusions — firmly held beliefs in things that are not real — may occur in middle- to late-stage Alzheimer's.

What is the most common type of hallucination for a person with dementia? ›

Visual hallucinations (seeing things that aren't there) are the most common type experienced by people with dementia. They can be simple (for example, seeing flashing lights) or complex (for example, seeing animals, people or strange situations).

Does sugar worsen dementia? ›

Well, the chilling answer is YES. According to research, an unhealthy diet makes a senior like you vulnerable to the cognitive impairment brought by dementia. In fact, a well-established study about diet implicates sugar as the major culprit in increasing your risk to develop the disease.

Why do dementia patients fixated on things? ›

Repetitive behavior is usually a sign of insecurity, since people with dementia are often looking for something comfortable and familiar - something over which they have some degree of control.

Why do people with dementia get mean? ›

Dementia patients who are mean and aggressive are most likely feeling fear, anger and embarrassment because they have been asked to use skills that they no longer have. When they fail, they may lash out at us.

How do you calm an agitated dementia patient? ›

Keep well-loved objects and photographs around the house to help the person feel more secure. Try gentle touching, soothing music, reading, or walks. Reduce noise, clutter, or the number of people in the room. Try to distract the person with a favorite snack, object, or activity.

How do you respond to dementia behavior? ›

Ten Tips for Communicating with a Person with Dementia
  1. Set a positive mood for interaction. ...
  2. Get the person's attention. ...
  3. State your message clearly. ...
  4. Ask simple, answerable questions. ...
  5. Listen with your ears, eyes, and heart. ...
  6. Break down activities into a series of steps. ...
  7. When the going gets tough, distract and redirect.

What are 2 proven methods of care for those with dementia? ›

Pharmacological and Non-Pharmacological Interventions. Interventions used in the care treatment and support of people with dementia can be both pharmacological (drugs) and non-pharmacological. The latter include both environmental and behavioural modification.

What is one of the most important things to consider in advanced dementia? ›

The most important thing to remember is that people with advanced dementia are people first. There is no doubt that they have either already lost or are in the process of losing the ability to do many things, such as to walk, to remember and so on.

How do you redirect an angry dementia patient? ›

5 Ways to Redirect Dementia-Related Behaviors
  1. Buy a few seconds to think. Is your loved one combative about bathing or something else? ...
  2. Watch nonverbal cues. Use gentle touch, eye contact, and a calm demeanor. ...
  3. Be creative in your verbal responses. ...
  4. Focus on what really matters. ...
  5. Don't try to correct your loved one.

Why are dementia patients afraid to be alone? ›

This typically happens when dementia causes changes in the brain that make it harder to recognize their caregivers or family, process what is happening around them, feel unsafe in their own home, and not being able to remember what they may have just done.

Should dementia patients watch TV? ›

For men and women with Alzheimer's disease or other forms of dementia, it can be especially beneficial. Watching movies and TV shows can help keep their brain active, which can stimulate positive memories, improve mood, and even increase socialization.

How often should you visit someone with dementia? ›

The person with dementia usually doesn't remember if you have been there for five minutes or five hours. Ultimately it's better to visit three times per week for 20 minutes than once a week for an hour.

What do dementia patients think about? ›

People with dementia think about the same things that any human thinks about — emotions, relationships, daily life, tasks to accomplish, and more. Receiving a life-changing diagnosis of dementia does not strip a person of their humanity and personhood.

What are the 3 R's in dementia? ›

Reassure: Remind your loved one that s/he is safe and cared for. Remove: Remove yourself physically or distance yourself psychologically for a moment to regain your composure. Return: Return fully to the situation when your loved one begins to calm down.

What are the three R's of dementia? ›

The 3 R's are the principles that the project is based on: Rights, Respect and Responsibilities. The 3 R's Project can assist individuals with social care support needs and third sector organisations which support individuals accessing self-directed support.

What actions can a person with dementia not do? ›

People with dementia often show unusual difficulty performing mental tasks. For instance, planning tasks, making decisions, or organising projects become more and more difficult. They also lose the ability to make simple monetary transactions such as paying a bill. Misplacing belongings.

What types of questions should you avoid when talking to someone with dementia? ›

Avoid asking too many open-ended questions, as it could be stressful for a person with dementia if they can't remember the answer. While it might seem polite to ask somebody about their day, it's better to focus on what's happening in the present.

What is the best way to talk to someone with dementia? ›

What you can do to help
  1. Be patient. Take time to listen and allow time for the person with dementia to talk without interruption.
  2. Learn to interpret. Try to understand what is being said based on the context. ...
  3. Be connected. ...
  4. Be aware of your nonverbal cues. ...
  5. Offer comfort. ...
  6. Show respect. ...
  7. Avoid distractions. ...
  8. Keep it simple.

How do professionals support people with dementia? ›

Social care professionals can help you with personal social care and non-medical support. This could include an assessment by a social worker to provide help and support at home with dressing or bathing, social activities, day care or respite.

Videos

1. Caregiver Training: Refusal to Bathe | UCLA Alzheimer's and Dementia Care
(UCLA Health)
2. The Do's and Don'ts of Visiting a Loved One with Dementia
(All Home Care Matters)
3. An expert guide to frontotemporal dementia - Online interview
(Top Doctors UK)
4. Aggressive Behavior in People with Dementia | Linda Ercoli, PhD | UCLAMDChat
(UCLA Health)
5. Reduce Aggressive Behavior Without Trauma
(ComForCare & At Your Side Home Care)
6. Preventing and De-Escalating Responsive Behaviours in Long Term Care
(RGP - Regional Geriatric Program of Toronto)
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