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Caregiver tips to address challenging behaviours from those suffering with Dementia

May 20th, 2014

Guest Post written by, Trish Felgar, Alzheimer’s Specialist

Throughout the last 15yrs working in the field of geriatrics, I have received countless inquiries from families having difficulty managing loved ones with memory loss. Specifically, families are overwhelmed with the aggression related to dementia and/or Alzheimer’s disease afflicting their parents or spouse. Families recount stories of parents yelling, screaming and punching. The family member is exhausted and tired and does not know how to manage these outbursts. Family members feel guilty, some feel sad and others want to give up. These ranges of emotions are all justified and it is important to have the knowledge and tools needed to help manage the change in behavior associated with dementia and Alzheimer’s. Keep in mind, some days are going to be better than others but if you are equipped with the information you are one step ahead of the game.

1. Patience/Flexibility:
Patience is the key to managing the behaviors associated with memory loss. Yes, I know this is a lot easier said than done. How do you keep your patience when your parent is yelling at you because they want breakfast and in reality they just finished it 15 minutes ago??

Take a deep breath and do not personalize the behavior. Understand that the behavior is a symptom of their memory loss.

If you need, remove yourself from their presence for a period of 10-15minutes. Once the 10-15minutes are done, reintroduce yourself to the situation and you will be in a better position to assess it. During that 10-15minutes break your loved one may have calmed down and if not, the 10-15 minutes break gave you a chance to regroup and not react to their verbal aggression.

You need to know your own personal limitations and reach out for support when needed.

We tend to have a routine for everything. However, sometimes we have to be willing to set aside our plans and be more reactive than pro-active. If your loved one is not in a good mood, it is best to read their cues, and plan accordingly.

2. Medical Evaluation:
It is important to seek the advice of your loved one’s doctor, geriatric specialist and/or neurologist to get an evaluation and proper assessment of their condition. A thorough medical evaluation can rule out any reversible conditions that may be causing the aggression and/or changes in one’s moods.

There is no cure for Alzheimer Disease but there are medications that can help assist in managing the symptoms associated with the disease. Medications can assist with anxiety, depression, hallucinations, and paranoia and an array of other behaviors. I am not a supporter of overmedicating the individual, however; there are many options available to help control aggression.

3. Keep a Journal:
There may be a pattern to their verbal and physical aggression. It is best to keep a journal throughout the week and review your notes every couple of days. Without realizing it, you may see that your loved one’s reactions are related to a specific activity and/or environment of which you are not aware. It allows you to change and/or adapt your approach, hopefully resulting in a more positive atmosphere for both you and your loved one.

As well, a journal is a useful tool to have at medical appointments to use as a reference.

4. Triggers:
There are several triggers that may cause someone to be aggressive. Pay attention, because a sudden change in one’s mood can be caused by any one of several triggers including:
• Change in the caregiver
• Change in the environment and/or living situation
• Hospitalization
• Change in the routine
• Activities of Daily Living-bathing, showering, dressing
• Noise and/or distraction
• Personal comfort: pain, hunger, constipation,
• Bladder infection, cold, fever, infection (seek medical follow up)
• Fearful or tired
• Time of day

It is really important for you to have a clear understanding of your loved one’s past and present medical and personal file. Their past can be a factor in how you approach your loved one and assist with their day to day needs.

5. Validate:
It is extremely important for you to validate your loved one’s feelings. To argue back, react to their behavior or try to orient them to reality will only further their aggression. Throughout the years, I have seen many family members reprimanding their loved one for the aggression, this may make you feel better but will only lead to a negative outcome. You will never win an argument with someone who has memory loss.

6. Reassure
It is extremely important to reassure the individual when they are confused and/or anxious. Non-verbal cues are extremely useful. Sit with your loved one in a quiet room with very little distraction, and reassure them that they are in a safe and secure environment. At certain times of the day they can be fearful and feel scared. Unfortunately, they have difficulties communicating this message. Be aware of their cues as you can intervene and offer them the comfort they are searching for.

One thing we mustn’t forget is that the individual displaying the aggression is not always aware of their actions. They have been diagnosed with a disease that, depending on the stage, is very scary for them. Without realizing it, they have a tendency to take out their anger on the one closest to them. Remember that they didn’t choose to have this disease and they will need your hand to help them walk through this maze.

Trisha Felgar
Alzheimer Support

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