Coping with Challenging Behaviors

It is important to know that someone with Alzheimer’s or related dementias can exhibit new and often challenging behaviors. As symptoms progress, control of certain functions such as perception begins to change. Information that was once readily perceived, interpreted, understood and acted upon may become unreliable.

Alzheimer's causes changes in the brain, leading to challenging behaviors.

People with Alzheimer’s and related dementias have a lower threshold to stress and stimulation, may be experiencing an altered state of reality and could show signs of aggression, paranoia, hallucinations, irritability or anxiety. Maintaining structure, consistency and daily routines is vital, as it allows for feelings of fulfillment and success when navigating day-to-day. The first line of defense in managing challenging behaviors is the non-pharmacological or behavioral approach.

Here are some tips to help you or a loved one cope with the challenging behaviors brought on by Alzheimer’s disease or related dementias:

Prevent frustration. Watch for signs of over-stimulation or confusion. Avoid loud noises and clutter. Turn off the television if you want to have a conversation, and try to phrase questions so they may be answered simply. Distraction can be a very effective approach to managing challenges. For example, if they are having trouble putting on a sweater, redirect to something else and then try again after some time has passed.

Avoid confrontation. Do not argue or try to reason if presented with a challenging behavior. Even if your family member is yelling or criticizing you, avoid expressing anger or impatience in return. Try softening or quieting your tone. Fatigue is the most common denominator in outbursts – both for the person with Alzheimer’s and the caregivers!

Be positive when coping with challenging behaviors.

Be positive. Use positive expressions and humor when appropriate to diffuse tense situations. Remain calm. Use a gentle touch to reassure (if the person is willing to accept it). Build periods of relaxation into the daily routine, such as sitting in a rocking chair or favorite recliner with a cup of tea.

Dealing with hallucinations. If your loved one is hallucinating that they had a conversation with a deceased family member, but this was a pleasant experience for them, go along with their reality. However, if the hallucination (or any behavior) causes fear and distress, it is vital to request a medical evaluation. Difficult behaviors that persist or have the potential to cause harm need to be attended to by a skilled and knowledgeable physician.

For more tips, use these online resources:
Understanding an Alzheimer’s Diagnosis
Help with Communication and Behavior
Communicating with Someone with Dementia
Alzheimer’s Care: Practical tips
Support: Message Boards
Caregiver Support Groups

About the Author:

Mary Baum is an expert in Alzheimer’s care with 20 years experience in assisted living and long-term care settings in Massachusetts. She has a BA in Psychology from University of Massachusetts and is a Certified Dementia Practitioner. Mary was instrumental in the development of several innovative programs that Senior Living Residences, of MA, implemented in all of their Memory Support Neighborhoods. The Reconnections Program, a curriculum-based adult learning program is based on research that cognitive stimulation may slow the progression of Alzheimer’s and recognizing that individuals with memory loss still have the desire and ability to enjoy learning. The Lifetime Achievement Award, by conferring personal recognition and dignity to individuals with memory loss, offers an antidote to the isolation and anonymity they experience.

On a personal level, Mary came face to face with the disease she is expert in treating when her father was diagnosed with Alzheimer’s. She knows firsthand that professional knowledge does not make you immune to the emotional impact of that diagnosis, and her own personal experience has intensified her commitment to helping individuals and families cope with dementia.