All behavior is simply communication. Verbal communication is often (but not always) the easiest to understand. In the absence of clear verbal communication, it can become a bit trickier, but certainly not impossible. This is where you as the care partner get to put on your CSI hat and figure out what’s really going on.
First, rule out the obvious. Is the person with dementia hungry? Thirsty? Tired? Needing to use the toilet? Had an incontinent episode?
Next, check the environment. Is too much going on at once, creating overstimulation? Turn off the TV, turn down (or off) the radio, eliminate any unnecessary distractions and noises, and leave the environment if you can’t control it (eg, a busy public place like Costco or Starbucks). Busy, overstimulating public places can also cause fear, especially if the person has impaired hearing and/or poor eyesight.
Finally, could the person be constipated or have a bladder infection or pneumonia? These conditions typically cause noticeable and sudden changes in behavior and personality. Also check for untreated pain. Use the PAINAD scale for people who are no longer verbal or having difficulty expressing themselves verbally.
When it comes to specific behaviors, consider the possible need/cause for the “behavior”:
- Rummaging through drawers=looking for something
- Wandering=trying to get somewhere/find someone
- Yelling/shouting=pain; trying to get your attention
- Crying/tearfulness=pain; sadness/unhappiness
- Public undressing=dressed too warmly; clothing too tight; tag rubbing on skin
- Hallucination/delusion=misinterpretation of environment due to poor eyesight or impaired hearing; sign of infection causing delirium
- Resisting/refusing/fighting offered care=doesn’t understand verbal communication; hearing impaired; offered care causes pain
The following interventions typically work well, but keep in mind not every intervention will work for every situation, or every time. It may take some experimenting to get to the “right” intervention.
- Well lit, but not too bright
- Soothing music
- No television or other unnecessary background noise
- Always approach slowly and from the front
- SMILE and remind person who you are, then clearly and succinctly state your purpose
- Leave and reapproach later if the interaction is not going well
- Use non-verbal (VISUAL) cues so the person can better understand
- Be calm and kind, LISTEN, then validate what you’ve heard
- Never attempt to drag people into your reality; instead, step into their reality and make that reality safe for them
- Lavendar for calm and sleep
- Eucalyptus for waking
- Citrus for appetite stimulation
Distract & Redirect
- Always offer a substitution before trying to take something away
- Cookies and/or coffee often work quite well J
- Anything you know the person really enjoys
- Flipping through a magazine or catalog
- Reading the bible/praying together
- Pet therapy
- Singing along to the radio
Christy Turner is the founder of DementiaSherpa.com and has enjoyed the privilege of working with 1,123 people living with dementia and their families. Follow on Facebook, Google+, Instagram, Pinterest, Twitter, and YouTube. Content varies across platforms.