Dementia: Teepa Snow Explores Challenging Behaviors

Teepa Snow, one of WayWiser’s Trusted Advisors, is passionate about educating people on what dementia is, and also what it’s not. 

She’s devoted her life to raising awareness about this often misunderstood condition, and is driven to promote quality of life for those with dementia, and for their loved ones and caregivers. 

Because Teepa recognizes—dementia doesn’t only impact the life of the person who has it. It also deeply affects the lives of their families and loved ones. 

If you have a loved one who you suspect or know to be experiencing dementia, educating yourself about this condition is a crucial step in effectively navigating it. 

Thankfully, Teepa has helpful information and tips for those dealing with this complex issue.

If you haven’t yet watched or read Teepa’s Dementia 101 article, you can find that here.

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Dementia is a comprehensive word that refers to the progressive loss of a person’s memory, intelligence, capacity to think sensibly, and social skills. Dementia is a group of symptoms associated with a long-term brain condition such as Alzheimer’s disease or vascular dementia.

While caring for someone with dementia can be a wonderful experience, it is normal for persons with dementia to behave in ways that are difficult for caregivers, such as roaming and rummaging.

Many times, these acts are not purposeful, but rather the outcome of what is going on in the brain as a result of dementia. Sometimes these behaviors are caused by issues that are easily remedied. For instance, if there is excessive noise or activity. These behaviors can also occur when a person is rushed or hurried to complete a task.

These habits are not always avoidable. People with dementia might become easily frustrated, and it can be difficult for them to express their feelings to others. Some behaviors, however, can be stopped or changed if the caregiver learns why they occur and changes their response.

Recognizing the Situation

Understanding what causes specific behaviors in a dementia patient will put you in a better position to approach the issue positively. In some circumstances, it may even be possible to prevent it from happening. It’s also crucial to realize that disruptive or odd conduct could be a resident’s method of reaching out to you, telling you something that he or she can’t express orally.

Understanding the Elderly Dementia Patient

The more you know about the individual exhibiting challenging behavior, the more probable it is that you will comprehend them. Behavior evaluation should be both functional and comprehensive. It should include the following:

• The time of the behavior
• Intensity
• Frequency
• Identification of triggers and the possibility of environmental factors that might or would increase the behavior
• Duration

Understanding Difficult Behavior

The phrase Behavioral and Psychological Symptoms of Dementia, or BPSD, refers to a broad spectrum of psychiatric behaviors and symptoms, as well as psychological reactions, that frequently occur in dementia patients. BPSD affects 40 to 80 percent of adults with dementia and is linked to greater caregiver burden and the chance of being admitted to a nursing home.

Remember that there are numerous varieties of dementia, and thus varied sorts of symptoms and behaviors. Alzheimer’s disease and vascular dementia frequently impact people’s behavior in the same way, although Lewy body disease and frontotemporal dementia (Pick’s disease) cause behavior symptoms early in the course of the disease and are more visible in the way they present themselves.

One of the most significant consequences of BPSD is an increase in stress within the family unit. The biggest reason for opting to place a loved one in a care facility is behavioral issues, which can have an impact on the family’s finances by increasing the cost of care.

Behavior issues have an impact on the person with dementia’s quality of life and, ultimately, their mortality. Another effect of problematic behaviors is that they can be very frightening and often disturbing to caretakers, producing anxiety, disrupting sleep, and rising stress levels, which can lead to health problems and even abuse by care recipients.

Common Challenging Behaviors

The following are examples of problematic behaviors exhibited in people with Alzheimer’s disease:

• Seeing things that do not exist
• Being irritated
• Rummaging
• Awake and busy when everyone else is sleeping
• Repeating the same actions
• Thinking people are stealing
• Biting, kicking, or hitting
• Pacing
• Uncertainty about what is being said
• Loss of interest, compassion, or motivation – the person may appear uncaring and disengaged
• Sexual behavior
• Hiding items
• Inappropriate behavior
• Wandering

These behaviors may represent various signs of agitation. Physical and verbal violence are major issues because of the impact they have on the caregiver and others. 

Environmental stresses, interpersonal connections, bodily discomfort, drugs, unmet needs, and misperception of the environment are all possible reasons of agitation, which can contribute to fear and dissatisfaction. Agitation and violence are common grounds for placing loved ones in care facilities if they are not regulated.

Challenging Behaviors

As you are aware, there is a lot to know and learn about caring for persons who have problematic behavior caused by dementia. Understanding what happens to the brain as the disease progresses and knowing the person you care for will help you understand why certain behaviors emerge. Many tough and demanding behaviors have been documented in persons with dementia, most of which arise as a result of sadness, fear, or frustration.

Caregivers must learn to read nonverbal cues to discover what may have triggered the distress, fear, or irritation in people with dementia.

While the majority of unpleasant behaviors are just humiliating or annoying, some can be prolonged and serious. For controlling problematic behaviors, a combination of non-pharmacological and pharmaceutical methods is often most beneficial. When contemplating drugs to manage problematic behaviors and reduce anxiety, a healthcare practitioner should be consulted. Non-pharmacological treatments should be tried in all circumstances.

Behavior Changes and Their Causes

Many variables contribute to dementia-related behavioral abnormalities. Some experts believe that some people with dementia may have displayed problematic behaviors prior to the onset of Alzheimer’s disease, and that these behaviors become accentuated as dementia progresses. This is known as a person’s pre-morbid personality.

Environmental Aspects

New or unfamiliar environments, as well as anything that can induce sensory deprivation or overload, such as clashing or brilliant colors, mirrors, hot or cold temperatures, and loud noises, can all play a role in troublesome behaviors. Soothing contrasts and colors, low background noise and loud noises, comforting and familiar objects, and a pleasant temperature should all be used to create a comfortable environment.

Human environmental elements can also have an impact on behavior. These include the caregiver’s general approach, attitude, and mood, as well as the caregiver’s family members or staff. Members of the care team should strive to maintain a positive, calm attitude and mood. Unfamiliar caretakers and disturbances in the caregiver’s schedule, such as shift changes or vacation time, can also lead to behavioral changes. 

Maintaining regular habits with known individuals is essential for reducing stress. Some dementia patients may have prejudices or phobias regarding caregivers, which may lead to undesirable actions. As a result, issues such as gender and race may need to be considered.

Keep in mind that any action or activity has an impact on individuals. People with dementia may experience stress when they are given new or unusual duties. A person who is used to taking showers, for example, may be anxious about taking a bath. If there are too many options, a person may become frustrated. 

Finally, things that are overly difficult, move too quickly, or require too much movement can be stressful. As a result, activities and tasks should be familiar and simplified to meet the individual’s level of ability.

Health and Aging Factors

Normal aging changes, which produce a general loss of capacities, can also create anger and frustration. Aging can impair a person’s mobility, independence, hearing, eyesight, and sense of time and place. These shifts might cause annoyance, indignation, and even fury.

Medication and acute and chronic illness, such as pain and discomfort, heart and vascular disease, sleep disorders, anxiety disorders, depression, constipation, dehydration, thyroid issues, and lung disease, are examples of medical factors that influence behavior. Medical problems not only have an impact on behavior, but they can also diminish or limit a person’s degree of functioning.

As a result, it is critical to treat and control medical concerns as much as possible with the assistance of healthcare professionals.

Dementia

Dementia impairs social behaviors, judgment, and motivation. Damage to the frontal lobe causes poor decision making and loss of impulse control. During childhood, people learn to manage their impulses, and this knowledge is stored and monitored by the frontal lobe. These critical skills are often lost in the reverse order in which they were learned as dementia progresses. Loss of control over impulses frequently leads in typical teenage or child behavior. As dementia progresses, people lose their ability to handle their environment and daily chores, which often leads to frustration, which leads to stress. The combination of increasing irritation and loss of control can lead to inappropriate outbursts and aggressiveness.

Furthermore, the person’s tolerance for stress decreases as the condition worsens. The individual is frequently unaware of the mounting stress or of ways to cope with it, so they react in more basic ways, such as lashing out. Stress is also associated with combativeness, restlessness, pacing and wandering.

It is the caregiver’s responsibility to search for signals that a person is approaching their stress threshold. These symptoms include pacing and restlessness, tense facial expressions, anger, crying out, and scratching or hand wringing.

Understanding the problem of stress and closely studying people for symptoms of escalating tension can help to prevent behavioral outbursts and catastrophic reactions.

Managing Difficult Behaviors

As a caretaker, you can sometimes prevent behaviors from occurring. You can also learn how to deal with them when they occur. The three-step strategy attempts to determine why the behaviors are occurring so that you can respond in a helpful manner.

Step 1: Recognize the behavior: What exactly was the behavior? What was going on before the behavior occurred? What happened immediately following the behavior?

Step 2: Consider possible solutions: Can you make a difference? Can you change your mind? Did the individual require anything?

Step 3: Experiment with various responses: Did doing things differently make a difference? What additional solutions are there to the problems? Did you seek assistance?

Understanding what is generating the challenging behavior and understanding how to respond to it will allow you to take control of events as they arise and reduce the likelihood of the behavior occurring.

That being said, there are tactics you can employ to make life significantly simpler for both yourself and the person you are caring for.

Here are some simple things you can do right now to help ease your dementia caregiving experience:

• Approach them calmly and respectfully.

• Even if the conduct seems embarrassing, try not to overreact; remember that the sickness is causing the behavior.

• It is preferable not to make physical contact with the person by leading or holding their arms; this may intensify the problem. Instead, give your arm and comfort them: “Here, take my arm, let’s go to the veranda/bedroom/dining room/restroom.”

• Be adaptable; if the behavior is related to a shower they don’t want to take, postpone this job until the person has calmed down.

• Avoid arguing; remember that the person is not attempting to upset you on purpose. The disease has hampered their logic and reasoning, and it is up to you to comfort and reassure them.

• Examine the individual and what their body language conveys. Allow them time to calm down while providing solace.

• Validate their emotions. If a 95-year-old man becomes concerned and asks if you have seen his mother, it is pointless to inform him that she is no longer alive. Agree with him and say something like: “I haven’t seen her yet. Was she a fantastic cook? What did she make that you enjoyed?”

• Provide a distraction such as a walk, board game, music, images, or completely shifting the subject.

• Be aware and ‘in the moment.’ If you’re talking to someone and your mind is elsewhere, you’re not going to receive the best results. Your body language and manner frequently speak louder than your words. To emphasize the communication, use a soft tone of voice and some physical touch.

• When you find a successful method, document it so that other employees can apply it as well.

Remember that people with dementia who show problematic behaviors are attempting to communicate unmet needs. Therefore:

• Implement routines that are individually personalized and flexible.
• Be patient and keep your cool.
• Whenever possible, try to cut back on antipsychotic medication.
• Recognize the importance of getting to know the person beyond the diagnosis.
• Make an effort to anticipate troubling habits.
• Plan activities that encourage creativity and satisfaction.
• Remember that hydration and nutrition are critical for their health.
• With compassionate overtones, offer direction and comfort.
• Gentle touch and physical contact are essential for reducing fear and anxiety.
• Put in place behavior management measures that emphasize dignity and respect.
• Take nothing personally. Nobody is to blame.
• Maintain a collaborative partnership between caregiver and patient.

Make a Plan

While the exact progression of dementia varies from person to person, there are things you can do to prepare as symptoms worsen.

Make a plan for how you’ll react to particular behavioral changes, such as tantrums or inappropriate conduct.

You should also consider how you would handle the need for more serious care. What will you do if and when you require assistance? Have you been to a memory care center or assisted-living facility in the area? Have you discussed long-term care with other family members as your condition worsens? And, if money is an issue, do you need to seek into financial assistance?

Though these are difficult thoughts to consider, they may be simpler to work through now, before the dementia worsens and your role as caretaker becomes even more difficult.

Summary

Dementia is a collection of symptoms that impair a person’s thinking and memory. You may need to step in as a caregiver if a loved one’s dementia worsens. While this might be a difficult task, there are several crucial actions you can take to better prepare yourself for both daily demands and future adjustments.

Remember that behaviors might occur for any reason and at any time. It’s crucial to learn how to anticipate and respond to them, but taking care of yourself can also help. It will be much easier to handle difficult behaviors when you are feeling good and receiving support from others. Find and become a part of a support group in your area, seek professional assistance, and discuss your concerns with your doctors.

Further Reading

Dementia 101: Teepa Snow Explores Important Facts to Know About This Complex Issue

Dementia: Teepa Snow Explores Brain Changes

Dementia: Teepa Snow Shares Advice for Meaningful Activities

Dementia: Teepa Snow Shares Advice on Connecting Through Music

For more lessons from Teepa, take a look at all that she offers on her website.