Caregivers offer advice for dealing with difficult behaviors

Caregiver Services of Waseca offered an informational session regarding behaviors frequently exhibited by people experiencing dementia the afternoon of Wednesday, March 18. After she was introduced by executive director Kelly Boeddeker, guest speaker Alisha Krueger shared information from the Minnesota and North Dakota Chapter of the Alzheimer’s Association. Krueger is attending the University of Minnesota, Mankato, working toward a Doctor of Occupational Therapy degree. Boeddeker and Krueger made it clear the session was designed so anyone affected by Alzheimer’s Disease could learn about it and get answers to their questions from trained professionals.

 

About 15 people attended; nearly all were senior citizens. Krueger explained she would be providing information to help caregivers “deal with” or “manage” behaviors exhibited by those with dementia. 

 

She began by letting people know many such behaviors are “a form of communication.”

 

She went on to say victims of the disease “have trouble knowing what’s real and what’s safe.” She clarified that people with dementia will have good or bad days, and that it’s helpful to know the person when trying to understand his or her needs.

 

She showed that dementia can change the way cells in the brain look and work, making it hard for individuals to understand the world around them, or to communicate what they are thinking and feeling.

 

Krueger advised caregivers never to take behaviors personally, even when they seem like messages of distrust or hostility. She listed “anxiety and agitation, sharp words, bouncing legs, aggression and anger, verbal or physical outbursts, suspicion and delusion.” An example was offered in the form of a video sharing the experiences of a woman who had become her mother’s caretaker. The mother suspected her of driving to the bank and stealing money.

 

Krueger warned that reacting in a negative way can affect both parties and make proper care more difficult; she said it is important to stay calm and not “trigger” the patient. She let everyone know there are both internal and external causes for behaviors. Patients might act out because they are experiencing some unmet need which they do not have the words to express, including pain or physical discomfort; they may need a bathroom break or be hungry. The presence of a stranger, a loud or unfamiliar noise, or even lighting may be causing discomfort.

 

The cause might also be something very difficult to identify, including emotions or memories whose source the patient has trouble reconciling. Krueger suggested, “Even if the reality they think they are experiencing isn’t true, to them it is.”

 

Before considering extra or changed medications, Krueger said non-medical approaches should come first, including confirming physical and emotional comfort, including going to the bathroom. Familiarity with the person is very useful in finding solutions. When one woman’s family learned she was having trouble going to sleep because she worried that the chickens had not yet been fed, caregivers were able to “shoo the chickens” into their pen for the night and the woman could get better rest.

 

Krueger offered a checklist for caregivers. The first approach, she said, is to “detect and connect,” in other words, use the individual’s history to deal with problems. “You must bring yourself into their reality, not them into yours. Approach them calmly and carefully, keep your voice low, don’t go in aggressive. Avoid correcting them–correction may cause agitation. Redirect instead of correct.”

 

Second: Taking care of physical needs, especially if an individual seems calm and at ease, but suddenly becomes aggressive. Try to determine what’s causing physical discomfort. “Are their clothes too tight? Do they need the bathroom? Is it too loud where they are?” Krueger also suggested asking medical providers to test for a urinary tract infection (UTI), because this is a common problem for those living with dementia.

 

Third: Focus on the emotion instead of the facts. “Offer comfort, let them know you’re there and try to make them comfortable. Even if they are wrong about something that didn’t happen, their emotions are 100 percent real. Redirect their energy to a more relaxing activity, doing puzzles, music or sitting in a relaxing place. If they are not reacting in a positive way, let them alone for a while; sometimes that works as well.”

 

Fourth: Review and plan for next time. “Many times these dementia related behaviors are reoccurring. What are the warning signs this may happen again? What responses worked well? Do they need to be taken out of the room first to calm them down or do you calm them down then bring them out of the room? When is a good time to step in? What has worked in the past? Does it help to have familiar faces around?”

 

Focus on what they can do, “Did your patient fold clothes as a homemaker? Then let them fold clothes. If they’re comfortable doing that activity and it can be done in a safe manner, go for it.”

 

When help is needed, “These behaviors can be hard on a caregiver. Sometimes patients can become violent, putting not only the caregiver in danger, but entire families.

 

Sometimes guns need to be removed. Police officers are getting training when it comes to Alzheimer’s patients.” There is also a free 24-hour helpline for dementia related concerns: 800-272-3900.