Understanding Dementia Behaviors

[00:00:03] Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies & Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30 plus years of experience as she guides you on a new path

[00:00:28] to a better relationship with those you care for. Here's Lisa. Hi everybody, welcome back to the Truth, Lies & Alzheimer's show. I'm Lisa Skinner, your host. Thanks so much for joining today. I want to cover a topic that so many family members and care partners struggle with on a day-to-day basis.

[00:00:57] And I'm sure any of you who are in that situation have already come up against behavioral expressions. And that is kind of unexpected behaviors that we see when our loved one is responding to something and they're trying to tell us something.

[00:01:21] And we're not really sure what exactly triggered that behavior. So today I am going to share with you scenarios and examples of different situations that can and do arise on a daily basis.

[00:01:41] Some of them will sound familiar to some of you and then share with you a effective response and a good approach and the outcome you should see as a result of implementing these strategies.

[00:01:59] So these are proven techniques that could literally become vitally important to help you diffuse the many unexpected situations that can and do arise with a life with dementia.

[00:02:21] The behavioral expression that we see on a day-to-day basis with dementia are a form of communication to alert us to an unmet need. When a person living with dementia can no longer verbalize or articulate what exactly it is that's bothering them. There are so many things that it could be a result of environmental, emotional.

[00:02:50] There are so many different things that can trigger these behaviors as we call them. So here are examples that illustrate the many factors that can trigger these behavioral expressions that are very common with dementia.

[00:03:12] And suggestions how to approach the situation that will result in the most positive outcome for you. And I want you to keep in mind that there are literally hundreds of ways that our loved ones will try to communicate their wants and needs to us. You're looking for something that's going to get your attention and get your help.

[00:03:40] And in addition to that, there are literally hundreds of things that can and do trigger the way they go about communicating their unmet needs to us. So it surely is a very complicated puzzle that we are tasked with trying to figure out. And that's what we are trying to do. This is not an exact science.

[00:04:05] So what I'm sharing here with you today are examples and illustrations that you can try when these situations arise. And they can be used for multiple situations. These are not necessarily the examples I'm sharing with you today are not necessarily specific to that exact situation. It can apply to many situations.

[00:04:33] But really what this is intended to do for you is provide you with a toolbox that you can pull from. My recommendation is always try one of these approaches in your particular situation that crops up.

[00:04:51] And if it doesn't turn the situation around, you'll have your toolbox and you can just pull another approach or response. There is no one size fits all when it comes to the situations or the responses, approaches that will be effective. So it's going to be a trial and error situation every time.

[00:05:18] So the first one I'm going to share with you is the one that so many of us absolutely love. And most of us have experienced it. It's when our loved one or the person we're caring for repeats the same question or tells us the same story over and over again. And we lose our patience. There's no getting around it.

[00:05:49] But that's just going to escalate the situation. So a possible trigger for this behavior. And I'm going to emphasize these are possible triggers. It could be something completely different, but you'll have a lot of different examples to lean on. So think of it this way.

[00:06:10] Anxiety plus memory, the memory loop that happens to people with dementia equals, I need an answer to feel safe. And that's exactly what they're telling us. And overstimulation from being repeatedly redirected without any reassurance whatsoever.

[00:06:33] That just completely that as a for sure recipe for escalating into an extreme situation. And it's because memory loss does often create this loop of repetitiveness. The question is really about reassurance and connection. They want to make sure that they're safe. They want to know where am I? Nothing looks familiar.

[00:07:01] They want to understand what's happening to them. So as the caregiver answers repeatedly, the individual may actually feel dismissed, rushed or anxious when they aren't able to retain the answer that satisfies them. No matter how many times the caregiver answers it.

[00:07:27] So here is my suggestion for an effective deescalating response in this situation. I'm going to share with you what to do and what to say. The first thing you want to do always is acknowledge and reassure them. And here's an example of that. Respond warmly and briefly, and then you're going to do what's called present them with an anchor.

[00:07:58] And here's an anchor. You're safe with me. You're safe with me. You're at home with me. And now it's time for us to enjoy a nice warm cup of your favorite tea and a snack. Okay? And wait for them to answer. Add the same common cue each time.

[00:08:21] Like, do they enjoy it when you're watching TV together or holding their hand or looking at photos and telling stories about the photos with one another? And then if your loved one asks immediately again, the same question or tells the same story, you, your response can be yes.

[00:08:50] It's morning right now or it's afternoon right now. And we're going to do that together after we have our tea and our snack or whatever it is you're going to do. Watch TV or go for a walk, whatever happens to work for your particular person.

[00:09:10] But the point is you short sentences so they could process those words and use the same wording each time. I'm going to explain now why this is the most effective approach.

[00:09:27] It reduces the perceived threat by removing confrontation and it restores control just by saying, we're going to do this together. It also prevents the conflict cycle that happens when the individual feels accused or dismissed. It reduces the why are you ignoring me feeling by validating safety first.

[00:09:56] And consistent phrasing prevents power struggles and decreases their cognitive load. Redirecting to a sensory or comfort activity settles the nervous system, even when factual memory can't and doesn't improve. So here are some tips answer once then anchor.

[00:10:24] Yes, it is the afternoon and we are having a delicious snack along with a nice warm cup of tea. Then you want to quickly redirect. Use the same anchor every time. Offer one consistent comfort step. Like, let's go sit together on the sofa. Let's have something to drink.

[00:10:52] Turn on a television show that you know your person enjoys. Hold her hand. Hold her hand. Look at familiar photos. And then if she asks again, immediately repeat the exact same sentence. And say her name. Betty, I just want to assure you that you are safe here with me.

[00:11:20] Then the same brief anchor. Snap next. Come sit here beside me. And the outcome you should see is that the question frequency usually decreases them asking you the same question or telling you the same story.

[00:11:41] And the intensity should drop after a few minutes of consistent reassurance and an anchor activity. And why it's most effective for individuals living with moderate to severe dementia. The first example was more of the earlier stage of the milder dementia.

[00:12:07] But here is an effective approach if they are living now with moderate to severe dementia. And the difference really is that because repeated questioning is often a distress signal and not a problem to solve with new information.

[00:12:31] So consistent reassurance and the same calming routine that I explained in the first example relieves threat and prevents escalation. So a reasonable outcome here to expect would be the questions may continue for a little while, but the intensity usually drops.

[00:12:56] And that looping over and over and over again becomes shorter when reassurance and a predictable activity are consistent. And here are some things to be mindful of. Things to avoid. And these are what we call common escalation drivers.

[00:13:24] Don't argue about the facts. Like saying, you already asked me that. Or you already asked me that a hundred times. That's a recipe for escalation. Explaining at length or correcting your person's memory. Avoid that. Asking counter questions that require them to do more processing.

[00:13:53] More thought processing. And here's an example. Do you remember or don't you remember? Avoid that statement. The care. So I'm going to go right into our next scenario. And this one is very common.

[00:14:18] Happens all the time that you as a caregiver or a family member are accused of stealing like your person's watch or some kind of possession. So a possible trigger for that negative response. Think of it this way. A misplaced item and them misinterpreting why it's missing. For example.

[00:14:48] They're thinking. I can't find this. It must be missing. And therefore, somebody must have taken it. That's the thought process. That's the thought process. Because they may, they probably more than likely put it somewhere and don't remember it at all or where they put it. So the gut reaction is to accuse somebody else.

[00:15:14] And as the caregiver or the family member, you are the target. Now it happens due to fear of loss or even fear of control and heightened agitation when confronted with us saying to them, well, that's not true and becoming defensive. Now, really what's going on here. The watch was misplaced or hidden.

[00:15:42] Again, memory plus attention issues that have declined. The individual interprets confusion as a threat. I know you took it, which can increase fear, anger and mistrust, especially if the caregiver argues or repeatedly explains the facts and why this absolutely is not the case.

[00:16:13] It's it's not worth your breath or your time. It's just going to create more tension between the two of you and escalate into what we refer to as a catastrophic reaction or a total meltdown. So here are some suggestions for an effective response. In other words, what you can do or say.

[00:16:39] And the first thing again, validate their emotion without agreeing to the accusation. So an example of that would be to say, well, I can certainly see that you're worried and also that you're quite upset about this. And I can certainly understand why you are. And I understand that you want to find your watch now.

[00:17:06] So you can switch to teamwork or a partnership approach by saying, for example, so let's look for it together right now. Partner search using simple categories and offer the steps you're going to take to try to help find it. First, we'll check the bed. Then we're going to check your nightstand.

[00:17:35] Then we're going to check your coat pockets and purses. Now, if you don't find anything, which you're likely not going to, unless you know all of their hiding places, you can say, well, you know, let's keep looking. I'm not finding anything yet, but I'm going to keep helping you look.

[00:17:59] And while we're doing that, here's something for you to hold and hand or something that is meaningful to them, a bracelet or, you know, something that they cherish so they can hold that because it gives them a sense of comfort and security. Offer a short substitute comfort item. That's what I'm talking about. That's what I'm talking about.

[00:18:26] If available, like a wrist strap bracelet, some something that is small that they can carry around with them and keep her holding or him the replacement item. Then you can redirect to a calming step while you continue later.

[00:18:53] You can say, OK, we've looked so many places and we still haven't been able to come up with it yet. So let's go ahead and sit for a minute and then we'll keep looking or let's go ahead and take a quick break and have a cup of coffee or whatever you want.

[00:19:14] To say, let's have a sweet snack, some cookies and take a little break. Try to get their mind off of the hunt for this item that they are convinced has been stolen. And then if you do find it presented matter of factly. Oh, my goodness. Here it is.

[00:19:44] Thank you so much for helping me look and avoid any long explanation. They just are not capable of processing too much information at one time. So simple is better. Short is better. And why is this an effective response?

[00:20:05] Well, it reduces perceived their perceived threat by removing the confrontation. It restores control by saying something like we're going to do this together. It's a partnership and prevents the conflict cycle that happens when your person feels accused or dismissed.

[00:20:32] And here are some things to be mindful of that you want to avoid. There's the again, the common escalation drivers and you want to take your foot off that pedal. Like, I didn't steal anything. How could you accuse me of doing something like that? This can definitely escalate into a very heated argument.

[00:20:59] And then repeatedly telling her what you're saying is impossible. I'm sure it's just in your room and you just don't know where you put it without offering some type of reassurance. This response does nobody any good.

[00:21:23] And then avoid leaving your person alone with the belief that while you do lengthy tasks, that you'll search for the missing item. Validate the feelings without agreeing to the accusation. I know you're worried. I can see you're worried. So let's find your watch together.

[00:21:53] Are there reasons why this approach is effective? Well, it's due to the validation that you shared with her or him. It lowers the threat and shame. You're not fighting the belief that this person is insisting upon. You are reassuring. Let's look together.

[00:22:24] That restores control and teamwork that you care. And then giving a substitute, a temporary substitute item reduces distress while you continue searching or decide on a plan or a next step.

[00:22:42] And the outcome that you should see as a result of this approach is that the accusations that they're, you know, hurling at you will typically soften. And she, he or she may still be concerned about it, but will most likely engage with you in searching.

[00:23:07] And it will soothe and calm the situation down rather than escalating it into a conflict, especially when they feel supported and reassured. um, this approach is effective. Okay. We're going to do one more today. Oh, but first we're going to have to go for a very quick break.

[00:23:36] And when we come back, I'm going to share with you one more. That's all we're going to have time for today. So don't go away. I'll be right back. This podcast is brought to you by Minding Dementia LLC. We encourage you to check out their website for resources, checklists, extra content, and more. Visit MindingDementia.com today. I've tuned into the Truth, Lies & Alzheimer's show with Lisa Skinner, your host.

[00:24:01] We're going to continue on with the third scenario that I want to share. And this is another very, very common one that we see that your person insists on going home. And you're baffled because you know they are already home. A possible trigger for this response, and think of it this way, is location or time confusion

[00:24:29] that they are experiencing, plus an emotional need for safety, attachment, or even old routines compounded by a feeling of urgency such as, I'm supposed to be there right now, and nobody's helping me, is a sure recipe for this type of behavioral response.

[00:24:51] Now, understand that home to a person living with dementia often represents comfort, safety, and security to them. It's not about literal geography. A sudden contradiction to this can feel dismissive to them and unsafe. Often it's tied to an anxiety habit or a former identity.

[00:25:18] Home equals safety, or that's where their spouse or children are, or even represents a familiar routine. So contradicting their belief by saying, we are home, you're already home, can feel invalidating, and most likely will increase their agitation. So here's an effective de-escalating response to this scenario. Again, validate first.

[00:25:47] For example, you want to go home. Okay, I understand that. Then set a calm boundary like, Her name, Betty, I want you to know that you are safe here with me right now, so don't worry. Reassure her and give a simple but concrete next step. Again, spell it out. So first we're going to get your coat and purse.

[00:26:16] Then we're going to go have some breakfast or lunch or get a snack or some other activity like we're going to go for a short walk together. Choose a time that your person can tolerate. Offer a home related anchor. Like, let's go sit in the living room and watch a little television. Hold keys, your phone.

[00:26:45] Adjust familiar items or open familiar items. Listen to a familiar song. Look at some photos. Or just be comfortably positioned with a familiar blanket. Then, if your person tries to leave, which of course is a safety risk, you want to always first try to approach her from the front. Secondly, would be from the side.

[00:27:13] And block gently if needed. The front is always the best way to approach somebody with dementia. No surprises. They startle easily. Keep your voice low and calm. And you can say something like, I can't let you go out right now. Keep it short. But I want you to stay here with me. So let's sit in the living room and get ready to go.

[00:27:43] That's all you have to say. And why this is effective? Because it meets the emotional need, the comfort, the security while giving a replacement plan that your person's brain can follow and process. Now, with moderate or severe dementia, debating the where usually fails. Replacing the feeling and sequence works much, much better.

[00:28:11] And the outcome you should expect to see is that the exit attempts usually reduce in frequency and duration when there is consistent reassurance with a predictable next step. And to wrap this up, please avoid these common escalation drivers. Avoid saying, no, we're already home. Don't you realize that?

[00:28:41] Isn't this familiar to you? That's a sure bet of increasing your person's agitation. Going into long explanations like arguing or threats, sudden physical restraint, without reassurance unless needed for immediate safety. Person with dementia tries to leave the house repeatedly. Sometimes they do.

[00:29:07] And a possible trigger for the negative response is again, this all ties in. They're confused about the time or location and feel they need to go. So that's what I have to share with everybody today. I hope this has been extremely helpful because these situations do arise. They arise unexpectedly.

[00:29:34] No telling what triggered this response from your loved one. And these are, you know, real life examples, very realistic examples of things that do crop up on a day to day basis. I have lots more.

[00:29:54] And one of the reasons why I put this together, because this is probably one of the most requested things that people want to learn more about because it's in their face every single day. And these things do happen.

[00:30:12] So anyway, we'll do more episodes with more examples and keep building that toolbox for you to use on your day to day dementia journey with your person or your loved one. And don't forget, visit us on our website at mindingdementia.com. Download the free gift that we're offering and explore around.

[00:30:40] There's always new information to be had. So I will be back next week with another new episode of the Truth, Lies and Alzheimer's show. I'm Lisa Skinner, your host. Be well, be safe and have a great rest of your week. Talk to you soon. Bye bye. Thank you for listening to Truth, Lies and Alzheimer's.

[00:31:09] We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lies and Mindy Dementia Support Group. We're a community of like-minded caregivers, and we're here to help. We'll go. Thank you. Thanks for reminding us about your work. Bye bye.