Dementia Coping Strategies
Family members who have dementia may exhibit a variety of symptoms. Knowing how to handle the emotional outbursts and changes in personality can be confusing and frightening for caregivers unfamiliar with dementia. Should they go along with the hallucination or set them straight? How do they calm someone down does no longer recognizes them as their spouse? Below are proven strategies found to work with dementia patients by those working in the field. Additional information is available from www.Alzheimer’s.org
Hallucinations are false perceptions of objects or events involving the senses. The person may see the face of a former friend in a curtain or may see insects crawling on his or her hand. In other cases, a person may hear someone talking and may even engage in conversation with the imagined person.
When responding to hallucinations, be cautious. First, assess the situation and determine whether the hallucination is a problem for the person or for you. Is the hallucination upsetting? Is it leading the person to do something dangerous? Is the sight of an unfamiliar face causing the person to become frightened? If so, react calmly and quickly with reassuring words and a comforting touch. Do not argue with the person about what he or she sees or hears. If the behavior is not dangerous, there may not be a need to intervene.
- Respond in a calm, supportive manner. You may want to respond with, “Don’t worry. I’m here. I’ll protect you. I’ll take care of you.”
- Gentle patting may turn the person’s attention toward you and reduce the hallucination.
- Acknowledge the feelings behind the hallucination and try to find out what the hallucination means to the individual. You might want to say, “It sounds as if you’re worried” or “I know this is frightening for you.”
- Suggest a walk or move to another room. Frightening hallucinations often subside in well-lit areas where other people are present.
- Try to turn the person’s attention to music, conversation or activities you enjoy together.
- If the person asks you about a hallucination or delusion, be honest. For example, if he or she asks, “Do you see him?” you may want to answer with, “I know you see something, but I don’t see it.” This way, you’re not denying what the person sees or hears, but you avoid an argument.
Modify the environment
- Check for sounds that might be misinterpreted, such as noise from a television or an air conditioner.
- Look for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls, and furniture. Turn on lights to reduce shadows.
- Cover mirrors with a cloth or remove them if the person thinks that he or she is looking at a stranger.
Coping strategies for sleep issues and sundowning
- Keep the home well-lit in the evening.Adequate lighting may reduce the agitation that occurs when surroundings are dark or unfamiliar.
- Make a comfortable and safe sleep environment. The person’s sleeping area should be at a comfortable temperature. Provide nightlights and other ways to keep the person safe, such as appropriate door and window locks. Door sensors and motion detectors can be used to alert family members when a person is wandering.
- Maintain a schedule. As much as possible, encourage the person with dementia to adhere to a regular routine of meals, waking up and going to bed. This will allow for more restful sleep at night.
- Avoid stimulants. Reduce or avoid alcohol, caffeine and nicotine, which can all affect ability to sleep. Discourage watching television during periods of wakefulness at night, as it can be stimulating.
- Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan more challenging activities such as doctor appointments, trips and bathing in the morning or early afternoon. Encourage regular daily exercise, but no later than four hours before bedtime.
- Talk to a doctor. Discuss sleep disturbances with a doctor to help identify causes and possible solutions. Most experts encourage the use of non-drug measures rather than medication.
- Be mindful of your own mental and physical exhaustion. If you are feeling stressed by the late afternoon, the person may pick up on it and become agitated or confused. Try to get plenty of rest at night so you have more energy during the day.
If the person is awake and upset:
Approach him or her in a calm manner.
- Find out if there is something he or she needs.
- Gently remind him or her of the time.
- Avoid arguing.
- Offer reassurance that everything is all right.
- Don’t use physical restraint. If the person needs to pace, allow this to continue under your supervision.
- Support groups can be very helpful, particularly an early-stage group for people with Alzheimer’s who are aware of their diagnosis and prefer to take an active role in seeking help or helping others; counseling is also an option, especially for those who aren’t comfortable in groups.
- Schedule a predictable daily routine, taking advantage of the person’s best time of day to undertake difficult tasks, such as bathing.
- Make a list of activities, people or places that the person enjoys and schedule these things more frequently.
- Help the person exercise regularly, particularly in the morning.
- Acknowledge the person’s frustration or sadness, while continuing to express the hope that he or she will feel better soon.
- Celebrate small successes and occasions.
- Find ways that the person can contribute to family life and be sure to recognize his or her contributions.
- Provide reassurance that the person is loved, respected and appreciated as part of the family, and not just for what she or he can do now.
- Nurture the person with offers of favorite foods or soothing or inspirational activities.
- Reassure the person that he or she will not be abandoned.
How to Respond to Anger and Aggression
Do: Back off and ask permission; use calm, positive statements; reassure; slow down; add light; offer guided choices between two options; focus on pleasant events; offer simple exercise options, try to limit stimulation.
Say: May I help you? Do you have time to help me? You’re safe here. Everything is under control. I apologize. I’m sorry that you are upset. I know it’s hard. I will stay with you until you feel better.
- Listen to the frustration. Find out what may be causing the agitation and try to understand.
- Provide reassurance. Use calming phrases such as: “You’re safe here;” “I’m sorry that you are upset;” and “I will stay until you feel better.” Let the person know you are there.
- Involve the person in activities. Try using art, music or other activities to help engage the person and divert attention away from the anxiety.
- Modify the environment. Decrease noise and distractions or relocate.
- Find outlets for the person’s energy. The person may be looking for something to do. Take a walk or go for a car ride.
- Check yourself. Do not raise your voice, show alarm or offense, or corner, crowd, restrain, criticize, ignore or argue with the person. Take care not to make sudden movements out of the person’s view.
- See the doctor. See the person with dementia’s primary care physician to rule out any physical causes or medication-related side effects.
- Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
- Rule out pain as the cause of the behavior. Pain can trigger aggressive behavior for a person with dementia.
- Focus on feelings, not the facts. Rather than focusing on specific details, consider the person’s emotions. Look for the feelings behind the words or actions.
- Don’t get upset. Be positive and reassuring. Speak slowly in a soft tone.
- Limit distractions. Examine the person’s surroundings and adapt them to avoid similar situations.
- Try a relaxing activity. Use music, massage or exercise to help soothe the person.
- Shift the focus to another activity. The immediate situation or activity may have unintentionally caused an aggressive response. Try something different.
- Take a break. If the person is in a safe environment and you are able, walk away and take a moment for yourself.
- Ensure safety. Make sure you and the person are safe. If the person is unable to calm down, seek assistance from others. Always call 911 in emergency situations. If you do call 911, make sure to tell responders the person has dementia, which causes them to act aggressively.
Aggressive behaviors may be verbal or physical. They can occur suddenly, with no apparent reason, or result from a frustrating situation. While aggression can be hard to cope with, understanding that the person with Alzheimer’s or dementia is not acting this way on purpose can help.
Causes of Aggression and Anger
Aggression can be caused by many factors including physical discomfort, environmental factors, and poor communication. If the person with Alzheimer’s is aggressive, consider what might be contributing to the change in behavior.
- Is the person able to let you know that he or she is experiencing physical pain? It is not uncommon for persons with Alzheimer’s or other dementias to have urinary tract or other infections. Due to their loss of cognitive function, they are unable to articulate or identify the cause of physical discomfort and, therefore, may express it through physical aggression.
- Is the person tired because of inadequate rest or sleep?
- Is the person hungry or thirsty?
- Are medications causing side effects? Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions?
- Is the person overstimulated by loud noises, an overactive environment or physical clutter? Large crowds or being surrounded by unfamiliar people — even within one’s own home — can be over-stimulating for a person with dementia.
- Does the person feel lost?
- Most people function better during a certain time of day; typically, mornings are best. Consider the time of day when making appointments or scheduling activities. Choose a time when you know the person is most alert and best able to process new information or surroundings.
- Are your instructions simple and easy to understand?
- Are you asking too many questions or making too many statements at once?
- Is the person picking up on your own stress or irritability?
Tips To Prevent or reduce agitation:
- Create a calm environment. Remove stressors. This may involve moving the person to a safer or quieter place, or offering a security object, rest or privacy. Try soothing rituals and limiting caffeine use.
- Avoid environmental triggers. Noise, glare and background distraction (such as television playing) can act as triggers.
- Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections, and skin irritation. Make sure the room is at a comfortable temperature. Be sensitive to fears, misperceived threats, and frustration with expressing what is wanted.
- Simplify tasks and routines.
- Provide an opportunity for exercise. Go for a walk. Garden together. Put on music and dance.
- Stay calm. Although being called by a different name or not being recognized can be painful, try not to make your hurt apparent.
- Respond with a brief explanation. Don’t overwhelm the person with lengthy statements or reasons. Instead, clarify with a simple explanation.
- Show photos and other reminders. Use photographs and other thought-provoking items to remind the person of important relationships and places.
- Travel with the person to where he or she is in time. If the person’s memory is focused on a particular time in his or her life, engage in conversation about recollections with an understanding that this is his or her current reality.
- Offer corrections as suggestions. Avoid explanations that sound like scolding. Try: “I thought it was a fork” or, “I think she is your granddaughter Julie.”
- Try not to take it personally. Alzheimer’s disease causes your loved one to forget, but your support and understanding will continue to be appreciated.