Unexpected behavior and what to do about it

For the caregivers can the behavior of persons with dementia be very surprising and unexpected. They have to cope with dementia-related emotional problems such as:

Anger and frustration

Anger often arises as a response to feeling frightened, frustrated, embarrassed or humiliated.

What might seem like random aggression could be the result of something in the environment. New places, strangers, activity and noise can be distracting or upsetting.

Some people with dementia may also get angry or frustrated when a caregiver tries to assist them because they cannot successfully perform a task on their own.

Caregivers should try breaking down complex tasks into smaller manageable steps to avoid overwhelming or frustration. Give the care recipients the chance to make their own decisions. Even when it is about small issues.

Depression

Depression as already mentioned is common for persons with dementia. The feeling of social isolation and loss of control that comes with the progression of dementia may contribute to depression and loneliness. It can be difficult to distinguish depression from dementia because some of the symptoms are the same, like apathy, memory loss, or trouble with sleeping (insomnia).

Caregivers who suspect that the care recipient has a depression, should talk to a doctor to determine if medical treatment or counseling is warranted. Caregivers should also try to make a bigger effort to keep the individual active and socially involved.

Anxiety and clinging

Anxiety may be due to difficulty processing information and experiences, both new and old. New places and faces can be unsettling for individuals with dementia, especially as their memories of familiar places and faces fade away. Some people respond to anxiety by pacing, experiencing insomnia, or restlessness; others may choose to cling to familiar objects or individuals.

The best thing caregivers can do for a person who feels anxious is to reassure and remind how much they care. It Can be helpful to come up with peaceful and distracting activities.

Mood swings

Sometimes people with dementia have mood swings because they are frustrated by a loss of abilities. Sometimes they are just scared, confused, or tired. Mood swings may also occur because an person has pain, is too hot or cold, is hungry or is bored. Other possible explanations include untreated psychiatric disorders, diet, caffeine, feeling rushed, clutter, noise and general “overstimulation”. Dementia may lower a person’s inhibitions or “filter” when it comes to expressing emotions, resulting in an increase in crying or angry outbursts.

Try to accept that mood swings are caused by dementia and are not the individual purposely acting out. To lessen the severity of mood swings and make occurrences less frequent, knowing the persons like’s and dislike’s is key, i.e. knowing what calms the person down, what upsets him/her, times of the day the individual is more likely to act out, favourite music and activities, etc. This allows the caregiver to predict when mood problems might occur, do your best to avoid them, and if they occur, know what might soothe the individual. Minimize distractions and noises, and be very patient.

The video “Henri Alive Inside” shows the influence of music on the behavior en mood of a very passive person.

https://www.youtube.com/watch?v=UlWBmUUutL0

Examples

Case 1:

A person in a nursery home with Alzheimer’s dementia is assisted daily with personal hygiene. He is able to go out to the bathroom himself and likes to. However, in the middle of the process he starts shouting for “help” so that it can be heard all over the nursing home and he looks scared. The social and health care assistant who is going to help him cannot figure out what is going on. With sparring, she finds that he feels that everything is going too fast for him and in the middle of the process; he cannot stand it anymore, but yells for help.

His need is for the care to take place at a pace where he can take part and not feel “run over” and that his long latency is taken into account. The assistant is now aware of this, she is grooming herself before going in and everything is now done at less than half the pace. When she does, she can complete the care without him yelling or getting scared

Another example of a need, which is not meet:

Case 2:

The person in a nursery home has vascular dementia. He is a sweet and kind person. He has been a night watchman at a newspaper all his life. He is not very socially inclined and does not like being with the others. His ability to function is very fluctuating. The night caregiver helps him to bed.

He gets upset at 8 o’clock in the evening. He gets something to eat and drinks a lot of coffee, cola and beer. The staff ration his drinks, as he has a heart disease and cannot administer them himself. The problem is that he is constantly shouting “Hello”. The caregivers try themselves out by contacting him for a very structured period of varying duration. The staff finds out that 15 minutes of contact with the person is needed before he feels tranquil and at ease. It helps and then he does not yell. During the evening, 15 minutes of contact time is planned, more times during the evening so that he does not feel alone and yells.

Case 3:

A resident in a nursery home with Alzheimer’s dementia of moderate severity, sits outside her residence in the hallway shouting, “Hello, is anyone here” all the time. The other residents get angry with her and tell her to “shout up” because she is awful listen to. When they say that, she looks at them incomprehensibly and then continues her shouting. The shouting can turn out to make contact, therefor the citizen shouts, even if this contact is negative.

Caregivers systemize their contact with her so that she gets contact at specified times and the contact is not put in the context of yelling.

Case 4:

The resident in a nursery home with Lewy Body Dementia has lived in nursing homes for five years. He has a wife who visits him with their dog and he has a deceased daughter. He is a wheelchair user and very space / directional disturbed. There have been problems around personal hygiene for a while. He gets very angry and lashes out for those who help him. The staff lifts him up in a toilet sling and wash him. They talk a lot and try to distract him, but he is very frightened and seems tactile shy.

The caregivers are now planning a different approach to the person. The person is very disturbed in his perception of space and he cannot feel himself when he is raised in a hoist. They decide to make sure that everything is collected and clear before they begin the personally care, including wet rags. They significantly slow down the pace. They limit the conversation to what they need and one provides hygiene while the other keeps in eye contact with him. It turns out that he can wash himself beneath with the help of mirroring. He responded with tears, joy, smiles, and life came to his eyes

Case 5:

An 81-year-old woman with Alzheimer’s dementia. She is living in a nursing home with her spouse, however not in the same apartment. He knows she is his wife and he is trying to help her, but she does not know she is his wife. They have a daughter with whom she has good contact and the daughter comes daily. The women has worked as a daycare provider. She is a happy and kind person, easy to smile. She suffers from arthritis and she is a catheter user and incontinent for stools. She is very timid and shy. She was raped earlier in her life and it has left her marked. During the personal care, she is scared out of her mind and screams throughout the process of the personal hygiene. The way the caregivers handle this is by one removing the duvet and one holding her hands away from the diaper. They constantly explain what they do.

The assistants then choose to change the method of care. Both lower the pace of their action. One of them constantly keeps eye contact with the citizen and does not talk together during the process. The other caregiver rolls the quilt up from below so the citizen can constantly hug it, even when she has to turn. It also means she cannot see the caregiver who washes her. Furthermore, the staff is aware of only touching her one at a time so that she does not experience it as an abuse. These changes mean that staff can complete the personal care without the citizen screaming a single time.

Persons with dementia have increased vulnerability and reduced tolerance to stress. One can reduce noise and stimuli in the surroundings.