Alzheimer Disease and Dementia Understanding and Dealing with Difficult Behavior.

It's important to know that angry, agitated behavior is the result of unmet needs in people with Alzheimer Disease and those with other types of Dementia. There are numerous possible causes.
 
Physiological or medical causes:
 

• Physical discomfort such as constipation, pain, or illness can be expressed as anger
• Adverse effects of medications such as sedatives or psychotropic drugs
• Sleep deprivation
  
• Impaired vision and/or hearing may cause misunderstanding
  
• Sensory overload – too much activity, too many people, too much noise, over stimulation
  
• Feeling lost, insecure, forgotten. Person may feel abandoned when surrounded by unfamiliar people
  
• Difficulty adjusting from lit to darkened areas and vice versa
• Sudden movements or noise
• Feeling hot or cold in environment

 
Other Causes
 

• Response to caregiver impatience, stress or irritability
• Activity perceived as insulting
• Surprised or frightened by unexpected physical contact
• Person scolded, confronted or contradicted
• Responding to conflict around them
• Change in schedule or routine
• Being asked to respond to multiple questions at once
• Attention span to short for requested task
  
• Instructions unclear or too complicated
  
• Task not broken down into manageable steps
  
• Inability to perform what was once a simple task, e.g. putting on shirt
  

 
Coping Strategies for Caregivers
 

• Medical assessment to rule out physical problems/medication problems
  
• Discuss drug side effects or possible interactions with physician
  
• Have vision and hearing checked
  
• Dental visit, possible tooth decay or poor fitting dentures
  
• Make sure person is comfortable – clothes fit properly, shoes fit properly
  
• Alternate quiet times with active periods
  
• Plan activities when person is rested and plan for periodic rests during activity.
  
• Keep daily routines consistent. For some people with dementia, even a slight change in routine can cause confusion and disorientation.
  
• When a change of routine is necessary try to gradually accustom the person to the change.
  
• Simplify the environment by reducing the number of people, noise, and clutter.
  
• Do not move furniture or familiar items.
  
• Person may lose sense of time. Orientate with calendars and large clocks.
  
• Remove sharp utensils and items from environment to prevent injuries.
  
• Exercise to help reduce stress. Walking or dancing are helpful.
  
• Calm or familiar music, massage, or readings are ways of calming a person.
  
• Using gentle physical touch may be calming, hugging or holding hands may be comforting to some and perceived as restraining by others.
  

 
Communication Strategies
 

• Have the person’s attention before speaking and touching.
  
• Avoid questions that rely on memory.
  
• Try not reason with the person, as they may not be able to think logically. This frequently ends in frustration.
  
• Do not express anger or frustration with physical gestures. Body language is easily sensed and can lead to increased agitation and confusion.
  
• Speak clearly and slowly using simple, short sentences.
  
• Always approach the person from the front. Approaching from behind may startle or frighten the person.
  
• Use repetition. Frequent, clearly stated reminders are needed to reassure persons with dementia.
  

 
 
The Alzheimer Society in your community will provide you with advise, education, support, and information about day programs available in your area. 
Remember to take care of yourself, so that you can take care of them.