Reprinted from: Coping With Challenging Behaviors: Educational Strategies for Work With Alzheimer’s Families*By Elizabeth A. Hinman-Smith, M.S.W. and Lisa P. Gwyther, M.S.W.
Introduction
In general, people with dementia will respond best to a stable, familiar environment and an established routine. Their activities should emphasize remaining abilities and strengths. Allowing a person with Alzheimer’s disease to participate in normal activities will help to maximize the person’s functioning and will help preserve self-esteem. Despite these precautions, difficult or frustrating situations will occasionally arise for the person with dementia and their caregiver. When this happens, the most useful overall strategy is to distract the demented person with a new topic or pleasurable activity. In this way, memory loss can be used to advantage...the source of the argument or frustration is often soon forgotten when something else is focused on.
Challenging Behaviors
Special Issues for Family Care
Bathing "Mother just refuses to take a bath now...it's such a struggle to keep her clean. She was always very meticulous about how she looked before and now it's a fight to get her in the tub."
Bathing
"Mother just refuses to take a bath now...it's such a struggle to keep her clean. She was always very meticulous about how she looked before and now it's a fight to get her in the tub."
Back to top Dental and Mouth Care "John seems to forget he needs to clean his teeth. It's gotten so I have to show him how each time, to get him started. I didn't believe he'd ever remember."
Back to top
Dental and Mouth Care
"John seems to forget he needs to clean his teeth. It's gotten so I have to show him how each time, to get him started. I didn't believe he'd ever remember."
Dressing and Grooming "My wife insisted on wearing the same clothes every day for days on end. We had to take them to wash only on the nights we could get her into her nightgown. So, I bought two more outfits of the exact same blouse and slacks. Now she changes into fresh clothes and we rotate the clean with the dirty."
Dressing and Grooming
"My wife insisted on wearing the same clothes every day for days on end. We had to take them to wash only on the nights we could get her into her nightgown. So, I bought two more outfits of the exact same blouse and slacks. Now she changes into fresh clothes and we rotate the clean with the dirty."
Back to top Eating "Daddy used to clean his plate and then have seconds. He was always a good eater. But now he never seems hungry - we have a hard time getting him to eat, though he still likes sweets the best."
Eating
"Daddy used to clean his plate and then have seconds. He was always a good eater. But now he never seems hungry - we have a hard time getting him to eat, though he still likes sweets the best."
Back to top Incontinence "I know he feels bad when he soils his clothes...and so do I. It's hard not to get upset when it happens, especially at night when I need to change the bed."
Incontinence
"I know he feels bad when he soils his clothes...and so do I. It's hard not to get upset when it happens, especially at night when I need to change the bed."
Back to top Wandering "Lately, she has started just taking off - she thinks she had to be going somewhere all the time. I'm afraid she'll go out of the house when my back is turned and get hurt."
Wandering
"Lately, she has started just taking off - she thinks she had to be going somewhere all the time. I'm afraid she'll go out of the house when my back is turned and get hurt."
Back to top Sleep Problems "My husband used to get up often at night and was very confused. I finally got him to rest in his recliner in front of the TV and he calmed down and fell asleep. He seems to feel more secure there."
Sleep Problems
"My husband used to get up often at night and was very confused. I finally got him to rest in his recliner in front of the TV and he calmed down and fell asleep. He seems to feel more secure there."
Back to top Communication "Some days I can't understand a word he says. When I ask him to repeat things, he gets angry with me."
Communication
"Some days I can't understand a word he says. When I ask him to repeat things, he gets angry with me."
Back to top Repetitive Speech and Gestures "Sometimes she'll ask the same question over and over again. It's okay for awhile, but then it gets to me. I get frustrated and snap at her...then we both feel bad."
Repetitive Speech and Gestures
"Sometimes she'll ask the same question over and over again. It's okay for awhile, but then it gets to me. I get frustrated and snap at her...then we both feel bad."
Back to top Catastrophic Reactions "Sometimes she gets so angry. She never used to be that way -- she was a gentle person. Now you never know what will set her off."
Catastrophic Reactions
"Sometimes she gets so angry. She never used to be that way -- she was a gentle person. Now you never know what will set her off."
Back to top Hiding Things "I have to be sure to get to the mailbox before he does. Last month he hid two bills and we got late notices before I even knew things had come due."
Hiding Things
"I have to be sure to get to the mailbox before he does. Last month he hid two bills and we got late notices before I even knew things had come due."
Back to top Aggressive Behaviors "When he says something that's not true, I try to correct him. Then he gets angry. There's just no arguing with him. It scares me how angry he gets at times."
Aggressive Behaviors
"When he says something that's not true, I try to correct him. Then he gets angry. There's just no arguing with him. It scares me how angry he gets at times."
Back to top Sundowning "Lately Mamma gets really agitated, fidgety, and irritable around suppertime. She gets all "revved up" and it's hard to settle her down for bed."
Sundowning
"Lately Mamma gets really agitated, fidgety, and irritable around suppertime. She gets all "revved up" and it's hard to settle her down for bed."
Back to top Inappropriate Sexual Behaviors "Lately Mom has been trying to undress at the Day Care Center. It just started in the last two weeks. If she starts doing it when she is out with me, I don't know what I would do."
Inappropriate Sexual Behaviors
"Lately Mom has been trying to undress at the Day Care Center. It just started in the last two weeks. If she starts doing it when she is out with me, I don't know what I would do."
Back to top Fear "He gets so nervous and scared sometimes. It seems especially bad when he's someplace new. He even gets frightened when he can't see me, even though I'm in the next room. Sometimes he thinks someone is trying to break in."
Fear
"He gets so nervous and scared sometimes. It seems especially bad when he's someplace new. He even gets frightened when he can't see me, even though I'm in the next room. Sometimes he thinks someone is trying to break in."
Back to top Shadowing "He never gives me a moment to myself. I can't even take a shower or use the bathroom anymore without him pounding on the door looking for me."
Shadowing
"He never gives me a moment to myself. I can't even take a shower or use the bathroom anymore without him pounding on the door looking for me."
Back to top Hallucinations and Delusions "Mom always thinks she sees a man on a bicycle outside the window. She's not afraid, but insists he's there. Daddy always teases her that he's going to go out and run her suitor off. It makes her laugh."
Hallucinations and Delusions
"Mom always thinks she sees a man on a bicycle outside the window. She's not afraid, but insists he's there. Daddy always teases her that he's going to go out and run her suitor off. It makes her laugh."
Back to top Profanity and Obscenity "My husband was always a polite Christian person...always considerate of others. Now he swears like a sailor. I find it so offensive. Before his illness, he'd never dream of using such words."
Profanity and Obscenity
"My husband was always a polite Christian person...always considerate of others. Now he swears like a sailor. I find it so offensive. Before his illness, he'd never dream of using such words."
Back to top Special Issues for Family Care Activities "My wife can't handle the cooking anymore. She also doesn't work on her needlework. She's idle so much of the day, but I don't know what to give her to do."
Activities
"My wife can't handle the cooking anymore. She also doesn't work on her needlework. She's idle so much of the day, but I don't know what to give her to do."
Back to top Driving "I worry about him driving. He does alright on familiar roads, but his judgment and sense of direction aren't as good."
Driving
"I worry about him driving. He does alright on familiar roads, but his judgment and sense of direction aren't as good."
Back to top Handling Money and Valuables "Last week I looked in his wallet and there was $900. I called the bank and he'd made a $2,000 withdrawal last week. I have no idea where the rest is!"
Handling Money and Valuables
"Last week I looked in his wallet and there was $900. I called the bank and he'd made a $2,000 withdrawal last week. I have no idea where the rest is!"
Back to top Holidays "The holidays can be bittersweet time for caregivers. But there are ways to make them fun and relaxing for family members and patients."
Holidays
"The holidays can be bittersweet time for caregivers. But there are ways to make them fun and relaxing for family members and patients."
Back to top Visiting the Doctor/Dentist "I know we should have her checked at the doctor's office, but she refuses to go."
Visiting the Doctor/Dentist
"I know we should have her checked at the doctor's office, but she refuses to go."
Back to top *Reprinted with the permission of Memory and Movement Disorder ClinicJoseph and Kathleen Bryan Alzheimer's Disease Research Center (ADRC)Division of Neurology, Department of Medicine, Duke University Medical CenterSupported by an educational supplement grant (AG05128) from the National Institute on Aging, 1990.
*Reprinted with the permission of Memory and Movement Disorder ClinicJoseph and Kathleen Bryan Alzheimer's Disease Research Center (ADRC)Division of Neurology, Department of Medicine, Duke University Medical CenterSupported by an educational supplement grant (AG05128) from the National Institute on Aging, 1990.