Practical Strategies for Challenging Behaviors

As your loved one’s dementia progresses, you will most likely experience moments when their behavior feels challenging, confusing or maybe even completely unexpected.  Being aware of some of the most common challenging behaviors can help you feel better equipped to respond to them while encouraging and supporting your loved one.

Aggression and Agitation

What you can do:

• Stay calm.
  Keep your voice as calm as possible and avoid arguing or raising your voice, which may escalate the situation.
• Identify triggers.
  Try to determine if there is an underlying cause for the agitation/aggression – such as pain, discomfort or frustration – and address this cause first, if possible.
• Distract and redirect.
  Use a more pleasant activity to help shift your loved one’s attention.
• Create a calm environment.
  In stressful moments, try to reduce noise and stimulation that might be increasing their discomfort and angst.

Wandering

What you can do:

• Use safety measures.
  Install locks or alarms on doors and windows. Make sure that your loved one has an ID bracelet with contact information on it.
• Create a designated safe space.
  If possible, provide a safe, enclosed area where your loved one can explore and move freely without risks.
• Engage in activities.
  Keeping your loved one stimulated and engaged in meaningful activities can reduce their desire to wander.
• Keep a schedule.
  Maintaining a regular daily routine can provide structure and predictability, decreasing your loved one’s stress level and tendency to wander.

Repetitive Behaviors

What you can do:

• Pause and breathe.
  Repetitive questions and behaviors can make a caregiver’s patience run thin.  That is completely normal. In these challenging moments, take a second to breathe and remind yourself that repetitive questions and actions are usually due to memory loss, something your loved one cannot help.
• Use a gentle approach.
  Make every effort to answer repetitive questions from your loved one as calmly as possible with a brief, consistent answer.
• Engage their mind and hands.
  Finding an activity that engages your loved one’s hands and mind – such as sorting objects or folding laundry – can help distract their mind from repetitive behaviors.

Sundowning (Late-Day Confusion)

What you can do:

• Maintain a routine.
  Establishing a consistent and predictable daily schedule can reduce your loved one’s confusion and anxiety and help reduce the intensity of sundowning.
• Use natural light. 
  Increasing your loved one’s exposure to natural light during the day can help regulate their internal clock.
• Limit stimulants.
  Be sure to have your loved one avoid caffeine and sugar in the late afternoon and evening.
• Create a calm evening.
  Our body needs time to settle down in the evenings, and this is especially true for those with dementia.  Have your loved one spend time in a calm space prior to bedtime that includes minimal noise and soft lighting.

Hallucinations and Delusions

What you can do:

• Stay calm.
  Although this can be an alarming occurrence, your best efforts to remain calm and validate your loved one’s feelings and perceptions – without arguing or trying to convince them that they are false – will go a long way to help diffuse emotions and allow you to comfort your loved one.
• Create a safe environment.
  Make sure that your loved one’s living space is free of items that could be misinterpreted if your loved one is delusional or that may contribute to increased agitation during a hallucination.
• Use a distraction.
  Try gently redirecting your loved one to a task, song or discussion topic that they enjoy.

Sleep Problems

What you can do:

• Maintain a sleep routine.
  When possible, keep consistent wake-up and bedtime routines. Designated times and routines can help regulate your loved one’s internal clock.
• Encourage activity.
  Daily physical activity – without overstimulation – can improve your loved one’s sleep. With time and practice, you’ll be able to determine a good balance of activity and rest throughout the day so that your loved one has good potential for a successful sleep at night.
• Limit naps.
  Keep daytime naps short in order to help improve your loved one’s nighttime sleep.
• Create a comfortable sleep environment.
  Having a quiet, dark and comfortable environment can help your loved one sleep their best.

Resistance to Care

What you can do:

• Communicate with your loved one. 
  When you help with a care task, be sure to explain what plan to do in simple terms before starting the task.  Catching your loved one off-guard can increase resistance.
• Encourage independence.
  Allow your loved one to do as much as they are able to do on their own and offer support to them only when needed.
• Be gentle.
  A gentle approach with calm communication can help reduce agitation and stress for both you and your loved one. Be mindful or allowing your loved one extra time so that you avoid rushing them.
• Use familiar things.
  Having a predictable and familiar routine can help your loved one be less resistant to care. In addition, incorporating familiar objects – or even a special or favorite item – can provide comfort to your loved one while you provide care.

Paranoia and Suspicion

What you can do:

• Provide reassurance.
  Instead of arguing about their suspicions or being dismissive of them, try to provide gentle reassurance to your loved one.
• Minimize confrontation.
  As difficult as it may be, try not to take the accusation personally. Take a moment to breathe and remind yourself that your loved one’s behavior is due to the complexity of the disease, something your loved one cannot help or avoid.
• Maintain a calm environment.
  In addition to keeping yourself calm, try to keep the environment calm as well. Seek to have it be a safe space where your loved one can share their concerns, which can be met with your calm and caring response.