Judson Haims: We need to recognize behavior issues related to dementia

When we hire caregivers, we often find that the applicants have a wide range of experiences. Some applicants have been nurses for many years and others are just beginning their nurse training. Regardless of medical training and life experiences, one thing we have noticed is that most persons are relatively unfamiliar with how to work with patients and/or loved ones who exhibit behavior concerns that may be related to dementia.

How would you explain the meaning of the following words to a grade school child?

• Irony

• Symbolism

• Esoteric

Did you have to take a few moments to think about the meanings? What about a proper description using words appropriate for their vocabulary? This could be challenging, even frustrating.

Have you ever awoken in your bed and briefly felt you did not know where you were? If you have, was it briefly unsettling?

For persons with any type of dementia — Vascular dementia, Parkinson’s disease, dementia with Lewy Bodies and Frontotemporal dementia — such frustrations and unsettling occurrences happen regularly.

Often, people with dementia may overreact to an inconsequential setback or minor criticism. This might involve them screaming, shouting, making unreasonable accusations, becoming very agitated or stubborn, crying or laughing uncontrollably or inappropriately. This tendency to overreact is part of the illness and is called a catastrophic reaction.

A caregiver’s role, training and education when dealing with behavior concerns is vital. There may be occasions when the caregiver is no longer a bystander and must intervene in order to prevent an escalation in a behavioral situation from developing. Such situations can be physical, verbal or behavioral concerns. If the caregiver acts to prevent abuse, the caregiver should take steps.

When our prospective caregivers go through our training seminars, we educate them on a number of techniques to deal with behavioral concerns. The following information may be helpful for you when dealing your loved ones.

Deal with behavioral issues in the same way as aggression. The caregiver needs to stay calm and be clear in her/his directions. Do not get drawn into an argument or become aggressive; however, make it very clear that the abusive behavior will not be tolerated. Try asking questions to help understand their frustration, i.e. “I want to see if we can work this out, can you explain to me more about what’s going on?”

The caregiver should only intervene directly if there is immediate risk. The caregiver will need to use their communication skills to ensure that they do not make the situation worse and to ensure the person at risk is protected. Be aware of the level of your voice along with the tone and pitch. Also, if possible, try and speak to the person at an eye level lower than theirs — you don’t want to appear to dominate. Additionally, be aware of your body language, facial expression (try smiling) and eye contact.

If the caregiver must intervene in an abusive situation, they will need to act assertively. The caregiver must state firmly and clearly what they want to happen. Do not shout, panic or get into an argument. The caregiver can deal with the consequences later; the key is to stop the aberrant behavior. This is a time for action on the part of the caregiver, not the time for discussion (that can come later). An article, “Alzheimer’s and Dementia Behavior Management” from HelpGuide.org has some great information as does this article, from the Alzheimer’s Association, “Preventing and managing aggressive behavior in people with dementia.”

Expression can often be frustrating for persons with cognitive disabilities. You need to think out-of-the-box to find solutions that may aid them. We have found that using pictures and iPads are great tools. For persons with artistic abilities, painting and drawing can be not only soothing, but also a means of communicating feeling and emotions. Cooking and music are also great tools.

If you notice the onset of behavior changes with your loved one, be aware of changes to the environment, social interaction and overstimulation. Think about the person’s surroundings, as these will have an effect on their behavior. It may be that you can make small changes to the home that will make it a better environment for the person with dementia.

There are many resources available to provide education both here in the valley and online. Locally, you can call the Hope Center at 970-306-4673. Online, The Mayo Clinic and the Alzheimer’s Association are great resources.

Understanding what is causing the person’s behavior can help you find a solution. Remember, the behaviors are symptoms of dementia and are not meant to deliberately upset you.

Judson Haims is the owner of Visiting Angels Home Care in Aspen, Basalt, and Carbondale. He is an advocate for our elderly and is available to answer questions. His contact information is http://www.visitingangels.com/comtns or 970-328-5526.