1. Leslie Pedtke, LNHA, King Management Company
Partnering with Family Members in the Care of Their Loved Ones with Dementia
Leslie Pedtke, LNHA, King Management Company

2. Understanding Behavior
“When you remember me, it means that you have carried something of who I am with you, that I have left some mark of who I am on who you are…For as long as you remember me, I am never entirely lost. When I’m feeling most ghost-like, it is your remembering me that helps remind me that I actually exist.” – Frederick Buechner
Understanding Behavior

3. Common signs of Dementia
Memory loss
Difficulty planning and carrying out tasks
Language problems
Decreased ability to concentrate
Visual, spatial and perception problems
Difficulty with complex tasks and learning new concepts
Personality changes

4. 50-80% of individuals with moderate and severe symptoms of dementia display clinically significant behavior problems.
64-83% of those in US nursing homes exhibit behavior problems
Up to 90% of behaviors may be triggered by the caregiver approach or something added to or missing from the social and/or physical environment.
Statistics

5. Behavior is
communication

6. Progressively Lowered Stress Threshold
Triggering Event
Something happens to cause the individual stress.
Inability to cope with stress
Stress threshold is lower for a person with dementia than those without cognitive deficits.
Catastrophic Reaction
Stress flips into a catastrophic event.

7. Caregiver communication
Common Triggers
Physical
Emotional
Environmental
Task-related
Caregiver communication

8. When a behavior occurs ask yourself the following questions:
When did it happen?
Where did it happen?
What happened leading up to the behavior?
Who was involved?
How often has this occurred?
Is it becoming a pattern?

9. Be proactive Focus on a familiar skill or task
Repeat instructions as needed
Break tasks down into simple steps
Demonstrate as needed
Limit distractions
Recognize triggers of the normal flow of a person’s day

10. Use good communication skills
Choose wisely your words
Tone of your voice
Body language
Approach
Eye contact
Sound level of your voice

11. Communication Do’s and Don’ts
Listen carefully
Argue, confront or correct
Help a person fill in the blanks
Give orders or make demands
Read facial expressions
Talk down to a person
Give compliments
Talk about a person as if they aren’t there
As open ended questions
Try to explain or prepare in advance
Give generous praise
Take negative comments seriously
Enjoy the person in every possible way
Be insincere, asking questions when you are in fact not giving a choice

12. Greetings and Magic Phrases
“I need your advice.”
“I need your help.”
“I’m sorry.”
“I was wondering…”
“Isn’t that always the way.”
“I’ve come to see how you are.”
“I’m so glad to see you!”
“Seeing your face really brightens my day!”
“What a warm smile you have!”
“I’ve come to see you. I hope this is a good time.”

13. Compliments and Encouragement
“I’d like to invite you to…”
“While I’m here may I help you…”
“Could you give me a hand with…”
“It would mean a lot to me if you would join me…”
“Could we do this together?”
“You have the magic touch!”
“I have always loved that color on you.”
“I really enjoy talking to you. You always make me feel better.”
“Seeing you is the best part of my day.”
“Well done!” or “Way to go!”

14. Behavioral and Psychiatric Symptoms of Alzheimer’s Disease
Sleep disturbances
Physical and verbal outbursts
Emotional distress
Restlessness, pacing, repetitive actions
Delusions (firmly held beliefs in things that are not real)
Hallucinations (seeing, hearing, or feeling things that are not there.
Behavioral and Psychiatric Symptoms of Alzheimer’s Disease

15. Wandering People with dementia walk, seemingly aimlessly for a variety of reasons:
Make time for regular exercise.
Recognize a person’s need for wandering.
Bathroom
Hungry
Boredom
Tired
Anxiousness (pacing)
Pain
Trigger of the day

16. Paranoia
If a person suspects money is missing, support their need to have money on them by providing a small amounts of money in their pocket for inspection.
Offer support by helping them look for the missing object. Validate their feelings by saying things like, “I’m sorry this is missing. I know how much it means to you.”
Try non-verbal reassurances like a gentle touch or hug.
Remember what the person is experiencing is very real to them.

17. Repetitive Speech or Actions
Provide plenty of reassurance and comfort
Try distracting with food and drink or movement
Never remind them they just asked that same question
Learn to recognize certain actions. An agitated state or pulling at clothing, for example, could mean the need to use the bathroom.
People will often repeat a word, statement, question or activity over and over.

18. Agitation and anxiety Reduce caffeine intake, sugar, and junk food
Reduce noise and clutter
Maintain a certain structure of the day by keeping to routines.
Try gentle touch, soothing music, reading or walks.
Support independence as much as possible.
Agitation refers to a range of actions including irritability, sleeplessness, and aggression. Remember what caused a person anxiety before their diagnosis of dementia.
What is their life story?

19. Eating and Nutrition
Meals are a social event, they shouldn’t be viewed as a task.
Involve the person in meal choices and prep if possible.
Eating independently should take precedence over eating neatly.
Sit down and eat with the person.
It is important to ensure that the person is eating enough nutritious food and drinking enough fluids.

20. Bathing
Adopt past bathing routines as much as possible
Respect modesty
Be mindful of the environment and safety..
Never leave a person with dementia unattended in the bath or shower.
If hair washing is a struggle use dry shampoo.
Remember there are alternatives to getting clean that don’t have to include a shower or bath.
People with dementia often have difficulty remembering good hygiene.

21. Family perspective: Feelings of grief and loss of control
Denial
Convincing themselves that the person has not changed
Attempting to normalize problematic behaviors
Anger
Being frustrated with the person or the caregiver
Resenting family members that cannot or will not help.
Feeling abandoned
Guilt
Having unrealistic expectations
Feelings that somehow they failed
Sadness
Feeling overwhelmed by loss
Withholding or displaying emotions more than usual
Acceptance
Learning to live in the moment
Asking for and accepting help from others
Family perspective: Feelings of grief and loss of control
Dementia gradually takes away the person they know and love. As this happens, the family may experience the different phases of grieving.

22. Just be with me…
Tips for a meaningful visit for Person’s Living with Memory Loss

23. Approach warmly and speak in soothing tones.
Be in the moment. Don’t dwell on what was or how things will be tomorrow.
Approach warmly and speak in soothing tones.
Speak directly to the person.
Don’t worry if comments don’t make sense or aren’t entirely accurate.
Use art as a tool to communicate.
Read to the person.
Give a hand or foot massage.
Lay or sit next to the person and just hold hands. Sometimes the best times are just sharing space with those we love.
Utilize the senses. Smells and sounds bring back memories.
Practice empathy and validation.
Be willing to try something different on each visit.

26. Thank you
Leslie Pedtke