1. Behavior Changes: Causes and Techniques
Yolanda Wright, MSW
Early Stage/ Support Group Coordinator
Alzheimer’s Association- Greater Maryland Chapter

2. Communication
Communication is so much more than just the exchange of words
When we communicate a message to others, it consists of three parts:
Words 7% Voice 38%
Body Language 55%
93% is conveyed NON VERBALLY

3. Communication Challenges
Speech
- Word finding
- Repeating words
Reading and Writing
- Reading small print
- Comprehending groups of words
Language
- Vocabulary skills, may revert to native language
- Ability to convey ideas
- Ability to understand
- Ability to speak, use words correctly

4. Expressive Methods Used to Communicate
Screaming
Repetition
Nonsensical verbal noises
Confabulation

5. Strategies: Verbal & Non-Verbal
Volume of voice, soft pleasant
Word choices
Identify yourself
One-step directions
Don’t argue
Non-threatening body language
Eye contact
Front approach
Stoop, squat or sit
Slow movement
Cueing, pointing, demonstrating
Touch

6. Strategies: Verbal & Non Verbal
Provide the solution rather than the question
Avoid confusing expressions
Avoid vague words
Always try to turn negatives into positives
Avoid quizzing
Use simple written reminders
Use pictures to replace written reminders
Refrain from discussing plans until just prior to event

7. Understanding Behavior
Changing caregiver behaviors to better meet the needs of the person with dementia
Treat the CAUSE of the behavior, NOT the behavior
Correctly identifying what has triggered agitated behavior can help in selecting the best intervention

8. Triggers Environment - Change in living arrangements - Travel
- Hospitalization
- Presence of houseguests
- Bathing
- Being asked to change clothes
- Noise
- Boredom

9. Additional Triggers
Medical Conditions - Poor sensory functions - Impaired mobility or pain - Infections - Dehydration - Toxic effects of medications Human Factors - Caregiver approach - Communication challenges - Fail to understand the person’s habits, likes, dislikes and routines

10. Goals in Behavior Management
Decrease stress in patient and family
Increase patient’s self-esteem
Tap into individual’s talents and strengths
Maximize independencies
Improve quality of life
Validate behaviors
Increase sense of fellowship with other people
Maintain social skills

11. Catastrophic Reaction
Definition:
Overreaction to a minor problem
Cause:
The patient feels…
Overwhelmed
Frightened
Frustrated
Over stimulated

12. When is behavior a problem?
If it violates the rights of others
If it poses a threat to someone’s health and safety (including their own)

13. Common Challenging Behaviors
Aggression
Anxiety or agitation
Confusion
Repetition
Suspicion/delusions/paranoia/
hallucinations
Wandering and getting lost
Trouble with sleep
Sundowning

14. Aggression
Aggressive behaviors may be verbal (shouting, name calling) or physical (hitting, pushing). These behaviors can result suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is important to understand what is causing the person to become angry or upset.

15. How to respond Try to identify the immediate cause
Rule out pain as a source of stress
Explore environmental changes
Focus on feelings, not facts
Don’t get upset
Limit distractions
Try a relaxing activity
Shift the focus to another activity/redirect

16. Anxiety or Agitation
A person with Alzheimer’s or another dementia may feel anxious or agitated. He or she may become restless and need to move around or pace. Or, the person may become upset in certain places or focused on specific details.

17. How to respond Listen to the frustration Provide reassurance
Involve the person in activities
Modify the environment
Find outlets for energy

18. Confusion
A person with Alzheimer’s or another dementia may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The purpose of common items, such as a pen or fork may also be forgotten. The situations are difficult and require patience and understanding.

19. How to respond Stay calm Respond with a brief explanation
Show photos or other reminders
Offer corrections as suggestions
Try not to take it personally

20. Repetition
A person may do or say something over and over again- like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity They may also pace or undo what has just been done. These actions are harmless yet stressful for caregiver.

21. How to respond Look for a reason behind the repetition
Remove things in the environment that may trigger repetitive questions
Focus on the emotion, not the behavior
Turn the action or behavior into an activity
Stay calm and be patient
Provide an answer
Distract the person with a favorite activity
Use memory aids- reminder notes or pictures
Accept the behavior. Work with it. If it isn’t harmful, don’t worry about it. Find ways to work with it.

22. Suspicion/delusions/paranoia/ hallucinations
Memory loss and confusion may cause a person to perceive things in new, unusual ways. Individuals may experience false ideas (delusions) and become suspicious of those around them, accusing others of theft, infidelity, and other improper behavior. Sometimes a person may misinterpret what he or she sees and hears; see and hear things that are not real (hallucinations).

23. How to respond Rule out physical/medication problems
Provide bright, evenly-lit living spaces
Don’t take offense
Don’t argue or try to convince
Offer a simple answer
Switch the focus to another activity
Duplicate any lost items

24. Wandering and getting lost
It’s common for a person with dementia to wander and/or become lost. In fact more than 60% of individuals with Alzheimer’s will wander at some point. They may try to go home when already there or attempt to recreate a familiar routine such as going to school or work.

25. How to respond Encourage activity Inform others Make the home safe
Sign up for Alzheimer’s Association Medic Alert + Safe Return and Comfort Zone

26. Trouble with sleep
People with dementia may have trouble sleeping or experience changes in their sleep schedule. Scientists don’t completely understand why these sleep disturbances occur. As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer’s on the brain.

27. How to respond Make a comfortable environment
Maintain a set bedtime and waking routine
Get the person up earlier or keep them up later
Talk to a doctor
Avoid stimulants
Consider accommodating the person’s need to be up at night

28. Sundowning
Sundowning occurs in the afternoon/evening. Disorientation, confusion, anxiety, pacing and agitation are common problems. Causes can include mental and physical exhaustion, increased noise and busyness at home, and reduced lighting and increased shadows.

29. How to respond Reduce noise and activity levels
Have the person engaged in appropriate physical activities during the day
Monitor your exhaustion
Plan ahead for calm evenings
Identify triggers
Plan for light dinners
Keep the home well lit in the early evening
Don’t physically restrain
Channel restlessness
Plan a medication schedule
Use pharmaceutical intervention as a last resort

30. 10 Quick Tips: Responding to Behaviors
1. Remain flexible, patient and calm
2. Explore pain as a trigger
3. Respond to the emotion, not the behavior
4. Don’t argue or try to convince
5. Use memory aids
6. Acknowledge requests, and respond to them
7. Look for the reasons behind behavior
8. Consult MD to identify causes related to meds or illness
9. Don’t take the behavior personally
10. Share your experience with others