Managing Difficult Behaviors
Some of caregivers’ greatest challenges come from the mood, personality, and behavior changes that occur as Alzheimer’s progresses.
Dear Caregivers,
Many caregivers report that some of their greatest challenges come from the mood, personality, and behavior changes that can occur in your loved one as their Alzheimer’s disease progresses.
Here at NAN we recommend handling these situations with a clear understanding that this behavior is not directed at you, but rather is caused by the biological impact of your loved one’s Alzheimer’s disease on their brain. Our emotions are "housed" in two key areas of our brains: One area, called the “frontal lobe,” is the brain’s center for personality, judgment, and emotional control. Alzheimer’s can damage this part of the brain, resulting in your loved one having difficulty controlling emotional responses such as anger or sadness.
At the same time, however, Alzheimer’s leaves intact the other key emotional center of the brain, known as the “amygdala.” As a result, while your loved one's emotional control center is being damaged, the amygdala continues to function as it always has, causing a range of positive emotions such as happiness, joy, love, and humor, as well as negative emotions such as fear, anxiety, loneliness and the "fight-or-flight" response. It is your loved one’s ability to continue to feel fear and anxiety, along with their inability to control their emotional response, that creates a potential for exaggerated emotional responses or unexpected upset.
Some strategies to manage these challenges include:
Look for a trigger for the behavior: Is your loved one in pain, hungry, tired, or feeling overwhelmed? Once you identify the trigger, you can try to resolve the underlying issue that is causing the behavior.
Have a daily routine: Having a predictable structure to the day can help reduce confusion and anxiety in your loved one. Consider creating a written daily schedule if your loved one is capable of using it. Other loved ones may be helped more by gentle verbal reminders of upcoming events during the day, but not too far in advance. For example, at breakfast, mention that you want to take a walk after you eat. Before dinner, suggest that it is a good time to read for a bit while you are getting the meal prepared.
Create a “safe space:” Make sure your loved one is surrounded by things they take comfort in, such as a favorite pillow, chair, or books.
Redirect attention: If your loved one becomes upset or agitated, redirect their attention to an activity that they enjoy.
Use a calming communication style: Don’t raise your voice or confront your loved one, but instead talk in calm, reassuring tones.
Give them a hug: Physical contact such as holding your loved one’s hand or giving a hug can be a calming force in reducing their agitation.
Read on for more on managing these challenging situations.
Stay Flexible!
It’s important to remember that while Alzheimer’s disease is changing your loved one’s mind, YOU cannot change your loved one. Because of the disease, your loved one’s brain is damaged in certain key areas controlling mood, personality, judgment, and behavior. It is not something that you can control. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.
Common Challenges in Caring for People with Alzheimer’s:
The symptoms of Alzheimer’s disease affect both your loved one and those who interact with them, especially caregivers. As Alzheimer’s alters your loved one’s ability to think and function, those changes may impact others, too. Here are some common challenges you may face and strategies that can help.
Understanding Clinging and Shadowing:
For people with Alzheimer's disease, clinging and shadowing behaviors can occur, which can be quite challenging for a caregiver. Being followed everywhere and being repeatedly interrupted when trying to complete a task is a common source of caregivers’ frustrations. Here are some coping strategies.
If Your Loved One Wanders:
While having your loved one wandering around the house might be challenging to you as a caregiver, it’s not necessarily unsafe. However, some wandering can be dangerous, including going into areas of the house such as stairwells, decks, hot tubs, or swimming pools. Also dangerous is your loved one leaving the house, yard, or property alone. To address the challenges of your loved one wandering, you can try some of these tactics.
Sundowning and How To Manage It:
Sundowning is a state of increased confusion, agitation, activity and negative behaviors which happen late in the day through the evening hours. When sundowning, the person may become demanding, suspicious, upset, or disoriented, see or hear things that are not there, and believe things that are not true. They may pace or wander around the house while others are sleeping. Here are some tips for potentially reducing the occurrence of sundowning and softening its effects when it does happen.
Remember, if you can’t find the information you need on our website, you can always “Ask NAN” by clicking on this link.
Best,
Rosemary D Laird, MD, MHSA
Founder and Chief Medical Officer
“It always seems impossible until it’s done.”
— Nelson Mandela
