Fight Against: Alzheimer’s disease

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Did you know Alzheimer’s disease and other dementias can cause people to act in different and unpredictable ways? Some individuals become anxious or aggressive, while others repeat certain questions or gestures, and many misinterpret what they hear. These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. So, it becomes important to understand that the person is not trying to be difficult and that all behaviour is communication.

Identify behaviours

Each person is unique, with their own life history, personality, likes and dislikes. It is very important to focus on what the person still does have, not on what they may have lost. It is also important to focus on what the person feels rather than what they remember.

Notice! Some of their negative behaviour may be related to:
› Physical pain or discomfort — Illnesses, medication, hunger or thirst.
› Overstimulation — Loud noises or a busy environment.
› Unfamiliar surroundings — New places or the inability to recognise home.
› Complicated tasks — Difficulty with activities or chores.
› Frustrating interactions — Inability to communicate effectively may cause fear, sadness or anxiety.

Aggression

Aggressive behaviour may be verbal (shouting, name calling) or physical (hitting, pushing). It’s important to try to understand what is causing the anger, as it can occur suddenly with no apparent reason or can result from a frustrating situation.
How to respond:
Rule out pain as the cause of the behaviour – Pain can cause a person with dementia to act aggressively
Try to identify the immediate cause – Think about what happened right before, which may have triggered the behaviour.
Focus on feelings, not facts – Look for the feelings behind the words or actions.
Try not to get upset – Be positive and reassuring. Speak slowly in a soft tone.
Limit distractions – Examine the person’s surroundings and adapt them to avoid other similar situations.
Try a relaxing activity – Use music, massage or exercise to help soothe the person.
Shift the focus to another activity – If a situation or activity causes an aggressive response, try something different.
Speak calmly – Using a calm tone, try to reassure the person.
Take a break – If the person is in a safe environment and you are able, walk away and take a moment for yourself.
Ensure safety – Make sure you and the person are safe. If the person is unable to calm down, seek assistance from others. Always call 911 in emergency situations.

Anxiety or Agitation

People with dementia can become anxious or agitated for many reasons. It can help to learn what triggers this response by looking at the person’s surroundings, the time of day, what has just occurred, and evaluating potential sources of pain, hunger, need for sleep and sudden changes.
How to respond:
Check for pain – Pain can often trigger anxiety or agitation. Sources include being in an uncomfortable situation, injury, reaction to medication or a urinary tract infection.
Listen to the frustration – Find out what may be causing the anxiety.
Provide reassurance – Use calming phrases. Let the individual know you are there.
Involve the person in activities – Engage the person in art, music or other activities to distract him or her from anxiety and promote relaxation.
Modify the environment – Decrease noise and distractions or relocate the person.
Find outlets for energy – The person may be looking for something to do. Take a walk or go for a car ride.

Confusion

A person with Alzheimer’s may not recognise 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. These situations can be difficult for caregivers.
How to respond:
Stay calm – Not being recognised can be painful, but try not to make your hurt apparent.
Respond with a brief explanation – Don’t overwhelm the person with lengthy responses. Instead, clarify with a simple explanation.
Show photos and other reminders – Use photographs and other thought-provoking items to remind the person of important relationships and places.
Offer corrections as suggestions – Avoid explanations that sound like scolding. Try “I thought it was a fork,” or “I think he is your grandson Peter.”
Try not to take it personally – Alzheimer’s disease causes forgetfulness, but your support and understanding will continue to be appreciated.

Repetition

A person with Alzheimer’s may do or say something over and over again — like repeating a word, question or activity. The person may also pace or undo what has just been done. In most cases, he or she is likely looking for comfort, security and familiarity. These actions are rarely harmful, but can be stressful for the caregiver.
How to respond:
Look for a reason – Try to find out if there is a specific cause or trigger for the repetitive behaviour.
Focus on the emotion– Rather than reacting to what the person is doing, respond to how he or she is feeling.
Turn the action or behaviour into an activity – If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
Stay calm and be patient – Reassure the person with a calm voice and gentle touch.
Provide an answer– Give the person the answer that he or she is looking for, even if you have to repeat it several times. It may help to write it down and post it in a prominent location.
Engage the person in an activity – The individual may simply be bored and need a distraction. Engage the person in an activity like taking a walk or working on a puzzle.
Use memory aids – Offer reminders that are meaningful to the individual like notes, clocks, calendars or photographs.

Suspicion

Memory loss and confusion may cause a person with Alzheimer’s to perceive things in new and unusual ways. Individuals may become suspicious of those around them, even accusing others of theft, infidelity or other improper behaviour. Sometimes a person may misinterpret what he or she sees and hears.
How to respond:
Don’t take offence – Listen to what is troubling the person and try to be understanding. Then be reassuring, respond to the feeling and let the person know you care.
Don’t argue or try to convince – Allow the individual to express ideas. Acknowledge his or her opinions.
Offer a simple answer – Share your thoughts, but keep it simple. Lengthy explanations can be overwhelming.
Switch the focus to another activity – Engage the individual in an activity or ask for help with a chore.
Duplicate any lost items – If the person often searches for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.

Wandering and Getting Lost

It’s common for a person with dementia to wander and/or become lost. In fact, six in 10 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.
As the disease progresses, the person with dementia will need increased supervision. At some point, it will no longer be safe for him or her to be left alone.
How to respond:
Encourage activity – Keeping the person with Alzheimer’s active and engaged can help discourage wandering behaviour by reducing anxiety and restlessness. Involve the person in activities such as doing dishes, folding laundry or preparing dinner. If the person shows interest in getting out of the house, consider safe outdoor activities such as an accompanied walk or gardening.
Inform others – Make sure friends, family and neighbours know that the person has Alzheimer’s and that wandering may occur.
Make the home safe – Install deadbolt or slide-bolt locks on exterior doors and limit access to potentially dangerous areas.

Trouble with Sleep

People with dementia may have problems sleeping or experience changes in their sleep schedule. Sleep changes somehow result from the impact of Alzheimer’s on the brain. However, the exact cause is unknown.
How to respond:
Make a comfortable environment – The sleeping area should be at a comfortable temperature. Provide nightlights and other ways to keep the person safe, such as appropriate door and window locks.
Maintain a schedule – As much as possible, encourage a regular routine of meals, waking up and going to bed.
Manage naps – If the person has trouble sleeping at night, it can be helpful to limit daytime naps.
Exercise – Try to include some type of exercise, as appropriate for the person, during the day. Physical activity may promote restfulness at night.
Avoid stimulants – Reduce or avoid alcohol, caffeine and nicotine, which can all affect ability to sleep. Discourage watching television during periods of wakefulness at night, as it can be stimulating.
Talk to a doctor – Discuss sleep disturbances with a doctor to help identify causes and possible solutions. Most experts encourage the use of non-drug measures rather than medication.