Alzheimer's disease - coping with difficult behaviour

Written by: 
Amena Saleem

People with Alzheimer's disease often act in ways that are described as difficult or challenging. Such behaviour may be defined as actions that prevent the individual from taking part in everyday life, or that present a serious risk to the safety of the individual or to other people. In addition, behaviour may cause practical difficulties for those caring for a person with Alzheimer's disease, for instance causing stressRelating to injury or concern. at home, or making it hard to go out to work.

The difficult behaviour may include shouting and screaming, pacing and wandering, and, in some cases, violence.[1]

People with Alzheimer's disease often repeat the same question over and over again, or display tearful or angry outbursts. They may also suffer from disturbed sleep patterns.[1]

Coping with challenging behaviour can be very stressful and requires a great deal of patience on the part of the carer. It is important to remember that such behaviour is not deliberate and is out of the person's control.  He or she may be quite frightened by it and need reassurance, even though it may not seem that way.

This article will look at coping with:

Aggression

Carers of people with Alzheimer's disease sometimes have to cope with both physical and verbal aggression. Aggressive behaviour, whether it consists of hitting out or using abusive language, is usually a form of anger, fear or frustration.[2]

You may be able to reduce the person's aggressive behaviour by:

  • Providing activity and exercise, as this can help to prevent some outbursts in the first place
  • Explaining what is going to happen in short, clear statements, such as, 'I'm going to take your coat off now.' This may avoid the person feeling as though they are being attacked and becoming aggressive as a self-defence response
  • Checking whether the aggressive behaviour arises from the person's attempts to get what they want. If so, trying to anticipate the person's needs might help
  • Looking for patterns in the aggression and avoiding those topics or activities that anger the person. To help identify a pattern in the aggression, you may want to consider keeping a log of when the aggressive episodes take place.

Screaming and shouting

Some people with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. overreact to a trivial setback or minor criticism. They might scream, shout or make unreasonable accusations, or they might become very agitated or cry or laugh uncontrollably and inappropriately. This tendency to overreact is part of the disease and may be caused by stressRelating to injury or concern. or frustration. It is known as a catastrophic reaction.[3]

Stress, leading to a catastrophic reaction, might be minimised by:

  • Maintaining a calm environment in which the person with Alzheimer's disease follows a familiar regular routine
  • Keeping the surroundings familiar. People with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. may become upset if they find themselves in a strange situation or among a group of unfamiliar people. It could lead to them feeling confused and unable to cope.

Wandering

People with Alzheimer's disease may wander round the house. This is not necessarily dangerous, unless they go near areas such as stairs or open windows. Carefully selected child-safety devices can help to make the home environment safer.

A bigger problem occurs if someone with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. wanders away from the house. Such occurrences are often preceded by a display of restlessness and disorientation, so these are signs to look out for.

Incidences of wandering can be reduced by:

  • Immediately redirecting pacing or restless behaviour into productive activity, such as folding laundry, or exercise
  • Reassuring the person if he or she appears disorientated
  • Reducing noise levels and confusion, which can further bewilder the person
  • Consulting the person's doctor if the disorientation becomes a problem, as it may be a result of medication side-effects, drug interactions or over-medicating
  • Distracting the person at a particular time of day, if that is when he or she tends to wander.

It is also helpful to have a plan in place of what to do if the person you are looking after does wander. This includes compiling a list of people to call, including neighbours, who may have seen the person going past. In addition, you may want to make sure that he or she always carries some form of identification bearing their name, your name and your telephone number.

Places to look include:

  • Within 30 metres (100 feet) of a road, as most people who wander are unlikely to stray far from the road, but may wander into places such as fields or down alleyways
  • Bushes or ditches, as the person may have fallen or become trapped
  • Familiar places, such as former homes or favourite spots. People who wander often have a particular destination in mind.[4]

Repetitive behaviour

People with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. may repeatedly say or ask the same thing. They can also become very clingy and may shadow you, even following you to the bathroom. Such repetitive behaviour can become very upsetting and even irritating for the carer.

You may find it useful to try the following:

  • If an explanation doesn't help, distraction sometimes works. This could be in the form of a food, a walk or a favourite activity
  • Recognise that the repeated questioning may be an attempt to express an emotion. For example, someone who continually asks 'What am I doing today?' may be trying to express that they are feeling lost or uncertain. A response to this feeling, rather than to the direct question, might help
  • Avoid reminding the person that they have already asked the question
  • Repetitive movements might be reduced by giving the person something else to do with their hands, such as squeezing a soft ball.[3]

Sleep problems

The natural cycle of waking and sleeping is often disrupted by Alzheimer's disease. People with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. may be unable to sleep during the night, and so become confused and disorientated from dusk until morning. Some people with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. may also have a fear of the dark, perhaps because of the lack of familiar daytime noises and activities.

Night-time restlessness may be calmed by:

  • Involving the person in physical activities during the day, such as going for a walk, so that they feel more tired at bedtime
  • Encouraging the person to have a short rest in the afternoon to regain their composure, if they seem fatigued. This can lead to a better night's sleep. However, over-napping during the day can increase night-time wakefulness
  • Limiting the person's caffeine intake during the day, especially in the hours before bed
  • Being consistent with a time for sleeping, and sticking to a routine for getting ready for bed
  • Creating a calm atmosphere for sleeping. You might like to give the person a bath and some warm milk before bed
  • Reducing noise and light, and playing soothing music to help the person get to sleep
  • Leaving a small night light on all night. Some people with dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. often imagine things in the dark, sensing presences that aren't there, and becoming upset
  • Placing a commode next to the bed so that the person can urinate during the night. Walking to the bathroom at night may wake them up too much, making it difficult or impossible to go back to sleep.[4]
References: 
  1. Anne Robinson, Beth Spencer, Laurie White. 'Understanding difficult behaviours: some practical suggestions for coping with Alzheimer's disease & related illnesses'. Eastern Michigan University, 2007
  2. 'Aggressive behavior: understanding and responding to challenging behaviors in Alzheimer's Disease'. Realmentalhealth.com. Link.
  3. Peter V Rabins, Constantine G Lyketsos, Cynthia D Steele. 'Practical dementiaDecline in mental capacity, brain functioning and memory that affects day-to-day living. care'. Oxford University Press, 2006
  4. 'Alzheimer's behavior management: learn to manage common behavior problems'. Helpguide.org. Link.