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Managing Behaviors

Often the most challenging part of caring for a person with dementia is the baffling, and at times frightening behaviors. We are wired to try to explain, to reason, to cajole others to affect others and their actions.

As dementia, be it Alzheimer’s, Lewy Body, Alcoholic, Frontal (Frontaltemporal), Vascular or Traumatic Brain Injury the usual approaches will not work.

I find when working with caregivers it all gets lumped into “agitation”.

However, when I ask, “What exactly is this person doing”. The answers range from

  • following a caregiver around
  • repeating the same questions over and over
  • tearing up (paper, clothes)… at times associated with plugging up the toilet
  • trying to leave, or they have left
  • becoming angry easily
  • hitting, biting, yelling, pinching
  • they are delusional- misperceiving stimulus (the wind blowing a curtain is an intruder, or a spouse is having an affair).
  • they are hallucinating- people coming in trying to hurt them (at home with no other people),
  • they are aggressive toward others
  • they refuse to bathe, eat, dress, get out of bed, come in out of the sun…
  • they are intrusive to others, taking their food, going into other’s rooms and going through their things.
The first step is always the behavioral approach. It is always important to understand, is the elder in pain, tired, hungry, cold or overstimulated by noise and people. I have found that reviewing the medications should be done at the same time. AI was asked to see an elder woman with nightly agitation, but could not see her for three weeks. I reviewed the medications with the family over the phone. She was taking Tylenol PM. I advised to stop it, and any caffeine and alcohol before I could see her and she got better in days.
managing behaviors

So, it’s critical to remove any problematic medications. I often find that if problem medications are not recognized, then other medications are added to treat the side effects of the first medication… bringing additional side effects. A common problem is that some antipsychotics, such as Haldol or Risperdal have stiffness as a side-effect, appearing like Parkinson’s Disease.

Then, Parkinson’s meds are added… that increase dopamine and the elder may become more delusional and paranoid. The better step is to stop the first medication and address the symptoms by engagement, treating pain and educating caregiver to be patient, calm and engaging.