Carers may find themselves coping with some of the challenging behaviours which are associated with Alzheimer's disease and related dementias. These may include restlessness,  pacing and wandering, repetitive questioning, constantly following the carer around, angry/upset/tearful outbursts, inappropiate toileting or social behaviour, apathy, repetitive calling out and/or disturbing sleep.

It is important to remember that behaviour will vary from person to person. Dementia is to blame, not the person with the illness, nor carer. This information offers some useful points to help carers to understand and deal with challenging behaviour.

Physical Considerations

Consider any illness or infection the person with dementia may have, don't automatically assume that dementia is the only cause. For example toothache and tooth decay may be present with no obvious signs of swelling of gums.

• Ask your doctor about the side effects of the medication the person with dementia is taking. Tablets and medicines can cause confusion, agitation or other side effects.
  
• Phyical discomfort from being to hot, too cold, or needing to go to the toilet is an important consideration. Seating may be uncomfortable - too high or too low.
  
• Dehydration (lack of fluids) Sometimes a person with dementia may forget to drink and insufficient fluid may cause many different problems.
  
• Constipation can be extremely uncomfortable and lead to agitated behaviour.

Envirornmental Considerations

• Sometimes people who have a stooped posture and are sitting in a normal chair can become distressed, because they can not see more than their knees and can not communicate!
  
• Too much stimulation in the environment, e.g. TV, radio or other loud conversation, may upset or frustrate a person with dementia.
  
• Lighting and use of patterns and colours can effect a person's behaviour.
  
• Routine is important to a person with dementia. Problems may occur because a routine has been altered.
  
• High expectations of the carer can cause difficulties if the person with dementia is given a task which is no longer within their capabilities.
  

Analysing the Problems

 

1. Identify the main problem. Deal with the most pressing problem first.
   
   
2. Is it really a Problem? Can you accept this behaviour rather than try to alter it?
   
   
3. Identify the possible cause(s) Identify what might trigger a particular behaviour at a specific time and place.
   
   
4. Are you using a caregiving style which is likely to reduce behavioural problems? Try to avoid hurry and bustle, provide distraction, avoid infantilisation, give choices, communicate clearly and simply with a calm voice and gentle touch.
   
   
5. Look at possible options Think of as many options as possible. Talk to others about the situation. Alzheimers Auckland Carers Groups can be helpful.
   
   
6. What worked? If the challenging behaviour is occuring less frequently, the plan is working.
   
   
7. It may not always be possible to solve the porblem completely. Reducing the frequency or severity of challenging behaviours (increasing the length of time between them) may be as much as can be achieved.
   
   

Some General Coping Strategies

• Rule out Physical and/or medication problems - discuss with your doctor.
  
• Distract with food/drink or activities (try simple chores or hobbies, walking, dancing, music, reading, or massage).
  
• Alternate quiet times with more active times; try rest periods to minimise fatigue.
  
• Reassure with a calm voice and gentle touch;
  if this doesnt work, sometimes ignoring the behaviour does!
  
• Keep things simple and routines reasonably regular; use written reminders and signs.
  
• For sleep problems, try leaving on a night light to assist orientation (e.g to find the toilet).

• For angry behaviour, try not to respond angrily yourself; approach from the front so you can be seen.

For more detailed information, please visit Alzheimers New Zealand website and browse their resources section www.alzheimers.org.nz/resources.php.