Behavior Management

Behavior Management

Alzheimer’s disease causes brain cells to die, so the brain works less well over time. This changes how a person acts. This lesson has suggestions that may help you understand and cope with changes in personality and behavior in a person with Alzheimer’s disease.

Common Changes in Personality and Behavior

Common personality and behavior changes you may see include:

  • Getting upset, worried, and angry more easily
  • Acting depressed or not interested in things
  • Hiding things or believing other people are hiding things
  • Imagining things that aren’t there
  • Wandering away from home
  • Pacing a lot
  • Showing unusual sexual behavior
  • Hitting you or other people
  • Misunderstanding what he or she sees or hears

You also may notice that the person stops caring about how he or she looks, stops bathing, and wants to wear the same clothes every day.

Other Factors That Can Affect Behavior

In addition to changes in the brain, other things may affect how people with Alzheimer’s behave:

  • Feelings such as sadness, fear, stress, confusion, or anxiety
  • Health-related problems, including illness, pain, new medications, or lack of sleep
  • Other physical issues like infections, constipation, hunger or thirst, or problems seeing or hearing

Other problems in their surroundings may affect behavior for a person with Alzheimer’s disease. Too much noise, such as TV, radio, or many people talking at once can cause frustration and confusion. Stepping from one type of flooring to another or the way the floor looks may make the person think he or she needs to take a step down. Mirrors may make them think that a mirror image is another person in the room. For tips on creating an Alzheimer’s-safe home, visit Home Safety and Alzheimer’s Disease.

If you don’t know what is causing the problem, call the doctor. It could be caused by a physical or medical issue.

Keep Things Simple…and Other Tips

Caregivers cannot stop Alzheimer’s-related changes in personality and behavior, but they can learn to cope with them. Here are some tips:

  • Keep things simple. Ask or say one thing at a time.
  • Have a daily routine, so the person knows when certain things will happen.
  • Reassure the person that he or she is safe and you are there to help.
  • Focus on his or her feelings rather than words. For example, say, “You seem worried.”
  • Don’t argue or try to reason with the person.
  • Try not to show your frustration or anger. If you get upset, take deep breaths and count to 10. If it’s safe, leave the room for a few minutes.
  • Use humor when you can.
  • Give people who pace a lot a safe place to walk. Provide comfortable, sturdy shoes. Give them light snacks to eat as they walk, so they don’t lose too much weight, and make sure they have enough to drink.
  • Try using music, singing, or dancing to distract the person.
  • Ask for help. For instance, say, “Let’s set the table” or “I need help folding the clothes.”

https://www.nia.nih.gov/health/managing-personality-and-behavior-changes-alzheimers

Coping with Agitation and Aggression in Alzheimer’s Disease

People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless or worried. He or she doesn’t seem to be able to settle down. Agitation may cause pacing, sleeplessness, or aggression, which is when a person lashes out verbally or tries to hit or hurt someone.

Causes of Agitation and Aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause. If you deal with the causes, the behavior may stop. For example, the person may have:

Pain, depression, or stress

Too little rest or sleep

Constipation

Soiled underwear or diaper

Sudden change in a well-known place, routine, or person

A feeling of loss—for example, the person may miss the freedom to drive

Too much noise or confusion or too many people in the room

Being pushed by others to do something—for example, to bathe or to remember events or people—when Alzheimer’s has made the activity very hard or impossible

Feeling lonely and not having enough contact with other people

Interaction of medicines

Look for early signs of agitation or aggression. If you see the signs, you can deal with the cause before problem behaviors start. Try not to ignore the problem. Doing nothing can make things worse.

A doctor may be able to help. He or she can give the person a medical exam to find any problems that may cause agitation and aggression. Also, ask the doctor if medicine is needed to prevent or reduce agitation or aggression.

Tips for Coping with Agitation or Aggression

Here are some ways you can cope with agitation or aggression:

Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.

Allow the person to keep as much control in his or her life as possible.

Try to keep a routine, such as bathing, dressing, and eating at the same time each day.

Build quiet times into the day, along with activities.

Keep well-loved objects and photographs around the house to help the person feel more secure.

Try gentle touching, soothing music, reading, or walks.

Reduce noise, clutter, or the number of people in the room.

Try to distract the person with a favorite snack, object, or activity.

Limit the amount of caffeine the person drinks and eats.

Here are some things you can do:

Slow down and try to relax if you think your own worries may be affecting the person with Alzheimer’s.

Try to find a way to take a break from caregiving.

Safety Concerns

When the person is aggressive, protect yourself and others. If you have to, stay at a safe distance from the person until the behavior stops. Also try to protect the person from hurting himself or herself. 

When a Person with Alzheimer’s Rummages and Hides Things

Someone with Alzheimer’s disease may start rummaging or searching through cabinets, drawers, closets, the refrigerator, and other places where things are stored. He or she also may hide items around the house. This behavior can be annoying or even dangerous for the caregiver or family members. If you get angry, try to remember that this behavior is part of the disease.

In some cases, there might be a logical reason for this behavior. For instance, the person may be looking for something specific, although he or she may not be able to tell you what it is. He or she may be hungry or bored. Try to understand what is causing the behavior so you can fit your response to the cause.

Rummaging—with Safety

You can take steps that allow the person with Alzheimer’s to rummage while protecting your belongings and keeping the person safe. Try these tips:

Lock up dangerous or toxic products or place them out of the person’s sight and reach.

Remove spoiled food from the refrigerator and cabinets. Someone with Alzheimer’s may look for snacks but lack the judgment or sense of taste to stay away from spoiled foods.

Remove valuable items that could be misplaced or hidden by the person, like important papers, checkbooks, charge cards, jewelry, cell phones, and keys.

People with Alzheimer’s often hide, lose, or throw away mail. If this is a serious problem, consider getting a post office box. If you have a yard with a fence and a locked gate, place your mailbox outside the gate.

You also can create a special place where the person with Alzheimer’s can rummage freely or sort things. This could be a chest of drawers, a bag of objects, or a basket of clothing to fold or unfold. Give him or her a personal box, chest, or cupboard to store special objects. You may have to remind the person where to find his or her personal storage place.

More Tips for Rummaging and Hiding Behavior

Here are some more suggestions:

Keep the person with Alzheimer’s from going into unused rooms. This limits his or her rummaging through and hiding things.

Search the house to learn where the person often hides things. Once you find these places, check them often, out of sight of the person.

Keep all trash cans covered or out of sight. People with Alzheimer’s may not remember the purpose of the container or may rummage through it.

Check trash containers before you empty them in case something has been hidden there or thrown away by accident.

 

Wandering and Alzheimer’s Disease

Many people with Alzheimer’s disease wander away from their home or caregiver. As the caregiver, you need to know how to limit wandering and prevent the person from becoming lost. This will help keep the person safe and give you greater peace of mind.

First Steps

Try to follow these steps before the person with Alzheimer’s disease wanders:

Make sure the person carries some kind of ID or wears a medical bracelet. If the person gets lost and can’t communicate clearly, an ID will let others know about his or her illness. It also shows where the person lives.

Consider enrolling the person in the MedicAlert® + Alzheimer’s Association 24/7 Wandering Support for a Safe Return Program (call 1-800-432-5378 to find the program in your area).

Let neighbors and the local police know that the person with Alzheimer’s tends to wander. Ask them to alert you immediately if the person is seen alone and on the move.

Place labels in garments to aid in identification.

Keep an article of the person’s worn, unwashed clothing in a plastic bag to aid in finding him or her with the use of dogs.

Keep a recent photograph or video recording of the person to help police if he or she becomes lost.

 

Tips to Prevent Wandering

Here are some tips to help prevent the person with Alzheimer’s from wandering away from home:

Keep doors locked. Consider a keyed deadbolt, or add another lock placed up high or down low on the door. If the person can open a lock, you may need to get a new latch or lock.*

Use loosely fitting doorknob covers so that the cover turns instead of the actual knob.*

Place STOP, DO NOT ENTER, or CLOSED signs on doors.

Divert the attention of the person with Alzheimer’s disease away from using the door by placing small scenic posters on the door; placing removable gates, curtains, or brightly colored streamers across the door; or wallpapering the door to match any adjoining walls.

Install safety devices found in hardware stores to limit how much windows can be opened.

Install an “announcing system” that chimes when a door is opened.

Secure the yard with fencing and a locked gate.

Keep shoes, keys, suitcases, coats, hats, and other signs of departure out of sight.

Do not leave a person with Alzheimer’s who has a history of wandering unattended.

* Due to the potential hazard they could cause if an emergency exit is needed, locked doors and doorknob covers should be used only when a caregiver is present.

Alzheimer’s and Hallucinations, Delusions, and Paranoia

Due to complex changes occurring in the brain, people with Alzheimer’s disease may see or hear things that have no basis in reality.

Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. For example, a person with Alzheimer’s may see children playing in the living room when no children exist.

Delusions are false beliefs that the person thinks are real. For example, the person may think his or her spouse is in love with someone else.

Paranoia is a type of delusion in which a person may believe—without a good reason—that others are mean, lying, unfair, or “out to get me.” He or she may become suspicious, fearful, or jealous of people.

If a person with Alzheimer’s has ongoing disturbing hallucinations or delusions, seek medical help. An illness or medication may cause these behaviors. Medicines are available to treat these behaviors but must be used with caution. The following tips may also help you cope with these behaviors.

Hallucinations and Delusions

Here are some tips for coping with hallucinations and delusions:

Discuss with the doctor any illnesses the person with Alzheimer’s has and medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.

Try not to argue with the person about what he or she sees or hears. Comfort the person if he or she is afraid.

Distract the person. Sometimes moving to another room or going outside for a walk helps.

Turn off the TV when violent or upsetting programs are on. Someone with Alzheimer’s may think these events are happening in the room.

Make sure the person is safe and can’t reach anything that could be used to hurt anyone or himself or herself.

Paranoia

In a person with Alzheimer’s disease, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets:

Where he or she put something. The person may believe that someone is taking his or her things.

That you are the person’s caregiver. Someone with Alzheimer’s might not trust you if he or she thinks you are a stranger.

People to whom the person has been introduced. He or she may believe that strangers will be harmful.

Directions you just gave. The person may think you are trying to trick him or her.

Paranoia may be the person’s way of expressing loss. The person may blame or accuse others because no other explanation seems to make sense.

Here are some tips for coping with paranoia:

Try not to react if the person blames you for something.

Don’t argue with the person.

Let the person know that he or she is safe.

Use gentle touching or hugging to show you care.

Explain to others that the person is acting this way because he or she has Alzheimer’s disease.

Search for things to distract the person, then talk about what you found. For example, talk about a photograph or keepsake.

Also, keep in mind that someone with Alzheimer’s disease may have a good reason for acting a certain way. He or she may not be paranoid. There are people who take advantage of weak and elderly people. Find out if someone is trying to abuse or steal from the person with Alzheimer’s.

Coping with Sundowning

Look for signs of sundowning in the late afternoon and early evening. These signs may include increased confusion or anxiety and behaviors such as pacing, wandering, or yelling. If you can, try to find the cause of the person’s behavior.

If the person with Alzheimer’s becomes agitated, listen calmly to his or her concerns and frustrations. Try to reassure the person that everything is OK and distract him or her from stressful or upsetting events.

You can also try these tips:

Reduce noise, clutter, or the number of people in the room.

Try to distract the person with a favorite snack, object, or activity. For example, offer a drink, suggest a simple task like folding towels, or turn on a familiar TV show (but not the news or other shows that might be upsetting).

Make early evening a quiet time of day. You might play soothing music, read, or go for a walk. You could also have a family member or friend call during this time.

Adjust lighting, letting in natural light during the day, if possible, and try softer room lighting in the evening.

Preventing Sundowning

Being too tired can increase late-afternoon and early-evening restlessness. Try to avoid this situation by helping the person:

Go outside or at least sit by the window—exposure to bright light can help reset the person’s body clock

Get physical activity or exercise each day

Get daytime rest if needed, but keep naps short and not too late in the day

Get enough rest at night

Avoid things that seem to make sundowning worse:

Do not serve coffee, cola, or other drinks with caffeine late in the day.

Do not serve alcoholic drinks. They may add to confusion and anxiety.

Do not plan too many activities during the day. A full schedule can be tiring.

If Problems Persist

If sundowning continues to be a problem, seek medical advice. A medical exam may identify the cause of sundowning, such as pain, a sleep disorder or other illness, or a medication side effect.

If medication is prescribed to help the person relax and sleep better at night, be sure to find out about possible side effects. Some medications can increase the chances of dizziness, falls, and confusion. Doctors recommend using them only for short periods of time.

Alzheimer’s Caregiving: Changes in Communication Skills

Communication is hard for people with Alzheimer’s disease because they have trouble remembering things. They may struggle to find words or forget what they want to say. You may feel impatient and wish they could just say what they want, but they can’t.

The person with Alzheimer’s may have problems with:

Finding the right word or losing his or her train of thought when speaking

Understanding what words mean

Paying attention during long conversations

Remembering the steps in common activities, such as cooking a meal, paying bills, or getting dressed

Blocking out background noises from the radio, TV, or conversations

Frustration if communication isn’t working

Being very sensitive to touch and to the tone and loudness of voices

Also, Alzheimer’s disease causes some people to get confused about language. For example, the person might forget or no longer understand English if it was learned as a second language. Instead, he or she might understand and use only the first language learned, such as Spanish.

Help Make Communication Easier

The first step is to understand that the disease causes changes in communication skills. The second step is to try some tips that may make communication easier:

Make eye contact and call the person by name.

Be aware of your tone, how loud your voice is, how you look at the person, and your body language.

Encourage a two-way conversation for as long as possible.

Use other methods besides speaking, such as gentle touching.

Try distracting the person if communication creates problems.

To encourage the person to communicate with you:

Show a warm, loving, matter-of-fact manner.

Hold the person’s hand while you talk.

Be open to the person’s concerns, even if he or she is hard to understand.

Let him or her make some decisions and stay involved.

Be patient with angry outbursts. Remember, it’s the illness “talking.”

To speak effectively with a person who has Alzheimer’s:

Offer simple, step-by-step instructions.

Repeat instructions and allow more time for a response. Try not to interrupt.

Don’t talk about the person as if he or she isn’t there.

Don’t talk to the person using “baby talk” or a “baby voice.”

Be Direct, Specific, and Positive

Here are some examples of what you can say:

“Let’s try this way,” instead of pointing out mistakes.

“Please do this,” instead of “Don’t do this.”

“Thanks for helping,” even if the results aren’t perfect.

You also can:

Ask questions that require a yes or no answer. For example, you could say, “Are you tired?” instead of “How do you feel?”

Limit the number of choices. For example, you could say, “Would you like a hamburger or chicken for dinner?” instead of “What would you like for dinner?”

Use different words if he or she doesn’t understand the first time. For example, if you ask the person whether he or she is hungry and you don’t get a response, you could say, “Dinner is ready now. Let’s eat.”

Try not to say, “Don’t you remember?” or “I told you.”

If you become frustrated, take a timeout for yourself.

Helping a Person Who Is Aware of Memory Loss

Alzheimer’s disease is being diagnosed at earlier stages. This means that many people are aware of how the disease is affecting their memory. Here are tips on how to help someone who knows that he or she has memory problems:

Take time to listen. The person may want to talk about the changes he or she is noticing.

Be as sensitive as you can. Don’t just correct the person every time he or she forgets something or says something odd. Try to understand that it’s a struggle for the person to communicate.

Be patient when someone with Alzheimer’s disease has trouble finding the right words or putting feelings into words.

Help the person find words to express thoughts and feelings. But be careful not to put words in the person’s mouth or “fill in the blanks” too quickly. For example, Mrs. D cried after forgetting her garden club meeting. She finally said, “I wish they stopped.” Her daughter said, “You wish your friends had stopped by for you.” Mrs. D nodded and repeated some of the words. Then Mrs. D said, “I want to go.” Her daughter said, “You want to go to the garden club meeting.” Again, Mrs. D nodded and repeated the words.

Be aware of nonverbal communication. As people lose the ability to talk clearly, they may rely on other ways to communicate their thoughts and feelings. For example, their facial expressions may show sadness, anger, or frustration. Grasping at their undergarments may tell you they need to use the bathroom.

 

Resources

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center

800-438-4380

adear@nia.nih.gov

http://www.nia.nih.gov/alzheimers

 

The NIA ADEAR Center offers information and free print publications about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimers.gov

http://www.alzheimers.gov

Explore the Alzheimers.gov portal for information and resources on Alzheimer’s and related dementias from across the federal government.

 

Family Caregiver Alliance

800-445-8106

info@caregiver.org

http://www.caregiver.org

National Respite Locator Service:  http://www.archrespite.org/respitelocator

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