Dementia: “Normal” Behaviors

1. Dementia: “Normal” Behaviors Linda Bliss, RN, QDCP Kemper House

2. Goals and Objectives • By the end of the session you will be able to… • Identify different types of “normal” behaviors • Identify what may trigger these behaviors • Restate what the behaviors are trying to communicate • Respond appropriately and effectively to these behaviors

3. What is Dementia? • Dementia is a symptom of a disease process • Alzheimer’s Disease is the cause of 80% of all dementias • The symptoms are such that they interfere with the person’s ability to function in every day life • People with dementia no longer have inhibitions learned in early childhood

4. What Are “Normal” Behaviors? • Verbal/physical aggression • Repetitive questions and actions • Wandering, exit seeking • Delusions/Hallucinations • Catastrophic Reactions • Sundowning • Hoarding, rummaging, hiding things • Mood Swings “What do you mean that’s normal?”

5. What are they trying to tell us? All Behaviors Are A Form Of Communication!

6. What Are They Trying To Tell Us?(Common Triggers) • They have unmet needs • They are anxious about an upcoming event • They have a fear of being alone, looking for a loved one, looking for “home” • They feel frightened or humiliated • They feel frustrated • The dementia has eroded their judgment and self-control • Their independence or privacy has been threatened • They are in physical discomfort or having pain

7. Behavior may be due to pain! People with dementia definitely feel pain!

8. Verbal/Physical Aggression • What happened just before the aggressive or combative behavior? • Consider the “5 W’s” (where, when, who, what, why) • Watch for early signs of potential combative behaviors • Know the common triggers • What works today may not work tomorrow

9. Early Warning Signs of Aggressive/Combative Behaviors • When they say “No” they mean “No” • Restless, nervousness, agitation • Annoyance • Arguing • Frustration • Pacing • Raising a hand • Throwing something • Verbal outbursts

10. Repetitive Questions Why do they remember the questions and not the answer? • They repeat themselves because they have dementia! • They are seeking reassurance rather than seeking information! • Inability to judge time • Separation from loved ones • Inability to store and retrieve information

11. Repetitive questions It maybe the 10th time you are hearing it, but it’s the 1st time they are asking it! Remember, repetitive questions are “normal”!

12. Repetitive Actions • Boredom • Side effects of medications • It’s a way of reassuring self, ex: rocking back and forth • May be a meaningful task • May be a task associated with a former job or hobby • If it’s not hurting anyone, don’t fix it!

13. Wandering, Exit Seeking • Looking for a loved one • Looking for “home” • They have a need unmet • Looking for the bathroom • Need to get to work • Do not open door if someone is standing there waiting to leave • Validate and Redirect

14. Hallucinations • Caused by changes within the brain • Experienced through one of the five senses • Most common are visual or auditory • False perceptions/misinterpretations • They see a rabbit on the couch • They hear a baby crying • They see a stranger in the mirror

15. Assess and Respond to Hallucinations • Is this upsetting to the person or for you? • Is it leading them to do something dangerous? • If it doesn’t cause a problem, don’t fix it • Don’t argue about what they see or hear • Reassure and redirect • Walk with them in their world! Validate! Their reality is not our reality

16. Delusions • Something a person believes to be true • False beliefs caused by deterioration of cognitive processes in the brain • Can be influenced by misunderstandings or misinterpretations It’s “normal” for someone with dementia!

17. Most Common Delusions • Spouse is being unfaithful • Their home is not their own • Someone is stealing their money • Someone is trying to harm them or poison them • Someone is spying on them

18. Responding to Delusions • Don’t argue or try to convince • Reassure, redirect • You don’t have to agree, but you do have to validate • Let them know you want to help; “Is there anything I can do to make you feel more safe?” • Always protect yourself

19. Catastrophic Reactions • Making a “mountain out of a mole hill!” • Over reacting to a seemingly normal, nonthreatening situation • Their reality is distorted and overwhelming feelings are normal • Most often occurs around dinner time or evening • Delusions can also make people more fearful causing catastrophic reactions

20. Try to Prevent Catastrophic Reactions • Don’t argue or try to convince • Don’t criticize or belittle • Avoid over fatigue • Keep tasks simple and one step • Be aware of the triggers

21. Sundowning • A group of behaviors occurring at the time of nightfall or sunset • Increased confusion, agitation, aggression, pacing wandering • The specific causes have not been proven. Some evidence suggests that the disruption of circadian rhythm enhances the behaviors.

22. Things You Can Try To Manage Sundowning • Consistent sleeping schedule and daily routine • Limit caffeine • Keep rooms well-lit, try to avoid shadows

23. Hoarding and Hiding • Take “collecting” to the next level • Failing to throw out large numbers of “stuff” • Hours spent collecting “stuff” • Were they a “pack rat”? • Did they grow up in the depression or during wartime? • Fear of being robbed • Security “the more the better” • Everything is fair game! They don’t realize taking things that are not theirs is wrong. They are not “stealing” they are merely “shopping”!

24. What Do People Hoard? • Food • Garbage • Newspaper, magazines, “junk” mail • Silverware • Plastic bags • Old clothes • Paper products • Stuff!

25. Rummaging • A constant, driven, searching through belongings and “stuff” • Hours spent looking for important items such as keys, bills, money • Catastrophic reactions when they can not find what they are searching for • Forget what they are looking for • Loss of object identification

26. Interventions for Rummaging • Lock valuables in a safe place • Always check wastebaskets before throwing out trash • When you find a hiding place, check it often • Know where to look, refrigerator, freezer, sugar bowl, under cushions, in shoe boxes • When decluttering, provide lots of emotional support

27. Mood Swings • Decreased coping mechanisms • Decreased self control • Folks are most often acting out of a sense of fear, feelings of persecution, a feeling of losing control, frustration

28. Tackle The Triggers • Always GREET before you TREAT (Teepa Snow) • Try to met their needs (do they have enough to eat and drink, do they need to use the bathroom) • Reduce demands and have a stress-free routine • Give them plenty of time to respond (10 second rule) • Give time outs • Do not be authoritative or criticize • Provide a safe and calm environment • Assess for pain or discomfort

29. When Do We Need To Treat The Behaviors? • When it is distressing to the person • When it can cause harm to the person or others • When it impairs self care, social interactions, or participation • When it effects quality of life These behaviors are “normal” for someone with dementia