Dementia challenges: Handling difficult behaviors with calm and care

MOSES LAKE — Once dementia has set in, it’s time to adjust to a new reality, which can include behavioral challenges as the family member experiences frustrations associated with their symptoms.

“Behavior disturbance is really where the rubber meets the road,” said Dr. A. Carroll Hayman, a Seattle physician who specializes in Alzheimer’s and other dementias, at a symposium in Pasco in October. “Memory loss is ... sort of manageable. A nic,e sweet person who has memory loss and sits in the corner, that’s OK. What’s hard is when that same person starts fighting with their caregivers over whether or not they’re going to shower, or starts pacing around and hiding underneath the trash can, or they say they want to die.” 

An important thing to remember, according to the Lewy Body Dementia Association, is that the patient isn’t behaving the way they are on purpose. They may be reacting to fatigue, pain, hunger or something else they can’t communicate, or the behavior may be a side effect of medication. In any case, you can’t correct the behavior or teach the person to act differently, so it’s important not to get angry or upset.  

The LBDA also recommends that caregivers: 

• Speak calmly and softly to the person. 

• If the behavior is aggressive, don’t argue. Back away, then calmly approach him or her. 

• Respond to the emotion, not the behavior. Don’t try to reason with them; they may not be able to follow a lengthy explanation. Be reassuring and deal with them where they are instead of expecting them to adjust. 

“It's way harder to take care of your loved one when they're accusing you of stealing from them than it is when they say ‘I can't remember,’” Hayman said. “…  One of the most important things to recognize is that the difficult behaviors that people are doing, that they're not important. And that can be really hard when it's your mom and your mom has (made you angry) for a variety of reasons for 15 years, and now she's going to be saying, ‘That's not me.’ We have to try to take a step away from that and realize that … they're not intentionally repeating the same story 15 times.” 

Knowing that it’s not the person’s fault doesn’t make it easy to deal with, Hayman added. There are coping techniques that caregivers can apply to the situation to understand and respond to dementia-driven behavior. One that she recommended is the DICE method, which stands for Describe, Investigate, Create and Evaluation. According to the Fein Memory and Aging Center at the University of California – San Francisco, DICE can include the following: 

Describe the behavior – What did the patient do? Is the behavior threatening them or others? What happened before and after? 

Investigate possible causes – Does the patient feel frightened, out of control or embarrassed? Have there been recent changes in medication? Is the patient’s environment overstimulating, boring or disorienting? Have there been changes in routine? 

Create a plan – Ensure the patient’s environment is safe. Discontinue high-risk medications. Get the patient on a regular schedule of waking and sleeping, and simplify their daily routine. 

Evaluate – What worked? What didn’t? Are there barriers to trying something else? 

Sometimes what works is admitting that it’s too much for the family to handle alone, and it’s time to look at a professional care facility. February’s Senior News will look at options for care in a patient’s final days.