Repetitive Behavior In Dementia
People with dementia may say things over and over again. They may also ask the same question or repeat certain actions frequently. They may become very clinging and shadow the person caring for them, even following them to the toilet. These behaviours can be very upsetting and irritating for the caregiver.
1. Physiological and Medical Causes:
* Memory loss
from the dementing illness which causes the person not to remember that
they have already asked that question or told that story;
* Physical changes to the brain which are caused by the dementia may have damaged that part of the brain which enables the person to change to a new activity - the person appears to be 'stuck' on one activity, repeating it over and over again;
* Some medication can cause side effects which result in repetitive movements or restlessness. Tranquillizers can cause the person to have repetitive movements of the mouth and tongue.
2. Environmental Causes:
* Separation from the caregiver may cause the person with dementia to repeat questions about their whereabouts;
* Misrepresentation of sounds or sights may cause anxiety; overwhelming stimuli (movement, noise etc.).
3. Other Causes:
* Inability to judge time may cause the person to think the caregiver has been away for a long time;
* Misunderstanding of what is happening, causing the person to constantly ask questions;
* Inability to express needs such as hunger, thirst, or needing to go to the toilet - this may manifest itself in repetitive fiddling or increased agitation;
* Repetitive questions may be the person's efforts to regain a feeling of control over an environment which has become increasingly confusing.
* Arrange a medical examination to determine whether the person is experiencing the side-effects of medication or whether there is any acute physical illness (eg. infection or fever) or pain;
* Distraction with a walk, food or favourite activity may be helpful;
* When the
person is repeating a question over and over, try to respond to the underlying
emotion rather than to the content of the question. "What am I doing
today?" may mean that the person is feeling lost and uncertain, and
a response to this feeling may help to reassure them.
* Try to use a calm voice when responding to repeated questions;
* Do not remind the person that they have already asked the question - instead, divert them to another activity; for the person who is still able to read, try written reminders;
* Use other
memory aids such as large, clear clocks and calendars and white board with
the daily schedule written on it;
* Try not to discuss plans with the person ahead of time - leave it until just before the event to avoid agitation and repeated questioning;
* Try to keep the routine as consistent as possible as this is reassuring. Video and audio tapes may be helpful for some people but confusing for others;
* Sometimes certain things in the environment may trigger repeated questions (eg. a coat and hat on a rack may make the person ask repeatedly to go out). It may help to remove such triggers;
movements may be reduced by giving the person something else to do with
their hands (eg. a soft ball, paper to tear up, clothes to fold);
* When a person becomes stuck on one step of a task, use of touch or pointing may help to cue the person to move on to the next step;
* Keeping a diary may help the caregiver to see whether there is a pattern to the behaviour so that a cause may be suggested (eg. does it occur at a particular time of the day, are there particular people present, could the person be hungry or thirsty?);
* Repetitive questioning may be an attention-seeking device - responding by giving your full attention and attempting to respond to their emotional needs may help to break the pattern;
* Take into
account the fact that the person with dementia may have lost the ability
to judge time - the carer may have only been absent for a few minutes but
the person believes it has been hours. Respond to this by acknowledging
the feelings of uncertainty and insecurity;
* Use of headphones to listen to music may be a way in which a caregiver can find some peace and personal space, but remain visible to the person with dementia.
Care For The Caregiver
Caregivers should try to make sure they get adequate breaks from caregiving so that they do not become worn down by irritating and demanding behaviour. Use of day care centres, in-home respite, and regular residential respite are helpful ways to achieve breaks so that you can continue in your role.