Steps to Understanding Challenging Behaviors
from the Alzheimer's Association

Alzheimer's disease can cause a person to act in different or unpredictable ways. Some individuals with Alzheimer's become anxious or agressive, others repeat certain questions or gestures. These changes can lead to frustration and tension, particularly between the person with Alzheimer's and the caregiver.

It is important to remember that the person is not acting this way on purpose. Changes in behavior can be caused by:

Physical discomfort (illnesses, medication)

Over stimulation (loud noises, busy or active environment)

Unfamiliar surroundings (new places, inability to recognize home)

Complicated tasks (difficulty with activities or chores)

Frustrating interactions (inability to communicate effectively)

Whatever the cause, be sure to indentify the specific challenge and consider possible solutions.

First, identify and examine the behavior

What was the undesirable behavior? Is it harmful to the individual or others?

What happened just before the behavior occured? Did something "trigger" the behavior?

What happend immediately after the behavior occured? How did you react?

Try to answer the following questions: What, where, when, why and how?

Next, explore potential solutions

What are the needs of the person with dementia? Are they being met?

Can adapting the environment help reduce the difficult behavior?

How can you change your reaction or approach to the behavior? Are you responding in a calm and supportive way?

And finally, try different responses in the future

Did your response help?

Do you need to explore other potential causes and solutions? If so, what can you do differently?

Understanding and Responding to Challenges

Each person with Alzheimer's is not the same, so the behaviors or changes he experiences are also different. Therefore, families and caregivers respond to difficult situations in different ways. This brochure discusses some of the most common challenging behaviors and explores possible ways to respond to them.

Repetitive Actions

A person with Alzheimer's may do or say something over and over again. He may repeat a word, question or activity. In most cases, the person is probably looking for comfort, security and familiarity.

The person may also pace or undo what has just been finished. These actions are often harmless for the person with Alzheimer's, but can be stressful for the caregiver.

Here are some ways to respond to repetitive behaviors:

Look for a reason behind the repetittion.
Try to find out if there is a specific cause for the behavior and eliminate it.

Respond to the emotion, not the behavior.
Rather than focusing on what he is doing, think about how he is feeling.

Turn the action or behavior into an activity.
If the person is rubbing his hand across the table, give him a cloth and ask him to help with dusting.

Stay calm and be patient.
Reassure him with a calm voice and gentle touch.

Answer him.
Give him the answer he's looking for, even if you have to repeat it several times.

Engage him in an activity.
He may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.

Use memory aids
If he asks the same question over again, remind the person with notes, clocks, calendars, or photographs.

Accept the behavior and work with it.
If it isn't harmful, let it be and try to find ways to work with it.

Consult a physician.
Repetive behaviors may be a side effect from medication. Talk with your family doctor.

Aggressive Behaviors

Aggressive behaviors may be verbal (shouting, name calling) or physical (hitting, pushing). These behaviors can occur suddenly without an apparent reason, or result from a frustrating situation. Whatever the case, it is important to try to understand what's causing the person to become angry or upset.

Here are some potential ways to respond:

Try to identify the immediate cause.
Think about what happened right before the reaction that may have "triggered" the behavior.

Focus on feelings, not facts
Try not to concentrate on specific details, rather consider his emotions. Look for the feelings behind the words.

Don't get angry and upset.
Be positive and reassuring and speak slowly with a soft tone.

Limit distractions.
Examine the environment and make adaptations to avoid similar situations in the future.

Try a relaxing activity.
Use music, massage or exercise to help soothe the person.

Change focus to another activity.
The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.

Suspicious Thoughts

Due to memory loss and confusion, the person with Alzheimer's may see things differently. He may become suspicious of those around him and accuse them of theft, infidelity or other improper behavior. At times, he may also misinterpret what he sees and hears.

If this happens:

Don't take offense.
Listen to what's troubling him and try to understand his reality. Then be reassuring and let him know you care.

Don't argue or try to convince.
Allow him to express his opinions. Agree with his assumptions and acknowledge his thoughts.

Offer a simple answer.
Share your thoughts with him, but don't overwhelm the person with lengthy explanations or reasons.

Switch his attention to another activity.
Try to engage him in an activity or ask him to help with a chore.

Duplicate items if lost.
If he's looking for a specific item, have several available. For example, if he's always looking for his wallet, purchase two of the same kind.

Recognition Difficulties

At times, the person with Alzheimer's may not recognize familiar people, places or things. He may forget relationships, call family members by other names and become confused about where he lives. He may also forget the purpose of common items such as a pen or fork. These situations are extremely difficult for caregivers and require much patience and understanding.

Caregivers should also:

Stay calm.
Although being called by a different name or not being recognized is painful, try not to make your hurt apparent.

Reply with a brief explanation
Don't overwhelm the person with lengthy statements and reasons. Instead clarify with simple explanation.

Show photos and other reminders
Use photographs and other items to remind the person of important relationships and places.

Offer corrections as a suggestion
Avoid explanations that sound like scolding. Try "I thought it was a spoon" or "I think he's your grandson Peter."

Try not to take it personally
Remember, Alzheimer's causes your loved one to forget. But your support and understanding will continue to be appreciated.

Anxious or Agitates Feelings

A patient with Alzheimer's may feel anxious or agitated at times. He may become restless and need to move around or pace. Or he may become upset in certain places or focused on specific details. He may also be over reliant on the caregiver for attention and direction.

If the person with Alzheimer's becomes anxious or agitated:

Listen to his frustration
Find out what may be causing his anxiety and try to understand.

Reassure him.
Use calming phrases and let him know you're there for him.

Involve him in activities.
Try using art, music or touch to help the person relax.

Modify the environment
Decrease noise and distractions or move to another place.

Find outlets for his energy
He may be looking for something to do. Take a walk, play ball or go for a car ride.

Tips for Responding to Challenging Behaviors

Stay calm and be understanding.

Be patient and flexible.

Look for reasons for each particular behavior.

Respond to the emotion, not the behavior.

Don't argue or try to convince.

Acknowledge requests and respond to them.

Accept the behavior as a reality of the disease and ty to work through it.

Explore various solutions.

Find other outlets for the behavior.

Use memory aids.

Try not to take behaviors personally.

Talk to others about your situation.

Find time for yourself.

Alzheimer's Association
Someone to Stand by You

The Alzheimer's Association is the only national voluntary organization deducated to conquering Alzheimer's disease through research and to providing information and support to people with Alzheimer's disease, their families, and caregivers.

Founded in 1980 by family caregivers, the Alzheimer's Association has more than 200 chapters nationwide providing programs and services, including support groups, to assist Alzheimer families in their communities. The Association is the leading funding source for Alzheimer research after the federal government.

Information on Alzheimer's disease, current research, caregiving techniques and assistance for caregivers is available from the Alzheimer's Association. For more information or to locate the chapter nearest you call:

(800) 272-3900

Alzheimer's Association
919 North Michigan Avenue
Suite 1000
Chicago, Illinois 60611-1676

Copyright © 1996 Alzheimer's Disease and Related Disorders Association, Inc.

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