Behavioral Challenges: Effective Strategies and Approaches

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hello everybody. Welcome to a brand new episode of the Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host. And today's episode, I'm really excited to bring this to you because I think Some of the episodes that are— have become the most downloaded and the most popular are the ones where I'm giving you information about behavioral triggers and tips for caregivers. Those seem to be really, really popular. So what I've done is I've created some true case studies. To illustrate a variety of common behaviors associated with what you as caregivers and family members can expect from your loved ones living with Alzheimer's disease and dementia. Now, the story scenarios are absolutely true. These are taken from my decades of experience seeing what behaviors show up, We know that they're unpredictable, but the names that I'm going to be using in these scenarios are fictitious. They are not the real names of the people that I've known who display these behaviors. So included in these scenarios are effective strategies that you can employ using a person-centered approach to dementia care. So the first case study, I'm going to call him Mr. Johnson. He's 78 years old. He has a diagnosis of Alzheimer's disease, and he's in the moderate stage or mid-stage. And the behavioral challenge that I'm going to be illustrating in this scenario is that Mr. Johnson frequently exhibits agitation, especially during bathing and dressing. He would often resist help and sometimes lash out verbally or physically, causing distress for him and his caregiver. So here are some intervention strategies to go along with this little scenario. First, the caregiver did an environment modification. She adjusted the bathroom environment by minimizing the noise, for example, turning off the radio, using calming scents like lavender. And then the caregiver who had learned about Mr. Johnson's past preferences, like what his favorite music is, and she played those songs during his bath time or shower time to create a comforting atmosphere. When the agitation arose, the caregiver calmly redirected Mr. Johnson's attention to his favorite hobby, such as looking at old photographs, which helped soothe him. And the outcome of this scenario is, after implementing these strategies, Mr. Johnson's episodes of agitation actually decreased significantly, and he became more cooperative during personal care routines. Now, the thing that you need to remember is what worked for the caregiver in this particular situation worked in this particular situation. That doesn't mean that doing exactly the same strategy will work the next time because every single episode, behavioral episode that we see with these diseases is, is going to possibly have to be managed differently each time. But as I've said before, and I can't overstate this to you, that The more of these strategies and techniques you are aware of, the more you will have to try to actually de-escalate the situation. So this is one of them if you see, if you experience your person displaying agitation and aggression. So the second scenario, we're going to take a look at the behaviors of withdrawal and isolation. And this woman's name is Mrs. Davis. She's 82 years old and she has vascular dementia, early stage. Mrs. Davis had become increasingly withdrawn, avoiding social interactions and activities she once enjoyed. Family members reported that she often sat alone and expressed feelings of extreme sadness. So here's your intervention strategy for this situation. The caregiver, knowing she should encourage social engagement, organize small group activities with familiar friends to foster social interaction, starting with short visits to prevent overwhelm. Which is something that, that can realistically happen with dementia. Then she incorporated familiar activities like knitting groups, book clubs, emphasizing Mrs. Davis's interest to stimulate engagement in conversation. The caregiver provided praise and encouragement whenever Mrs. Davis participated in an activity reinforcing her involvement, and emphasizing positive reinforcement. Over several weeks, Mrs. Davis began to engage more with her peers, showing improvement in mood and a renewed interest in activities, ultimately reducing her feelings of isolation. So that's something that you can try. I'm gonna share 10 case studies with you so I don't overwhelm you with information because these are all different scenarios, and I think, um, that would probably be a comfortable number for you, um, per episode. So the next behavior that we are going to, um, assess is wandering and disorientation, which are other common behaviors that we frequently see in certain people who live with Alzheimer's disease and related dementia. This gentleman's name is Mr. Smith. He's 75 years old. He has mixed dementia. It's more specifically, he has Alzheimer's disease and vascular dementia happening simultaneously. Now, the behavioral challenges in this scenario is that Mr. Smith often wandered around the house. He wandered around his neighborhood showing signs of disorientation and confusion. Now, this raised safety concerns for his family. Which stands for reason. So here are some intervention strategy— strategies for you to consider if this happens to you. This caregiver installed safety locks on the doors and windows but created a designated safe space within the home where Mr. Smith could explore freely without risk. This is an excellent approach. Um, a structured daily routine was implemented, helping Mr. Smith anticipate daily activities and reducing his need to wander. Another proven technique. Then, when wandering occurred, the caregiver would gently redirect him to a favorite activity such as gardening or puzzles. He loved to do puzzles to keep him engaged and focused. So the outcome in this scenario is with the new safety measures and structured routine, Mr. Smith's wandering actually decreased significantly, and he felt more secure in his environment. The next scenario, we're going to take a look at what you can do if you are seeing a display of mood swings and depression. And poor Mrs. Thompson, she's 80 years old. Her diagnosis is Alzheimer's, and she's in her mid-stage. And unfortunately, Mrs. Thompson experiences frequent mood swings, often transitioning from happiness to sadness within very short periods of time. Her caregiver noted that she expressed feelings of hopelessness. So the intervention strategy that this caregiver implemented for this situation is she introduced art therapy sessions allowing Mrs. Thompson to express her emotions creatively, which helped reduce her mood swings. Family members were encouraged to visit regularly, engaging Mrs. Thompson in conversations about her life and her interests, which lifted her spirits. Uh, this caregiver collaborated with healthcare professionals to assess Mrs. Thompson's medications and ensure they were effectively managing her symptoms. Another thing that always should be checked into, because some of the behaviors that we see in people with dementia could actually be a result of reaction to their medication. If it's— they're overly medicated, not medicated enough. So that's something that you always want to take into consideration. So the outcome for Mrs. Thompson's story is that she did exhibit fewer mood swings and reported feeling more positive, showcasing the effectiveness of creative expression and social support. Love it. So the case studies that I've shared with you so far exemplify how understanding the underlying causes of behaviors and applying tailored strategies can lead to improved outcomes for individuals living with Alzheimer's disease and dementia. I'm moving on to the next story. This one seems to be a point of frustration for most family members and caregivers. It's repetitive questions, and we're seeing this displayed by Mr. Lewis. He's age 79. His diagnosis is also Alzheimer's disease, but he's in the early stage, so this actually does show up in the early stage of dementia in some people. And Mr. Lewis frequently asked the same questions over and over and over again in the same conversation, often becoming frustrated when he didn't receive a satisfactory answer. And this is key— they will continue to ask the same question because they want to, in their mind, have a satisfactory answer. And if you don't provide them with that, they're going to keep asking you that question. So here are some suggested intervention strategies in this situation. His caregiver learned to respond calmly and patiently, providing the same answer while reassuring Mr. Lewis that it was okay to ask questions. She created a chart with key information about daily routines and family members, allowing Mr. Lewis to refer to it instead of asking repetitive questions. Then, when Mr. Lewis became fixated on a question, his caregiver redirected him to engaging activities such as playing a game or looking through a family photo album and discussing what was in each picture. By implementing these strategies, the frequency of repetitive questioning decreased, and Mr. Lewis experienced less frustration, leading to more enjoyable interactions between him and his caregiver. Next one, nighttime disturbances. Now, this happens frequently, and I'm sure a lot of you already are aware of that. And my— in my story today, the woman's name is Mrs. Martinez. She's 85 years old, and she actually is living with Lewy body dementia. The behavioral challenge that her caregiver is dealing with right now is that Mrs. Martinez often experiences confusion and restlessness during the night, leading to significant sleep disturbances for both her and her caregiver. So here was the intervention strategy for this particular Scenario: The caregiver established a bedtime routine by implementing a calming bedtime routine that included soft music, dim lighting, and relaxation exercises to signal that it was time to sleep. Maybe you want to try a nice soothing calming hand massage. I've seen this work a million times. Just take some lotion, and just do a gentle relaxing massage as part of the new bedtime routine. I've seen that work miracles. The environmental adjustments that she made were putting nightlights throughout the home to reduce confusion and anxiety when waking up in the middle of the night., and this particular caregiver consulted with her, Mrs. Martinez's, healthcare providers to assess Mrs. Martinez's medications so they could determine if the medications needed to be adjusted as necessary to minimize the nighttime agitation episodes. So the outcome for Mrs. Martinez with her caregiver using these strategies actually was very positive. With a structured bedtime routine and environmental modifications, Mrs. Martinez experienced fewer nighttime disturbances and improved sleep quality. Hopefully they'll work for your person too if you find yourself in this situation. Okay, the next one, which is extremely common, I saw it with my own grandma, uh, is paranoia and suspicion. And this gentleman's name is Mr. Patel. He's age 72, and he is in the moderate stage of his Alzheimer's disease. The behavioral challenge that Mr. Patel occasionally displayed is paranoia, believing that caregivers were stealing from him or plotting against him, which led to conflict and distress. This was the same scenario as I witnessed with my grandmother. So some good intervention strategies. If and when this occurs is to build trust with your person. Caregivers worked on establishing a trusting relationship by consistently being present and demonstrating reliability in daily tasks. When Mr. Patel expressed suspicion, his caregiver or caregivers would validate his feelings without arguing with them, gently redirecting the conversation to positive topics. The caregivers also involved Mr. Patel in decision-making regarding his belongings, allowing him to feel in control. This is very important and very secure within his environment. So the outcome for Mr. Patel was that over time, his feelings of paranoia diminished as trust was built with caregivers, leading to more peaceful interactions and positive outcomes. Got a couple more, and then we will, uh, continue with this in future episodes. This one happens probably more frequently than we would like to admit, but it does happen, and it's unpredictable, just like all the other ones that I'm sharing with you. And this is— this one addresses inappropriate behavior, and this is coming from Mrs. Jenkins. She's 83 years old. And she has frontotemporal dementia. This— these inappropriate behaviors are common with frontotemporal dementia because that brain disease attacks our thought processes, our ability to reason things out, and to use judgment about things. So here's the challenge. Mrs. Jenkins began exhibiting socially inappropriate behaviors, such as making crude jokes or comments that were out of character for her, causing discomfort among family members. Another common behavior you'll see a person with, especially frontotemporal dementia, swear like a sailor. That's very common. So here are some intervention strategies if this occurs. First of all, you want to understand the behavior. Caregivers who are educated, who have educated themselves on frontotemporal dementia and its impact on social behavior, recognize that these behaviors are not intentional. They need to set boundaries. So in other words, the caregiver, per her, calmly addressed inappropriate comments, explaining why they were not acceptable, but she maintained a very supportive tone. When inappropriate behavior surfaced, as in Mrs. Jenkins' case, her caregiver redirected her to engaging activities such as arts and crafts. Crafts to focus her energy positively. And the outcome in Mrs. Jenkins' case was by establishing boundaries and redirecting her focus, Mrs. Jenkins exhibited fewer inappropriate behaviors, resulting in a more harmonious family environment. And that's what our goal is, of course. So, case study number 9. This one is going to illustrate fear and anxiety, which we had another intervention for anxiety. This one is fear and anxiety. And this is Mr. Thompson, I'll call him. He's 76 years old, and he too has mixed dementia. So, He has more than one brain disease happening simultaneously in his brain. So that's a double whammy, of course. And this resulted in Mr. Thompson experiencing heightened anxiety and fear, particularly in unfamiliar environments or during transitions, leading to panic attacks. So here are the intervention strategies, uh, that this caregiver used. We call them familiarization techniques. The caregiver gradually introduced Mr. Thompson to new environments, allowing him to explore at his own pace while providing him with reassurance. The caregiver taught Mr. Thompson breathing exercises and mindfulness techniques to help him manage anxiety when it arose. This was a calming strategy that she used. And by establishing a consistent daily routine, for Mr. Thompson, that helped reduce his unpredictability and, uh, helped him feel more of a sense of security. So the outcome for Mr. Thompson was through gradual exposure and calming techniques, his anxiety and fear decreased, allowing him to engage more comfortably in his various settings. And then finally, number 10, I'm going to name this lady Mrs. Wilson. And Mrs. Wilson's 81 years old, and she's in her moderate stage, the moderate stage of her Alzheimer's disease. And Mrs. Wilson often displays emotional outbursts, often crying or becoming angry over minor frustrations, which leaves her caregivers unsure how to respond. And they come out of nowhere, so they got to figure out, okay, what was the trigger for that? And then how do we manage this? So as far as identifying triggers, it is helpful for the caregivers to keep a journal to track when and why emotional outbursts occur, identifying specific triggers such as changes in routine or unmet needs. Keep that journal and then you'll probably start seeing patterns to what triggers these emotional outbursts. So it'll become easier to avoid them once those patterns are established. Her caregiver learned to offer comfort through gentle touches, reassuring words, and validation of Mrs. Wilson's feelings during these episodes. They engaged her in calming activities like listening to soothing music. Mrs. Wilson loved gardening, so they would go to the garden and start some gardening activities. This helped her express her emotions in a much healthier way. So the outcome in this last scenario is By understanding triggers and providing emotional support, the frequency of Mrs. Wilson's outbursts actually did decrease, leading to a more peaceful environment. So these are true-to-life examples of things that do show up unpredictably most of the time on a day-to-day basis for your loved one who's living with Alzheimer's disease, dementia, and other brain diseases, and for caregivers, and we'll give you some very strategic tools to use to help turn the situation around to a positive outcome. So hopefully you'll find these very helpful and be able to relate them to some of the things that you do experience, have experienced, or will experience in the future, and you'll have strategic approaches to deal with these. So that's our episode for today at Truth, Lies Alzheimer's. And again, I'm Lisa Skinner, your host, and I will be back next week with another brand new episode of the Truth, Lies Alzheimer's podcast. So have a great week and stay healthy and just enjoy every day to its fullest. And I'll see you all next week. Bye-bye.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a Caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.