How to Handle Dementia Behaviors | Caregiver Tips That Really Help

expertise with you about what living with Alzheimer's disease and dementia is truly like for those who have it, and how it impacts the lives of not just the people who live with it, but everybody involved, like you. This tragic disease strikes so many families who really need to have a better understanding of it in order to focus on what really matters, and that is to spend quality time with your loved ones without the added stress and anxiety of the many hidden aspects of this diseases that show up unexpectedly every single day. Well, this takes knowledge. And with this knowledge, you can become empowered to be prepared for anything that might be a challenge for you along the way. I'm a behavioral specialist with expertise in Alzheimer's disease and related dementia. I'm also a certified dementia practitioner, a certified dementia care trainer through the Alzheimer's Association, a best-selling and award-winning author, and the host of an internationally distributed radio, radio show called The Truth, Lies Alzheimer's Show, which is about this very topic. Now, I've been counseling families for almost 30 years, and my goal for you is to be able to provide hope and inspiration as to how people who live with Alzheimer's disease and related dementia actually can lead very fulfilling and meaningful lives despite having this disease. As Americans age, many will require senior living, and as they age in place, many will develop a dementia-causing illness like Alzheimer's. Therefore, at some point, senior care does become dementia care for so many people these days. That said, it is extremely important to understand as much as we can about dementia, its related behaviors, communication difficulties, and how to successfully intervene. People with dementia commonly suffer from delusions, hallucinations, and paranoia, which are very common with dementia. And unfortunately, we now know that no amount of reasoning can talk a person experiencing a delusion out of their belief. So we must rely on alternative strategies to manage these behaviors. According to the Alzheimer's Association, approximately 1 out of 3 Alzheimer's disease sufferers will develop paranoia and suspiciousness. And because people living with brain disease do suffer from Impaired reasoning— they may easily misinterpret others' intentions and have difficulty understanding what is being communicated to them. Their ability to separate fact from fiction may also become impaired. Additionally, problems with memory and misperception can generate suspicious and paranoid thoughts in a person living with dementia. Therefore, the ability to perceive things the same way we do, those with healthy brains, will affect the person living with dementia's judgment, not just visually, but visually and conceptually. Their level of confusion will increase over time because they are losing the ability to make sense of what their senses are taking in. So consequently, this can produce several adverse reactions such as fright and combative behavior. Alzheimer's disease and other related dementia gradually diminish a person's ability to communicate. Communicating with a person who lives with Alzheimer's disease requires patience, understanding, and good listening skills. Additionally, the right treatment environment can actually provide a great sense of purpose and belonging. And a big part of the solution is in identifying activities that folks who live with dementia enjoyed during their prime years. So for us to help them engage in those types of activities will do wonders for their self-esteem and provide much-needed sensory stimulation. A well-coordinated program which incorporates these elements, can decrease challenging behaviors and most importantly, fulfill their need to feel like they're living a meaningful life. A person living with a brain disease that causes dementia will slowly change over its course as the disease progresses. The person you once knew will begin to fade and will eventually disappear. And sometimes you'll see extreme personality changes and watch them become different people from who you knew before. And the control that the person once had over his or her life will unfortunately erode. Now, it's extremely difficult for family members and caregivers to understand and accept these changes. However, knowing that these changes are inevitable and being prepared for them will make your journey with your loved one much easier to bear. You will eventually become the interpreter of your loved one's signs, symptoms, and behaviors. So today we're going to be exploring how helping a person living with dementia can prever— preserve their very basic human instinct and need of purpose and dignity, which can make all the difference to enhancing their quality of life. Now we know that the brain is at the center of our thought processes and is central to our lives. It takes in daily experiences and enables us to make sense of our world. Our memories are actually the threads that sew our lives together in sequence and in continuity. So when our memories begin to fail, that tie to our life just unravels. The first memory problems with Alzheimer's disease typically occur with our recent or short-term memories. The person will have difficulty recalling the events that have happened most recently. However, their long-term memories can and usually do remain intact far into the disease, typically till the end. A person experiencing lost memories may feel confused when the world as they knew it begins to disappear, and then their past and their present collide. Well, this can elicit feelings of fear and anger, as well as unveil uncharacteristic behaviors of that individual. With an overall prevalence of about 30%, agitation is the third most common neuropsychiatric symptom with dementia. After apathy and depression. Confusion is one of the leading causes of anger and aggression in Alzheimer's disease and folks living with related dementia. Confusion can be triggered by lost trains of thought, mixed-up memories, or a sudden change in the environment, such as a change from one caregiver to another. So we use a variety of strategies like Join Their Reality or reminiscence therapy to help people cope with the loss of their core self. The best we can do is keep them safe, engaged, and comfortable in the last years of their life. With Alzheimer's disease, a person's short-term memory becomes so diminished that they become disoriented to time and place and believe they are living in a different period of their life. This can also lead to personality changes such as irritability, anxiety, and an obsession with an idea that isn't real to us, but it is real to them. Trying to change their reality will prove to be futile for the caregivers. And it will only exacerbate the situation. Success will rely on finding creative ways to enter and embrace their new world. Your loved one may display an unusual preoccupation, but know that with a little insight into what's driving that preoccupation and a little creative troubleshooting, We can find ways to put our loved ones at ease. Our memories keep us plugged into the work and play of our lives, what we do and how we do it. It also allows us to understand how we fit into the social fabric because our memories store key habits, beliefs, and values that make us unique and vital individuals. But dementia profoundly affects a person's ability to keep their world in order and therefore impacts the way they live in that world, in that new world, and how they get along with other people in it. Most people living with dementia become confused when situations go beyond the limits of their thinking abilities. And as the disease progresses, The mind's ability to avoid confusion declines because they lose the normal filters and protections they once had when their brains were healthy. And then during the middle stages of Alzheimer's disease, people often experience depression, anxiety, irritability, and repetitive behaviors.. And then as the disease continues to progress, other changes, other significant changes may occur, including sleep changes, physical and verbal outbursts, and wandering. Now, the Alzheimer's Association tells us that as many as 60% of people with dementia will wander. Now, wandering in itself isn't necessarily a negative behavior if done in a safe environment. However, if a person is able to leave the security of their home and not be able to communicate who they are or where they're supposed to be, this could inevitably put that person in extreme harm's way. So it's important to understand that as Alzheimer's disease continues to destroy memory and mental skills, it also begins to alter emotions and behaviors. Approximately 70 to 90% of Alzheimer's patients eventually do develop behavioral symptoms. Agitation is one of the most common behaviors seen with dementia and can be displayed in a variety of ways, including restlessness, pacing, fear, and/or in changes in body language and facial expressions. Agitation can also easily escalate to aggression. If not responded to appropriately. Now, it's important to understand that a behavior— these behaviors that we see that are manifested due to the changing brain, um, should be considered a problem only if it has a negative impact on the person afflicted or on others around him or her. Now, these behaviors can be triggered by one or more of several contributing factors, such as an environmental issue like sensory overload, too much noise, or even the temperature of a room can make a huge difference. So we're gonna take a closer look at these types of triggers. There are so many of these underlying reasons why a person might, what they might be reacting to. So the important thing to keep in mind is that the reactions or behaviors are the only way that our loved ones are able to communicate that there's a problem that needs to be addressed. That said, One of the most important principles to take away here is that you must be careful not to take these behaviors at face value or rush to judgment about what's causing them. And through the process of elimination, the underlying reason can be uncovered. Normal thinking abilities allow us to control our emotions. Adjust our responses to situations, judge the difference between a big deal and a little deal. But with dementia, that ability is gradually lost. Dementia, once it has been officially diagnosed, sadly does not go away. But the symptoms can come and go, and the condition can manifest itself in a variety of ways depending on each individual person. The symptoms and signs of Alzheimer's disease or related dementia do progress at different rates. They vary from person to person. So we're going to explore different ways to identify and then fulfill that need that may exist when a person can no longer tell us what it is they want or what it is they may be needing. Now, be mindful that a person with Alzheimer's disease may do or say something over and over again. Like repeating a word, asking the same question over and over again, fidget. They seem to love to fidget or undo something that has just been finished. That's not uncommon. In most cases, he or she is probably looking for comfort, security, and familiarity. These repetitive behaviors are demonstrated by people with dementia because they may be unable to remember recent events or actions due to short-term memory loss. They may also repeat words or gestures as a means to soothe themselves. The behavior may be an attempt to communicate a need or physical discomfort. People with dementia can seem perfectly fine one moment and in the next, they can become anxious and detached from our reality, not their reality. And this can definitely be one of the most troubling behaviors for family members and caregivers to deal with. The difficulty stems from not wanting to see our loved ones uncomfortable and from not knowing how we should be handling the problem that exists in their mind. Losing touch with reality is, is a normal progression of this disease, and this is due to the short-term memory diminishing throughout the course of the illness. So again, your loved one may repeat things. They may repeat activities, questions, or stories. They may also pace around the room, and these types of behaviors are often a coping mechanism for dealing with stress or fear, but can be annoying for caregivers and family members. There's no question about that. Now, our brains process information in different ways. Through abstract thought or through concrete thought. And we rely on these thought processes every single day. But this ability becomes lost early in the disease. This means that many of the concepts that we have relied on to live in this world no longer have any meaning for people living with dementia. So that's another thing that I'll cover, is how we can help our loved ones make better sense of the world, the new world that they are currently living in. The prevalence of anxiety symptoms in Alzheimer's disease is about 40%, and it can be a prelude of Alzheimer's disease. Anxiety can be especially present among patients with mild cognitive impairment, mild dementia, or early onset forms of Alzheimer's disease, and can promote progression or conversion to Alzheimer's clinical syndrome. So I'm going to share with you a true story to illustrate, um, some of what you can expect to see in a day to day life of a person living with Alzheimer's disease and dementia. So my story started almost 50 years ago when my grandmother began displaying some very peculiar behaviors. And I called this story Birds in the Mattress. I changed her name. Mrs. Walker only lived a few miles from her family, so they visited her often. When her eldest granddaughter got her driver's license, she loved to spend time with her nana. And during one of her visits, she encountered some very peculiar behavior from her nana that she was not expecting. Well, they were sitting in the living room having a nice conversation when Nana told her about these birds that lived in her mattress and came out at night to peck at her face, that she saw rats running along her walls and all over her floor, and that they were planning to invade her home, and also shared with her that there were these men who were constantly trying to break into her house because they wanted to steal her personal possessions, steal her jewelry, and then she was absolutely convinced that they would eventually do away with her and take over her life. Well, I was the granddaughter listening to these tales, and I honestly didn't know what to think the most far-fetched stories I had ever heard in my life. To me, they just sounded unbelievable and, um, just so far-fetched that I was just dumbfounded and didn't understand what was happening with my grandmother because I truly adored her and I desperately wanted to believe what she was telling me. So what I did was I led her into the bedroom one day and told her that I wanted to help her, that I could tell how terrified she was. And so we could check her mattress to see how these birds were getting in and out of the mattress at night. So I pushed the mattress up, looked underneath, and told her that I just wasn't finding any holes. And I couldn't find any evidence to see where these birds were getting in and out. I said, are you able to show me so I can help you and maybe know the right thing to do? She looked at the mattress. She stared at that mattress, and then she looked me straight in the eyes and said, oh, Lisa Skinner Skinner, they're there. They're just very, very clever. Well, that actually was a brilliant response for her to say to explain the birds away to me. And unbeknownst to the family, while my grandmother was alone, she was calling the police 2, 3, 4 times a day to report these intruders. Well, they initially did send a patrol officer out to her house to check things out, but of course they didn't find any evidence of anything that she was claiming. But she did continue to call them day in and day out. So one day there was a knock on my family's home at the front door. It was the police chief, and he was there to talk to my mother about her mother's relentless calls to the police station. And then he said to my mom, "Lady, you need to do something with her. We cannot continue to take her calls. We don't have the time or the resources to deal with this every day. Your mother is some kind of a nutcase," he says to her. Well, I was standing there listening to this conversation and I could not believe that the chief of police just called my grandmother a nutcase. He showed absolutely no concern for her safety or any consideration that maybe, just maybe, there was something wrong with her. He just rushed to that judgment that she was a nut. Well, I was mortified. And guess what? I've never forgotten that day. It stays with me always. Now, at that time, I didn't know exactly what was wrong with my grandma. I only knew that she was changing right before our eyes. Well, soon after that, my mom told me that my grandma had been diagnosed with what they called back then senile dementia, which is synonymous with today's Alzheimer's disease. And that turned out to be the beginning of our 20-year journey of watching my grandmother decline until her death. Well, here are some further thoughts about that story. As was evident in the story, my grandma was experiencing a couple of common behaviors that we see with dementia. The birds in the mattress are what we call a delusion or a false belief. The rats running around the living room are what we call a hallucination. And her believing that men were breaking into her home and stealing her personal possessions, that they were eventually going to do away with her, was— is an example of the suspiciousness and the paranoia that people living with dementia do commonly develop. Now you can see them displayed individually or separately, and not everybody who lives with dementia experiences those behaviors, but they are very common. My grandmother's belief that there were birds living in her mattress and that they pecked her face at night was a true example of a, of a delusion, which is a false sensory perception, which usually manifests as hearing voices or seeing things that aren't there. And of course, we talked about a paranoid delusion because she did believe someone was going to harm her. And as we know from, you know, just decades of trials and tribulations, that unfortunately we now know that no amount of reasoning can talk a person experiencing a delusion out of their belief because it is their truth. It is their reality. It's just not aligned with ours. So often the most effective solution is to either attempt to redirect their attention to something else or to acknowledge what they're feeling, to validate what they're feeling, and then to offer a way to help resolve the situation, as I did when I took her into the bedroom for for her to show me the holes. Now, finally, paranoia is very often seen in those living with dementia. And according to the Alzheimer's Association, approximately 1 out of 3 Alzheimer's disease sufferers will develop paranoia and/or suspiciousness. And many times a person with dementia will misplace a belonging and then accuse a family member or a caregiver of taking it. And part of the reason is because people with brain disease do suffer from impaired reasoning. They may easily interpret others' intentions and have difficulty understanding what is being communicated to them. Their ability to separate fact from fiction almost inevitably becomes impaired. Hallucinations, paranoia, and delusions can sometimes be mitigated with behavioral management therapies. However, extreme psychotic symptoms may require medication, and periodically we do see that. So establish a relationship with your loved one's doctor and make sure the doctor is provided with consistent updates on your loved one's conditions and the behaviors that they are displaying. One of the key functions that our brains perform is that of perception. In a person living with dementia, the ability to perceive things the same way we do diminishes and affects that person's judgment, both visually and conceptually. Their level of confusion does increase over time because they lose the ability to make sense of what their senses are taking in. And as I mentioned before, this can produce several adverse reactions And we typically see fright, which is, you know, an instinctive reaction, fight or flight, and also combative behavior. Additionally, problems with memory and perception can generate suspicious and paranoid thoughts, like we saw with my grandmother. And, you know, the truth of the situation is there are So many aspects of living with dementia that are just so unexpected. It can surface out of nowhere at any time. We need to be prepared for this. I call these the hidden or secret faces of dementia, and as many of you know, they do show up unannounced. And are completely unpredictable. You don't know what triggered any given behavior, and this is why it's so critically important to be prepared for anything that might show up on this journey. So one of the core principles that I teach and that I've been certified in is called a person-centered approach to dementia care. And that methodology focuses on each individual as they are experiencing living with Alzheimer's disease and dementia, as opposed to focusing exclusively on the disease and the symptoms. And what we learned was that because each individual person does experience the disease differently, it is important to adjust our care and communication strategies to each specific person because this will enable us to create a care and communication plan that is customized to the needs of each person as they do progress through the different stages of the disease in a way that will be effective and compassionate for them. When a person living with dementia can no longer communicate with us to have their wants and needs heard, they will find alternative ways to do so. This typically does manifest in the way of a variety of behaviors that we see every day during the course of the disease, and it is going to be up to us to recognize these behaviors as their way of trying to tell us something. But we're going to have to figure out what that something is. The most common association that people make with Alzheimer's disease is that it destroys their short-term memory so they don't remember short-term or recent events, and that they can become extremely confused. Now, this is true. Memory loss is the hallmark of Alzheimer's disease and related dementia. However, as you're starting to hear with, you know, what I'm saying in this special presentation, the scope of the disease and the way it affects people is far more complex, far more complicated than just memory loss and confusion. The brains of people living with Alzheimer's or one of the other over 100 brain diseases that we know of that cause dementia is changing rapidly as the disease progresses. So consequently, most of these changes that are happening in the brain, many people are not aware that they are a common occurrence of the disease process, but they are. For example, some of the more common behaviors that we expect to see are wandering, The delusions that I spoke about, constant repetition of questions, stories, and habits, not recognizing our loved ones. Again, the suspiciousness as well as the paranoia. Living with dementia is absolutely unlike anything any of us can imagine. It's kind of like falling into a rabbit hole and entering a world unlike anything we've ever known, a world that becomes completely unfamiliar. With that said, it is equally important to not only understand what will occur on a day-to-day basis, but why they occur. What's happening to a person's changing brain as they progress through the various stages of Alzheimer's disease. When you're equipped with this understanding and knowledge, then hopefully you too can be prepared for what might present inevitable challenges for you day after day. And that's really the key, is being prepared and not being caught off guard. Well, there's another very common symptom that happens in people living with Alzheimer's disease and dementia that I want to tell you about. It's called aphasia. And aphasia refers to the loss of spoken language or speech comprehension, reading and writing abilities due to brain damage, which is due to neuropathy, for example, Alzheimer's disease, and it's caused by the deterioration of neural connections that destroy the brain, and they eventually can lose the ability to understand speech, to speak themselves, And aphasia sadly does worsen as the disease progresses. It becomes harder to remember the right words to plug into a sentence and process what other people are saying to them. They process words very slowly compared to when their brains were healthier. Aphasia can be a common symptom of Alzheimer's disease, and it does refer to the loss of spoken language and/or speech comprehension, which includes reading and writing abilities, due to the brain damage caused by the brain disease. It happens through the deterioration of neural tissues accompanied by behavioral and functional decline, and this includes their ability to communicate. So here, this is another true story that I want to share with you to illustrate a client of mine who did develop aphasia and what that actually looked like for me. So I was called over to a client's home. And the daughter that asked me to come by to assess her dad told me that he was really, really advanced in his dementia. This gentleman that I was asked to assess and visit lived with his wife of over 50 years and had been diagnosed with Alzheimer's disease. Now Carly, his daughter, who was concerned about him, still living there at home with her mom, she had described to me that he was unable to do anything on his own and also could not communicate, um, to his family at all. But to my surprise, he was much more high-functioning than I expected him to be. So I was introduced to Harvey, which was his name, as Carly's friend who was stopping by to say a quick hello because my husband and I were on our way to Ashland, Oregon to see the Shakespeare Festival, and they lived not far from that destination. So the first thing he says to me when I walked in was, oh, you must be Carly's friend who's going, going somewhere. He couldn't remember where she said I was going. Um, they had told him that I was stopping by on my way to Ashland, Oregon, but he didn't remember that detail. But he did remember that a friend was stopping by. That was the first thing that surprised me because based on what his daughter described, I wasn't expecting him to not only not say anything to me, but not remember that they told him where I was going and that I was a friend. So that was my first clue. Then I proceeded to sit down at the kitchen table with him and I noticed a blue pill organizer sitting on the windowsill marked with the letters M, T, W, T, H, F, S, and S. So I pointed to it and I asked Harvey, what, what's that thing there on the windowsill? I said, what does that do? And he said to me, well, That's where I put the little things that keep me alive. I was completely taken aback at his response. Well, I continued with Harvey. How do you know where to put the little things? I asked him. He couldn't recall the word for medication. Or what the letters on the organizer actually stood for, but he showed me how he took a pill from each of his prescription bottles and placed them in the organizer, beginning in the leftmost compartment and then the next one to the right, and so on, until the pills were correctly placed in each compartment. Then, out of the side of my ear, I heard his wife Darlene say, "Yeah, and the old codger gets them right every time. I do check to make sure," she says. Now Carly, his daughter, had definitely been mistaking his father's decline in verbal skills for a decline in his cognitive skills. Skills. But it was very apparent to me that by then he did understand much more than they believed he did. He was actually still what I considered very high functioning. So after my visit, I wrote up my assessment of Harvey with some recommendations of what they could provide for him while he still stayed in the home. In ways of activities and care options to keep him engaged and active so he could stay as independent as he was capable of doing based on his skill level and to avoid the temptation to continue to do everything for him. I said that would just definitely perpetuate turning him into an invalid. So understand that as Alzheimer's disease and other related dementia destroy our brain cells, a significant symptom, aphasia, what I just described to you through my story, may develop. It becomes harder to remember the right words. And to process what others are saying, as we heard in this story. Now, Harvey did obviously suffer from aphasia and lost some of his ability to communicate. Now, there are many types of aphasia, and it can present itself in a variety of different ways. The condition results from damage to the communication centers of the brain, And for me, it was evident that Harvey was still what I considered high functioning cognitively. He understood everything that I was saying to him, but he did have difficulty finding the correct words to use as well as difficulty articulating his thoughts. For example, when I asked him what the pillbox was, he couldn't remember the correct name for it, as I said, even though it was very obvious to me that he knew and understood exactly what the function of that pillbox was. Now, a more cognitively impaired person would not have been able to recognize what a pill— the function of a pillbox was or what it was supposed to be used for as Harvey did. There are also a lot of misperceptions from the family members in this story, which is perfectly natural and by no means a negative reflection on them, but we do all have blind spots me included. And of course, we don't know what we don't know. This was their first experience with Alzheimer's disease. It's important to remember that what connects us with others in the world is our ability to communicate. It's the ability to get and give information as well as express our needs and feelings. Using language is the most common form of communication that we can use effectively, but there's also body language, facial expressions, and gestures. Sadly, the ability to communicate is gradually lost with dementia. It's not uncommon for people with dementia to substitute words when they can't think of the proper word. The proper word that belongs in a sentence, so they unintentionally make something up, and we call this confabulation. The first problem is typically with finding the right words that fit into what they're trying to tell us, and then later in the disease, a person may have more difficulty expressing thoughts and ideas. Their brains might know what they want to say, but they lose the ability to actually articulate it. This decline in the ability to communicate can lead, obviously and understandably, to frustration and emotional outbursts. Also, the ability to understand what's being said also declines. Words become less effective for them. And eventually, efforts to communicate will become shorter and simpler and may be limited to single words and gestures. So that's one of the things that we're gonna explore in this presentation of ways to more effectively communicate with people who live with Alzheimer's disease and dementia. Now, eventually, family members and caregivers will learn to rely on visual cues for prompting and cueing. And again, according to the Alzheimer's Association, approximately 1 out of 3 people living with Alzheimer's will develop paranoia and suspiciousness, and approximately living with dementia will also display behavioral impulses. And let me explain why. Because people living with these brain diseases, like Alzheimer's, eventually do lose all of their thinking powers. That includes judgment, memory, language, abstraction, organizational abilities, reasoning, perception, as well as their ability to pay attention to the world around them. All of these things work harmoniously and in concert for a person to be able to operate effectively in their world. We rely on these skills to maintain control and keep confusion away. They work together to define a world and a— that a healthy person understands. But once these abilities are damaged by a brain disease, those people are no longer capable of that type of understanding. Therefore, because people with brain disease do suffer from impaired reasoning, They may easily misinterpret others' intentions and have difficulty understanding what is being communicated to them. Their ability to separate fact from fiction becomes impaired. And in a person living with dementia, the ability to perceive things the same way we do diminishes and affects that person's judgment, both visually and conceptually. Their level of confusion will increase over time because they are losing the ability to make sense of their surroundings and what's happening around them. Now, consequently, this can produce many adverse reactions. I mentioned earlier the fight or flight response, which is to run from the situation or to, uh, become combative to protect yourself. And they will eventually fall back on these instinctive raw emotions when reacting to any given situation. Confusion can be triggered by lost trains of thought, mixed up memories, and sudden changes in the environment. And as the disease progresses, the mind's ability to avoid confusion declines. They lose the normal filters and protections they once had when their brains were healthy. Also, our normal thinking abilities allow us to control our emotions adjust our— the way we respond to them, judge the difference between something happening in our life. But with dementia, again, the ability is gradually lost altogether. So here are some examples of effective reactions, responses, and best practice approaches to the different ways that we can communicate with people living with dementia. So always make eye contact and be at their level. Don't stand above them. If they're sitting down, you sit down and you make direct eye contact. Always approach them face to face in full view. And slowly. Say their name. It is vital that they are able to see you and that their attention is focused on you. Read their eyes. Always approach from the front, never from the back, as approaching and speaking from the side or from behind can very easily startle them. Again, be at their level. Position your head to be at the same level as their head. Bend your knees or sit down to reach their level and do not stand or hover over them. That's very intimidating and scary to them. They can't focus on you and what you were saying if they were focused on their fear. Explain what is about to happen, what you're going to do, or what you're going to do together, and do it in short, clear statements such as, "I'm going to help you take off your coat," especially if you're going to touch them. That can be very frightening if you touch them without forewarning them. They need to know what is coming so they don't think that you are grabbing them or going to harm them. So again, always speak calmly, always speak slowly, pause between each sentence. Remember, they cannot process words as fast as you can, so give them a chance to catch up to your speaking speed. Speak in short sentences, in short direct sentences with only one idea to a sentence. That way they only have to focus on one idea at a time. Only ask one question at a time and let them answer it before you ask another question. You can ask who, what, where, and when, but don't ask why. Why is much too complicated for a person living with dementia to explain. They will try to answer, but will inevitably fail and get frustrated. Don't Ask them if they remember. Many times they will not be able to remember, so really you're just reinforcing and pointing out to them of their disability, and this can cause anger and embarrassment. You can turn negatives into positives. For example, say, "Let's go here," instead of, "Don't go there." Be inclusive and don't talk down to them like they were a child. Respect the fact that they are adults and treat them as such. Please don't argue with them. It gets you nowhere. Check to see if the aggressive behavior is about getting what they want. So trying to anticipate their needs may actually end up being extremely helpful for you. I'll say this again, and I really can't emphasize it enough: validate their feelings by saying something like, "Mom, I can see that you're very upset right now," and it lets them know that they're not alone, and then you can try to redirect them to become interested in another thought. So the following is a list of communication tips that I gathered over the years that are expressed directly from individuals who are living with memory loss. They want us to speak with a smile so that I know you care. If I'm tense, remember, I can feel your tension too. A smile takes away my tension and helps put me at ease. Please use language that I can understand, and you can do that by keeping it simple, and try not to use jargon or slang. I can't relate to that. Slow down your speech so I can understand what you're saying. I can't process words like I used to be able to. Speak slowly. Keep it short and to the point. One idea at a time. Let me take the time to think through what you just said to me. Let me set the pace for the conversation. Let me be the leader in the conversation and give me charge of the conversation. Always make sure you have my attention. Pause once you say your thought. Pause so I can say my thought. Give me time to find the words and to say my thoughts. And let's take turns during the conversation. Plus, please let me finish what I am trying to say because it might take me a little longer to say what I want to say, so don't cut me off. And please repeat information if I ask you to. Make sure I hear you and ask if I understand what you have just said. Adjust your tone of voice up or down. Louder is not always better. I might not necessarily be deaf, And please face me when you talk. Your eye contact helps to get my complete attention. Please don't interrupt me. And lastly, please be patient with me. Don't give up on me. I really do want to be a part of our conversation. In a person with a healthy brain, all thinking powers like memory and reasoning do work together to define our world that we understand, allowing us to function effectively in that world. In people with dementia, those powers of thoughts shrink. Creating a world that becomes increasingly overwhelming and less able to make sense of. People living with dementia lose their— that knowledge of how to handle situations, and they're going to react based on how a particular situation affects them emotionally first. That's why agitation Anxiety, fear, aggression, and anger are all examples of some of the most common behaviors that will surface as a result. Alzheimer's aggression can flare up without warning, and there may not be an obvious cause. However, some of the triggers that are common include they're uncomfortable from lack of sleep, They have— they're experiencing side effects from medication or pain that they can't tell you they're experiencing. Maybe the environment around them, including loud noises, is just way too much activity, or there's too much clutter around and it's making them extremely nervous. They could also become confused from being asked too many questions at once, trying to understand complex instructions, or they feel the stress that is being put out by their caregiver. Now, being touched or feeling like their personal space has been invaded, or as with bathing or changing their clothes, can be a huge trigger for difficult behaviors. They'll pick up on your anger or your frustration and emulate it. They don't like to be criticized or told that they're wrong. That can trigger a behavior. Feeling rushed can trigger a behavior. Not being allowed to do something or go somewhere. Having to do something that they just absolutely do not want to do, or feeling threatened, confused about what's happening or going to happen, believing something is happening that isn't— like they believe you're stealing from them. A growing number of studies and research confirm the power of music in caring for people who live with Alzheimer's disease and other types of dementia. This we know. Music has been found to stimulate parts of the brain, and studies have demonstrated that music does enhance the memory of Alzheimer's and dementia patients, including a study conducted at UC Irvine, which showed that scores on memory tests of Alzheimer's patients did improve when they listened to classical music. We now believe wholeheartedly that music definitely has a magical way of reaching and helping people who live with Alzheimer's disease and dementia. Because music stimulates many parts of the brain, which is why people with Alzheimer's may still be able to recall the words of songs but can't remember words in a general conversation. Music also encourages physical activity amongst patients, which can be an important part of their everyday activities and care plan. Other benefits of music in clinical settings include: it can reduce stress by reducing the production of cortisol and increasing the release of stress-reducing neurotransmitters. Mitters. And this is based on extensive medical research that has shown conclusively that music in a clinical setting can provide significant positive benefits. It can also reduce stress by reducing a patient's sense of isolation. And helping them reconnect with positive places within themselves. It can help healthy circulation by reducing blood pressure and stabilizing their heart rate. It can strengthen the immune system by triggering the production of gamma globulin A and the killer cells that are within. It can help improve mood, increasing the production of dopamine, serotonin, and endorphins. And then another therapy that we have found to be extremely popular and effective is what we call doll therapy. It is actually a recognized intervention for people living with dementia to help address cases of depression, agitation, and a lack of feeling fulfilled. Dolls are introduced to residents where it is felt that they may provide a sense of comfort or meet an individual's need to care for something or someone. It has shown to have a significant calming effect on individuals living with dementia. So we always want to use calming phrases when we are interacting with those living with dementia. And here are some examples: You're safe here. I'm here with you. I'm sorry that you are upset, but I'm going to stay with you until you feel better. Always let the person know that they are— that you are there for them. Involve them in activities. Try using art, music, and other activities to help engage the person and divert their attention away from their anxiety. Other benefits reported by care staff include a reduction in wandering, increased communication, and improved speech. Many of them expressed the opinion— that's referring to the caregivers— that the effect was the result of the individual now having a sense of purpose or focus. One caregiver said of the person that they were in charge of, "He's a different man since we've introduced the doll." And I've been able to find out more about him and see the tender side that was within him all along. Our nurturing instinct is strong. This instinct is a big part of the reason that doll therapy is so effective. Multiple research studies have been conducted on the use of doll therapy for people living with dementia, and the researchers have been seeking scientifically based answers on it and how doll therapy does benefit those living with dementia. And while the ethical concerns noted, um, when referenced in research, the results of the studies actually have demonstrated that the benefits outweigh the concerns. And some of those benefits that have been substantiated are decreased anxiety, decreased agitation, increased happiness levels, increased social interaction. Increased activity levels, improved ability to receive their care, fewer negative verbal expressions, improved moods, decrease in wandering, decrease in obsessions, and improved food intake. Now, a study actually revealed that doll therapy was found to be associated with a significant decrease in negative verbalization and mood wandering, aggression, and obsessions. Fidgeting is an obsession. So those Those against the use of dolls for people living with Alzheimer's disease are often concerned about the dignity of the person. They point out that an adult with memory loss is not a child and should not be treated as such. But in dementia care, we emphasize not using approaches such as elder speak, with an older adult, which involves treating a person like a child. But giving an adult a doll could work against this emphasis, causing people to respond with statements such as, "Oh, aren't they cute?" This can cause the person with dementia to be viewed as being demeaning towards them. Cute, of course, can definitely So instead of— as an adult who is living with a memory problem, whether or not dolls are used, always be certain to treat them who they are, as adults, with respect for their life knowledge and contributions to those around them that they've made over the years. A diagnosis of dementia does not erase the need to be treated with dignity, never ever. So what might doll therapy— why might this work? Well, it potentially offers meaning and purpose for someone who is living with dementia. There is a familiarity with being a caregiver for the doll that can be comforting to a person and bring purpose and meaning instead of constantly being a receiver of assistance and care. A doll offers the opportunity for meaningful interaction that is directed by the person living with dementia. So I want to sincerely thank everybody for being here with me today for this special presentation to learn all you can about how to live well with Alzheimer's disease and related dementia. And hopefully this information that I've shared with you will offer you more insights into new and more effective ways of communicating with people who can no longer communicate with you in the same way that they did before. There are now many effective tools, techniques, and strategies that we have learned about, that we have seen work, that can help decrease a lot of the stress that does accompany these diseases and that can help take the guesswork out of many of the situations that will inevitably arise, along with valuable information that can enlighten you, that can empower you, and will make your life easier to bear while trudging through this journey by being prepared to adapt to their new world instead of hoping that they can still adapt to yours, because they cannot. Remember, dementia awareness is every day, and kindness is the ability to speak with love, listen with patience, and act with compassion. And these are all very necessary attributes to have to outlast Alzheimer's disease. Thank you again for being here. I'm Lisa Skinner.