Recognizing Key Behavioral Triggers

This is The Truth, Lies and Alzheimer's Show, brought to you by Global Media Network LLC and Passionate World Talk Radio. Passionate World Talk Radio is a wholly owned subsidiary of Global Media Network LLC, and our motto is to educate, enlighten, and entertain. I'm Ken Palia, and I'm here to introduce your host She's an Alzheimer's and dementia expert, a best-selling author, and a world-renowned public speaker. She is Lisa Skinner, and we have a fantastic episode planned for you today. Lisa will be discussing some of the things we can do as family members and caregivers to minimize a catastrophic reaction occurring from our loved ones who have Alzheimer's disease and dementia. Lisa will give some real, true, live examples situations that may occur and suggest solutions. And in her What's New segment, Lisa will discuss how hearing aids slow cognitive decline for people at high risk for Alzheimer's and dementia. And with that, I will turn it over to Lisa Skinner Skinner for today's show. Hi, Lisa, how are you?

I'm doing well, Ken. Thanks for your wonderful introduction. Welcome back, everybody. I'm so happy that you've tuned in to another episode of the Truth, Lies Alzheimer's Show. Well, as we all know, especially those of us who care for people living with Alzheimer's disease and related dementia, and family members, whether you care for them full-time or not, There are so many things that show up on a daily basis that are completely unexpected and take us by surprise. And some of the reactions and the responses that we see to these triggers can easily and quickly escalate to what is called a catastrophic reaction. And I have done previous episode all about catastrophic reactions. But what I want to talk about on today's show are some of the behavioral triggers and what— some of the strategies and suggestions that we can do to reduce the risk of their response and/or reaction getting out of control, and it really doesn't take much because something that we perceive as not being such a big deal to a person living with dementia, person living with Alzheimer's disease, it can seem like a really big deal. A big deal to them, and it's easy for them to overreact to anything that is upsetting to them. So, some of the obvious and common behavioral triggers, number one is the environment. So, some of the strategies that I suggest to minimize having unnecessary reactions to their environment is to make changes gradually if you're going to make changes. Again, people living with dementia, especially once they reach their mid-stage and beyond, don't do well with changes. They like routine, they like familiarity. So reduce the stimulation in the environment. You can avoid having more than one source of noise at a time if you can. So minimize music playing, the TV, traffic noise, etc. And, you know, for example, if you have music blasting, a TV going, thin-pane windows, they can hear traffic noise outside the window, this is going to be overwhelming for some people living with Alzheimer's disease and dementia. It can actually trigger a negative behavior. So these are definitely some of the things to be aware of, because if a response is shown and you're really put in a position where you're going to have to figure out what the trigger was, these are some of the things you want to take into consideration. So, back to the environment. Decrease the clutter in the environment, so in the room and any outside noises, and keep their environment as simple as possible. Physical triggers. So, be aware and mindful of recent medication changes, because side effects can cause mood swings. Or it's also possible that they're not tolerating the medication changes. Watch for their body language showing signs of increased discomfort, such as restlessness, fidgeting, blushing, and pacing. Now, physical discomfort It does and can cause anger in people. You want to try to assess whether or not they're in pain. Are they ill? Or maybe they're constipated. That's very common in seniors. Or maybe they're hungry. Ask yourself, do they need to use the bathroom? Maybe they're too hot or too cold. This is something that can trigger a response. Are their clothes fitting them properly? Maybe they're too tight. Something might be uncomfortable about what they have on. Also, fatigue can make them more susceptible to frustration and anger. So, one of the things that we suggest is Simplify their tasks and decrease noise. Mental triggers. One of the things that I have learned through my 30-plus years of experience and working with people who live with Alzheimer's disease and dementia is don't focus on what they can no longer do. Learn to accept their current abilities and try to avoid reminding the person of who they used to be because that can be very, very upsetting to them. One of the things that I definitely learned through trial and fire and through the school of hard knocks is having an expectation. So if you're doing a project with somebody or an activity, Having an expectation that you are placing on the result of that activity, it doesn't matter. What matters is they are enjoying whatever it is they're doing, and it doesn't matter whatsoever the outcome of that activity. Don't strive for it to be perfect like it may have been when they were a healthy person, even though maybe that's what you're looking for, it really doesn't matter to them. It's really about the enjoyment of doing the activity because everybody's skill level is now different who is living with Alzheimer's disease and related dementia. So, it doesn't matter the outcome or even if they finish it. So, look for signs that they're enjoying what they're doing, and if you start to see changes in body language, in other words, maybe signs of frustration, then move on to something else. It's much easier to give people living with Alzheimer's disease limited choices. So, one or two things to choose from at a time. Otherwise, it's overwhelming to them. Provide verbal cues. For example, I might say, "Mom, hey, it's Lisa." Don't ask them if they know who you are. That's really setting them up for failure and puts them in a very embarrassing position. And it also puts the burden on them. So, Take the burdens off of them and don't put them in that position. Break down the tasks into small steps. Give them adequate time to accomplish a task or activity. And again, if they don't finish it, if it's not— it may not be accomplished to you, but it might be accomplished to them. So keep that in mind because they can't task sequence after a certain— when they reach a certain point in this disease. So they might think they're finished even though you obviously know they're not, but in their mind they are finished. So let it go. Plan more difficult tasks for the time of day when they are at their best. And my advice is earlier in the day to midday, the more difficult tasks should be planned for earlier in the day and not later day. Always offer positive reinforcement. For example, after your shower, We'll have some ice cream. But make sure you follow through. Don't announce your intentions ahead of time. For example, you can go for a walk through the house or building and stop by the bathroom. You don't have to structure everything. A lot of times they're not going to remember what you told them anyway, so just kind of Go with the flow. This is really important. Don't talk about people who live with Alzheimer's disease and dementia as if they weren't there. Include them so they know that they can ask a question or voice an opinion. Misinterpreting a conversation may upset them. And always identify other people that you might be bringing with you to visit or that happen to be in your environment. Don't assume they will remember if you told them previously, so tell them at the moment. Don't ask if they remember. It reminds them that they have a problem, and anger does frighten them. If you're angry with someone or something, stay away and don't try to accomplish difficult tasks until you have calmed down yourself. Because, and this is really important to understand, people living with dementia pick up on your mood and your emotions and may emulate them. So, hints for handling stressful times. During stressful times, share an activity together that you both enjoy and find relaxing. So, one of the suggestions I like to mention is, do you both like to cook? You can— one of the things that I've done in the past that people really seem to enjoy is Make cookies and let them do it to their skill level. So just, you know, be mindful of what they can do independently and then you help them with the rest. And maybe all they're able to do is frost the cookies and then enjoy eating them. That makes a great activity. You can do the same thing with cupcakes. Do you both enjoy a cup of tea? Music is powerful for relaxation and triggering memories. Always avoid getting in an argument with person living with dementia. I'll tell you what, you won't win because they don't know they can't. It's a Simple as that. I always like to recommend that you plan personally meaningful activities and offer them when their agitation increases. So, example, you can say to them, come on with me. That may work better for you than an explanation. Extend your hand out to them. And smile to get them to join you. Dementia can and does make people feel foolish and scared. One of the first noticeable signs of dementia is a change in their personality, and part of this is due to the chemical changes happening in the brain. Another part is due to the loss of ability to analyze their environment around them. They just don't have those cognitive skills anymore. We act the way we do by taking cues from the people and events around us. With Alzheimer's disease, learned behavior we acquired as we grew up is systematically erased. We can actually track it in the reverse order we learned it. So, they tend to follow a reserve— a reverse path of human development, which was their development. But it's not like running a movie backward with all the pieces intact. Their memory, don't forget, is being erased— good and bad. So, the development they experienced into adulthood is gradually fading away. The behaviors a person will exhibit are what someone at that age would do, but not necessarily what they did at that age. This is where knowing details about their past will really come in handy. For example, did they grow up during the Depression and have to go without food? So, if that's the case, they're always going to be worried. I think they call it food insecurity these days, and they will feel food insecurity if they experience that in their previous time of their life. So, what you can do is keep plenty of food around for them and see that there is— that it is there and available for them to access. Does your loved one or the person you're caring for have a history of abuse? So, you need to know that because they could be ultra-sensitive to you raising your voice or maybe afraid of being hit. So avoid loud noises, startling noises, or angry displays. During moments of fear and paranoia, which are very common in dementia, there are several tips and techniques that can alleviate the situation for the person and for you. Try one technique, and if that doesn't work, try another. Try the same technique another time. And I've mentioned this before on several episodes, what works one day might not the next. But the more tools we have in our toolbox, the more techniques we will have to pull from and try and see if it works for that specific situation. I recommend that you make lists of what you've tried and under what circumstances. So, these lists will definitely be helpful to you in assembling your toolbox. General guidelines for caregivers: smile. Smile as often as you can. A smile can calm and completely change an entire situation. It may also surprise them enough to distract them. You gotta keep a sense of humor even in the most difficult situations. Humor can help you cope with the frustration, but remember to laugh with them, not at them. They know the difference. Always approach them from the front and in a non-threatening way. Keep your arms at your sides, not behind your back or in your pockets. Position your palms forward so they can see that you don't have anything to hide. And smile. Think ahead. Plan for situations that could be upsetting to them and avoid them. If at all possible. Again, evaluate your environment. Anything can be perceived as frightening if you don't know, if they don't know what it is. Shadows can be very disturbing and distorting to people living with dementia. If a particular situation becomes overwhelming Remove the confused person. Simply take them to another room or cut an outing short. If necessary, ask guests to leave. Take time to explain to others that suspicious accusations are part of the disease. And you want to respond to the emotion or feelings behind the accusation. If it involves hurt or the death of someone who has passed away, try saying, "I know you really miss your mother, so let's talk about her. Tell me a little bit about her. Tell me some stories that you remember." Look beyond the insult to the underlying message they are trying to tell you. If they ask, "Why are you trying to steal my money?" Don't starve me. It might actually mean that they're hungry. Don't lock me up might mean I can't find my way out of here. I don't know where the bathroom is. Don't get defensive if they accuse you of things you didn't do. This is normal when there are gaps in memory and confusion. Remember, they are not purposeful. They're not simply being malicious. They simply cannot remember what happened or where their possessions have gone. More than likely, they put them someplace and don't remember where they put them. And it's very common because paranoia sets in that they believe that somebody has stolen their possessions. So go along with it. Tell them you're gonna help them find whatever it is they're looking for. They are protecting their self-esteem by blaming other people. So, maintain a calm manner when confronted with threatening behaviors. Your calm may defuse the situation and decrease their fear. If you, the caregiver, become frustrated or angry, Try to find someone else to handle the situation, even temporarily, and you leave the room. Because your anger will only increase unpleasant behavior. Just as you can read their body language, they can read yours. And I'll take it one step further, they can feel yours. So, go slow. Quick moves can make them feel unsafe and out of control. Being startled to somebody living with Alzheimer's disease and dementia can almost be a painful experience for them. Learn to work to recall their past habits and follow them. Again, familiarity is key. Do they prefer a shower or a bath? Doing what they've never done before in a way that is unfamiliar to them makes them feel more out of control. Remember, person-centered approach. Try to discover triggers for the behaviors. Again, I can't emphasize enough, make a list of them and use good common sense in any situation. If you can't understand the verbal content of what they are saying, try to respond to the emotional content. So, look at their body language and what they are saying nonverbally. You can choose short, simple sentences, but speak to them as adults, as the adults they are. It's better to speak slowly and repeat what you said if necessary. Use the same word. Don't keep trying different words with the same meaning hoping they will understand. That's just way more confusing to them. Give them time to understand. Give them time to process what you're saying and respond to what you are— and give them time to respond to what you are asking of them. And please, Don't bombard them with questions. Too many questions can just increase frustration. Their minds aren't as quick as they used to be, so they're not processing the information the way your brain is. So slowly is better than quickly. Use statements rather than questions. So, for example, say to somebody, "Okay, it's time to take your pills now," instead of, "Do you want to take your pills now or after you eat?" That's too complicated for somebody living with dementia. You decide when later is. If the person starts to become agitated with a particular subject or event, just gently change the subject or redirect the person's attention. So as far as tasks and activities, I want to stress the more familiar and comfortable the activity is to them, the greater the chance of success for both of you. Establish routines early on in the disease and stick to them. Later, you will find they more— may be more acclimated to ways of doing things and more cooperative. And keep things simple. Complex situations do cause frustration and escalate behavior problems. Focus on their moods and behavior rather than the task you want or need them to complete. Keep reminding them of what they are doing instead step-by-step terms, and you determine when you think they have had enough, even if the task is not complete. So, give one instruction at a time. Break a task down into small steps. Think beyond the task to the environment around them. Are they modest? Seldom undressing with someone around. Many of our elderly today from the Depression era generation are extremely modest. You got to be mindful of that. Do they have a preferred time of day to do a specific task? So again, relying on person-centered approach to care, strategies. Maybe your loved one was a stay-at-home mom and a homemaker and raised the children, so she was used to providing them with breakfast at a certain time of the day, making their lunches to go to school, doing laundry when they were at school. The more you know about the prime time of their lives, the better— the easier it will be for you to emulate the activities that they may have been used to. Do they have a— would a same-sex caregiver be preferred for intimate activities such as bathing? Now, my mom had a male caregiver. But he did not shower her. I took on that responsibility because she was a Depression-era generation person, and that just was not okay with her to have a guy bathing her. So I did it, and that's just something that I knew she was uncomfortable with. So focusing on their mental state, use positive reinforcements always. Food, smiles, a gentle touch, personal attention. Let them know how beautiful their hair looks or how much you admire the color of the outfit and how well it goes with the color of their hair. Lots and lots of praise is worth its weight in gold. Try nonverbal reassurances when possible. Like holding their hands, a gentle touch, or a hug. Again, limit choices to 2 or 3, no more than that, otherwise it's too overwhelming. And let the person always feel that they still have some sense of control. That is one of the things that we know can cause negative behaviors when they feel like they are totally losing control over their lives, which makes sense. Being able to save face is important to all of us, and especially to a person who is confused. And I can't emphasize enough how important routines are for people who live with Alzheimer's disease and dementia. And that you really want to keep a routine the same. Changes are very upsetting since they are not predictable to them and may not be familiar. And they are, therefore, particularly frightening. Always treat people with respect. You never know when they will have a moment of lucidity. Or what's going to stick in their mind even for just a very short period of time. And these moments can happen well into the disease. Don't assume they can't understand what is being said. That's why you don't want to talk as if they aren't there because they may be understanding way more than you give them credit for. I have seen that. So many times. Always want to promote a sense of security and comfort. They become frightened when they can't make sense out of the events and the environment around them. So you can use familiar photos and items to remind them of current relationships. And you can keep them current. They won't connect you as that cute little 6-year-old on the wall if you're now 35. One of the tips we've learned is to label pictures with names and relationships. A caption of Judy, daughter of Lucy, might be helpful. Don't worry about dates, as time is a lost concept. And always reassure them and let them know that you are there to help and protect them them. You will look— be looking after them. I'm here with you. I'm going to take care of things. If they're worried about money, they'll perceive it as missing. Let them keep change and small bills in their pockets or a wallet or a purse. When they're upset, distract them with an enjoyable activity. Figure out what that activity is ahead of time and be prepared to switch over to it. Don't wait until they are upset before you go searching for the old comforter or game. Some people are comforted by a stuffed animal or security object such as a sweater or a blanket. Again, identify these and keep them handy. So, I don't want to overwhelm you too much with too many things because, as I'm sure you are well aware, anything can trigger a behavior and upset a person living with dementia. And unfortunately, in most cases, they are not capable of articulating what that something is. So, it's up to us to figure it out. And the better you know your loved one and the better you know the person that you are caring for, you will learn the things that may have upset them. So, that's my tips. For minimizing a catastrophic reaction and helping resolve these unexpected situations that do and will arise minute by minute, hour by hour, day by day when you have a loved one or caring for somebody living with Alzheimer's disease. Or related dementia. So, I am going to share with you the article that I brought for my What's News section. And I know that I have brought this to your attention before in Risk Factors, going over what the modifiable risk factors are for either increasing a person's chance of developing Alzheimer's disease or helping to minimize that risk. And so we know, and there have been plenty of studies to support this, hearing loss definitely increases a person's risk for developing Alzheimer's disease. And just like the other modifiable risk factors that I have brought to your attention and we've discussed, you can negate that if you have that condition by treating it, you, or doing whatever it takes to resolve it, and negate that from kind of, piling on your risk and raising your personal risk of developing Alzheimer's disease. So, bottom line, if you suffer from hearing loss, we know that hearing aids do slow cognitive decline in the people at high risk. Of developing Alzheimer's disease. Hearing aids reduce the rate of cognitive decline in older adults at risk of dementia by almost 50% over a 3-year period. That is significant. Treating hearing loss may be a safe way to lower the risk of dementia in vulnerable populations. As the world population ages, the number of people living with dementia and other types of cognitive impairment does continue to rise. I know that the latest statistic out there from the Alzheimer's Association and the World Health Organization is projecting that by the year 2050, which is only 22 years away, the number of people who will develop Alzheimer's disease will increase as much as triple from the number of people suffering from it today. So, safe and affordable interventions to prevent or slow age-related cognitive decline are greatly needed. Studies have found an association between hearing loss and the development of dementia in older adults. They've been researching this for decades. But research also suggests that using hearing aids to treat hearing loss may help slow the development of cognitive problems, but potential links between hearing loss treatment and improved cognition hadn't been tested in large randomized studies. So to close this gap, the National Institutes of Health funded research team co-led by Dr. Frank Lin from Johns Hopkins University enrolled nearly 1,000 adults ages 70 to 84 into a clinical trial. They compared the rate of cognitive decline over a 3-year period between people who did and did not receive hearing aids. So, this is what they found. The researchers, after recruiting participants with Substantial hearing loss from two different study populations. About 250 healthy older adults came from a long-term study of heart health at four sites in the U.S. and another 739 people were newly recruited from the surrounding communities at the same four sites. Participants recruited from the heart healthy— had more risk factors for developing dementia, including being older and having faster rates of decline than those from the general community. I don't know if you remember me telling you this, but the number one modifiable risk factor for a person's risk for developing dementia happens to be cardiovascular disease. So, this was significant. The researchers randomly assigned participants to one of two interventions. About half of them received hearing aids and instruction in how to use them. The other half were assigned to a health education program focused on promoting healthy aging. Both groups then received follow-up visits every 6 months to reinforce the training. Before the start of the study and annually for 3 years, all participants took a battery of tests to measure their cognitive functioning. The results were published on July 17, 2023, in the publication The Lancet. People who received the hearing aids reported substantial substantial improvement in communication abilities over the course of the study. Those in the health education group, as expected, did not experience improvement in hearing and communication. So, in the main analysis of all study participants, the researchers saw no difference in the rate of change in cognitive functioning between people who received— the hearing aids and those who didn't. However, when the analysis focused on the people from the Heart Healthy Study who had a higher risk of dementia, the benefit of the hearing aids was substantial. Those who received hearing aids had an almost 50% reduction in the rate of cognitive decline compared with people in the health education group. Hearing loss is very treatable in later life, which makes it an important public health target to reduce the risk of cognitive decline and dementia, Dr. Lin says. The researchers are continuing to follow the study participants to see how changes in cognitive development over time. They're also looking at brain scans and data on social engagement to better understand how protecting hearing may prevent cognitive decline in vulnerable older adults. Until we know more, Dr. Lin adds, we recommend for general health and well-being that older adults have their hearing checked regularly and any hearing issues be properly treated and properly addressed. So, if I receive some updated information on hearing loss, hearing aids, of course I will share it with you and keep you up to date on this very important information as well. So, before we sign off today— Ken does have a few announcements for you, and then I will come back just to wish you a wonderful weekend, to say goodbye.

Ken, to our listeners, thank you for listening to The Truth, Live and All-Timer Show with your host Lisa Skinner. This program can be found on our website at passionateworldtalkradio.com under the shows tab. You can also search for us on YouTube, and you can find Lisa on Facebook by searching for Lisa Skinner Author. If you're interested in Lisa's books or training programs, go to truthliesandalzheimers.com. Lisa's books are also available on all major platforms, including Amazon and Apple Books. We absolutely love the audio version of her book, Truth Lies in Alzheimer's: Secret Faces. So if you like to listen to books while you drive or walk or run, we definitely recommend that you check that out. And with that, I will hand it back over to Lisa Skinner to close today's show.

Thanks, Ken. Yeah, I just want to thank everybody once again for taking the valuable time out of your day to listen to this show. I genuinely hope that this information is very helpful, especially if you're on this journey with a loved one or caring for somebody living with Alzheimer's disease and dementia. This is a very complicated disease. There is so much to know, but once you have your toolbox assembled, Trust me, you will be able to go to fall back on and focus on what really matters and what is really important, and that is spending quality time with your loved one and quality time if you are caring for somebody and not have it be stressful and spend all your time trying to figure out why this person is not cooperating or why they're upset or why they're angry. It all will just completely make sense to you the more you know. So thanks again for being here. I just want to add one more thing. If there's any topic, subject that you personally would like me to talk about, please don't hesitate to send me an email, and my email is dementiawhisperer1@gmail.com. Don't forget, this show is for you. I want to do everything that I possibly can to help you have an easier time with this experience. So, if there's anything that you specifically want to know about, Just shoot me a message and I will provide it for you. Thanks again for being here. I look forward to having you all back next week. Bye-bye for now. Have a good week.