Top 10 Triggers for Sudden Behavioral Changes in Dementia

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.

Hi everyone, welcome to another new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host. I have a question for you. How many of you have encountered a situation, whether it would be spending time with a loved one living with dementia or caring for someone who's living with dementia. And then out of nowhere, the entire climate changes and you have no idea what just happened. Does this sound familiar? And maybe for no apparent reason, For example, the person you're caring for just flat out digs their heels into the floor and refuses to take a shower. Or you could be right in the middle of that shower, shampoo is still on their head, and they all of a sudden out of the blue decide they're done. But obviously the shower isn't. Or a couple other scenarios that happen pretty regularly and are very common is that all of a sudden they become angry or anxious or combative for no apparent reason. Well, these sudden changes in moods do happen regularly with dementia, as a lot of you've probably already experienced. But there is almost always a reason. I would say 99.9% of the time. And we call these incidences triggers. Something trigger the sudden change in mood. And unfortunately, the hard part's on us as family members and caregivers. Because we are tasked with having to figure out what that something is, and it's not always obvious. And the other thing is, is there are so many things that can trigger sudden mood changes or behavioral changes. So that's what we're talking about today on this episode. I'm going to go over the top 10 triggers for sudden behavioral changes with dementia. And I'm gonna give you some tips for de-escalating the situation, uh, effective responses and strategies, as well as other helpful information that will help you turn these situations around into positive outcomes. Now, there are more than 10 triggers, but I'm just gonna go over probably the top 10 that we know that would, you know, cause a sudden behavioral change in the person you're caring for or family member. So you want to look to see if they are somehow in pain or they're experiencing discomfort. But dementia can make it hard for them to express pain. So what you want to do is look for nonverbal cues. Are they grimacing? Are they resisting movement? Do they seem withdrawn? Then there could be one another trigger commonly is hunger, thirst, or they have a physical need. Do they need to go to the bathroom? Is the temperature of the room too hot, too cold? Are they sleepy? So one example is, uh, a full bladder, being hungry, or being too hot or cold does cause agitation or can cause agitation and/or aggression. A change in their routine or their environment can trigger a behavioral change, such as a sudden schedule change, bringing in a new caregiver, Relocating them to an unfamiliar place or unfamiliar surroundings can trigger confusion and also distress. Number 4 is it's a medical issue or has to do with a medication they're on. Infections such as urinary tract infections, pneumonia, dehydration, Constipation and side effects of medications can and do alter moods and behavior. Number 5 is overstimulation or sensory overload can trigger behavioral changes. So what does that look like? Noise, being in a crowded space, the lights are too bright, or busy environments. These things can all overwhelm people living with dementia. Also, number 6 is understimulation or being bored. So too little engagement can lead to restlessness, pacing, and repeating-type behaviors. Fidgeting can also show up when they're bored or overstimulated. Number 7 is communication gaps or frustration with expression, and that would look like difficulty finding words on their part or understanding their symptoms that would inevitably cause frustration and outbursts. A recent loss or emotional trigger. So anniversary reactions, grief, or reminders of their cognitive decline can definitely provoke mood changes. Fatigue and/or sleep disruption. If you remember me telling you in one of the previous episodes, when people live with dementia, their circadian rhythm is completely thrown off. So a lot of people with dementia think they're supposed to sleep during the day, and they're wide awake and wandering around and restless at night because their bodies can't tell the difference anymore. So, um, poor sleep definitely can worsen memory, cause confusion, and irritability. And then number 10 is they feel unsafe or that something is a perceived threat to them. Perceived danger or lack of control can trigger fear-based reactions. So keep that in mind. They could become aggressive. They can become you know, guarded and lash out. So these are all things that you want to kind of go through a process of elimination and see if it's any of these. Now, as I mentioned, there are so many triggers that are out there, but these are the top 10 things to probably start with. So now I'm going to offer you some de-escalation and response strategies for for caregivers and family members who might be visiting or, or, you know, spending time with their loved one, and then these mood changes occur and you're not really sure what just happened. So identify and address their underlying need. Look for signs of pain. Do they need to go to the bathroom? Are they hungry? Are they thirsty? Are they tired? Check for medical issues or medication effects with their care team. Always create a calm, safe environment. So some of the things you can do is reduce noise, reduce clutter, use soft, soothing, calming lighting, minimize competing stimuli. Turn down the TV or the radio if it's way too loud, or you're noticing that, you know, based on their body language and the way they're acting, that they're overstimulated. And then always ensure that the person has a comfortable temperature in the room that they are in. Use clear communication and be patient. Speak slowly. They don't process information the way they used to. One idea at a time and use simple words. Ask yes or no questions and give options. Would you like to sit here or would you like to sit here? Validate their feelings. I can see you're upset and I'm here to help. Redirect rather than confront. So what does that look like? Offer a simple, engaging activity for them to do to, you know, help them get their mind off of whatever it is that's bothering them. You can ask them to help you fold towels, sort things, let's go for a short walk. But the key is avoid arguing about who is right. Acknowledge their emotion first. There is no right. Establish predictable routines. Maintain consistent daily schedules for meals, activities, and rest. This makes a huge difference in the day of a person living with dementia, trust me. Prepare in advance for changes and use visual schedules or calendars if Those are helpful. So, learn to manage these triggers proactively. If a known trigger is present, like you walk into a room and the music is obviously loud, modify it, remove it, turn it off. Prepare for predictable events. So, in other words, you got to go to the doc, take your loved one to the doctor or the person you're caring for. So preparation for that is to show them or give them a familiar object, provide them with reassurance, and make sure you allow plenty of time. And then using soothing techniques like gentle reassuring touch, if appropriate and welcome on their end. Use soft, a soft voice, slow breathing exercises, playing familiar music for them. It's very common and triggers most of the time very fond memories. Familiar routines or reminiscing with them, looking at photos, telling simple stories. Now there's safety considerations also. Monitor for aggression safely. Give space if someone needs it. Move to a safe, quiet area. If the aggression escalates, remove the trigger that you believe is causing this aggression and allow time for them to calm down. Avoid physical restraint unless necessary for safety. And then of course, always allow for time and patience. Allow pauses. Give the person time to process. Be consistent and calm. Your emotional state communicates a lot. They pick up on your emotions and they emulate your emotions. This is a known fact. Plan for difficult episodes. So what one of the things that we recommend is that you have what we call a calm kit ready. What's in your calm kit? Well, you can be creative with that, but some of the suggestions are to have a favorite snack readily available or a comforting item, a familiar blanket, and a water bottle, and then The other thing that you can do whenever these behavioral changes happen, document the patterns. So include what happened, the triggers you identified, what calmed the person in that given situation, and of course you always want to share this information with the care team. So, if the exact similar situation arises, you will have documented what de-escalated that particular situation. But I just want to tell you that the strategy that worked for this particular situation may not work for the next time it happens, even though the circumstances are pretty much the same. So this is why we really emphasize having a toolbox that you've assembled with different strategies, skills, and techniques. So if one strategy doesn't work for a situation, you have something else to pull from or others to pull from. So I'm going to give you this quick checklist to keep handy of all the things that I just went over. So You can write these down and have a checklist. Number 1, check the basic needs. Are they hungry, thirsty? Do they need to go to the bathroom? Could they be in pain? Is the temperature, surrounding temperature in the room comfortable for them? Have they had enough sleep? Number 2, eliminate or reduce triggers in the environment. Number 3, speak calmly using simple sentences and validate their feelings. Always recognize and acknowledge the emotion first and then the problem. Number 4, offer a distraction or gentle redirection. Let's go for a walk. It's a beautiful day outside. The next one, use a familiar comforting routine or object. Next, ensure safety for yourself and the person you are caring for or your loved one. Um, in other words, make sure that they're in a safe space, that they can't exit the building or the environment, and they're properly supervised. Record what happened and what helped for future reference. And then the last one is communicate with healthcare providers about recurring or severe changes. One of the questions that comes up quite often is, well, when should I seek medical advice when these things arise? Our advice is if sudden new or escalating aggression or confusion occurs, signs of infection, dehydration, or new medications that are causing these occurrences to happen. Severe withdrawal. You thinking they may be at risk of self-harm or harming others. And then, uh, here are some additional tips for you. Use meaningful activities tied to their past interests. Do they like to garden? Or did they like to garden? Were they a baker in their earlier years, younger years? Were they a craft person? So you can offer these types of activities and limit the sessions to 10 to 15 minutes to avoid fatigue, because that can create a mood change. Build a simple choice board with 3 easy options for activities to reduce their decision-making fatigue. They just can't process information very easily anymore, so too many choices is overwhelm for people living with dementia. Use nonverbal cues such as nodding gentle facial expressions, and hand gestures to support your spoken words. Validate briefly, then offer concrete options. So here's an example: I know you're upset, so would you like to sit here next to me, or would you like to sit in the chair right there? Create a stimulation map of your home, zones that are quiet, predictable, and safe. Label rooms with photos or words. Use familiar smells, vanilla, lemon, chocolate chip cookies coming out of the oven, bread, anything that you know they really resonate with. The other thing you can do is play soft music to create calm. Establish a predictable rhythm for mornings and evenings, but allow wiggle room for days when it's obvious that they're just feeling off. Build in, built-in buffer times between activities to reduce rushing and frustration. Maintain an up-to-date medication list, including the vitamins and over-the-counter items that they're currently taking, and review them on a regular basis with their doctor. Schedule regular check-ins, even if they're short and brief, with their primary care provider or geriatrician to catch evolving needs early. Track symptoms in a simple diary: moods, sleep patterns, appetite patterns, pain indicators, and any new medications that they have been prescribed. You can use a simple pain scale adapted for dementia. For example, you might have a category, facial expressions,? And are you noticing from— on a scale from 0 to 3, what is their current facial expression and what is it trying to tell you? And you want to note this during uncomfortable moments. And then check always. This is part of your process of elimination. Check for subtle signs of constipation, dehydration, or urinary issues, which are extremely common triggers. Now, it is very common for people living with dementia to become dehydrated, and part of the reason is they can't tell. They get to a point in their decline, they can't evaluate or tell when they're thirsty, so they're probably not going to indicate to you that they need something to drink. That's going to be The responsibility of the caregiver and/or the family member to, on a regular basis, offer hydration. It doesn't always have to be water. It can be other forms of liquids or popsicles, things like that. But they do become dehydrated very easily and quickly. Remove any trip hazards. And ensure good lighting at night. Consider grab bars and non-slip mats where needed. Keep a list of emergency contacts and a copy of key medical information available at all times. Schedule regular breaks for yourselves as caregivers. Use respite care when possible. I recommend joining a caregiver support group either in person or online. It is always so nice to feel that you are not alone in this journey and that other people are experiencing a lot of the same situations that you face on a day-to-day basis. And you can share your strategies and, and be supportive emotionally for one another. Set boundaries for yourself and realistic expectations. Acknowledge when a situation is beyond your capacity and seek help. A lot of times family members and caregivers believe that they're superhuman beings and they can do it all, and that is a recipe for quick caregiver burnout. Consider reminders on a simple timer. Or watch for medications and routines. Use big button phones or tablets with easy navigation for reminders or for communication. And then there are door monitoring devices that can provide alert cues for safety while preserving independence. You can visit on my website, mindingdementia.com, and there is a products list there that you can find these door and monitoring devices. Maintain a care plan document with typical triggers, effective de-escalation approaches as you continue to collect them and learn them, the medical history of the person that you're caring for, and preferred objects, things that they really seem to take to. Create an advanced care directive and discuss future wishes early when possible. So when do we involve professionals? If the behavioral changes are abrupt, severe, or are increasing in frequency. If there are new safety concerns, you've seen an increase in significant memory decline or confusion, and as a caregiver, if you're feeling overwhelmed or you're feeling that you're at risk in some way. And then some of the resources that are out there that you can tap into our local Dementia and Alzheimer's Association chapters, geriatric care managers and social workers, home health aides or respite care services, palliative or comfort care specialists, if you feel that's applicable. And then there are cognitive rehabilitation and also occupational therapy providers for engagement strategies. If you'd like, share the details about the person's living situation, their typical routines, and the current challenges that you're noticing, like the time of day that they seem to become more agitated or when some of these behaviors spike and what specific triggers you've noticed bring these on. So, uh, that is what I have for everybody today. I hope this has been extremely helpful. I will share other triggers, um, in the future, on future episodes, because there are a lot to consider. But these— let's start with these 10 so we don't get you too overwhelmed and puts you in information overload mode. Okay, so again, I want to thank everybody for spending part of your day with me here on the Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host. I'll be back next week with another brand new episode for you. I hope you'll be joining us and hope you enjoy the rest of your day. And always try to stay happy and healthy. Okay, talk to you soon. 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 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.