What Has Triggered Your Loved Ones' Behavior – Encore

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

Hello to all of you who have tuned in to listen to this episode of the Truth, Lies Alzheimer's Show. I am Lisa Skinner, your host, and I'd like to shout out a very warm welcome to all of you who have joined us today. Thank you so much for being here. There are so many aspects of living with dementia that are unexpected and can surface out of nowhere at any time. These are what I call the hidden or secret faces of Alzheimer's disease, and as many of you know, they show up unannounced are completely unpredictable, and that is the reason why it's so important to be prepared for anything that emerges on this journey. And to be honest with you, I don't think there's much doubt that what makes our relationships and caring for those who live with Alzheimer's and related dementia so challenging is the disconnect that occurs in our ability to communicate effectively with one another. As the progression of disease worsens over time, it clearly becomes more and more difficult to know what your loved one is trying to tell you when they are no longer able to articulate their wants and needs to you. This is the very reason why I cannot stress the importance of arming yourself with an arsenal of tools and strategies so you can be as prepared as possible when these situations arise. And just like we can count on the sun rising each morning, you better be sure we can count on these situations arising unexpectedly every day. And I want to remind you, because I've I've said this before, not every strategy works for each situation every time. So, the more tools you have collected in your toolbox, the more options you will have to use to try to defuse a situation from escalating into a catastrophic reaction where it can just really get out of control. So, what I'm going to share with you today are some triggers and responses to some of the behaviors that occur as a result of this disconnect in communication. They typically manifest as behaviors, and this is really the way that the person you're caring for or your loved one is trying to tell you that there is something genuinely wrong. They are not trying to be difficult. They are not trying to make your life hard. They are not trying to be spiteful. They honestly can no longer tell you what is bothering them. So, they will behave in a way to get your attention, trying to relay a message to you. And these are the things that you must learn to recognize that is their way of communicating with you. You learn to recognize the behaviors, and then you're going to have to learn how to identify what the trigger was for that particular behavior. So, the tips and the tools that I share with you You want to just kind of file them away or collect them in your toolbox, as I said, and if one thing doesn't work, you can try another. And the more tools you have to pull out and try, the better equipped you're going to be for any circumstance that will arise. So, Environmental issues can create behavioral problems in people with dementia. Examples of environmental-related issues are sensory overload. So, in other words, too much going on around them. Being around unfamiliar people. Noise. Lighting. Something that startles them, agitating behaviors of others in the environment. People with dementia pick up other people's moods and emotions, and they can mimic those emotions. And that's the other thing I wanted to mention. Because people lose so much of their cognitive skills, what it really comes down to at the end of the day is everything that they are reacting to is basically comes down to raw emotion because they no longer have the ability to reason things out or to think things through. So, these behaviors are raw emotion trying to tell you that they need or want something. Tasks presented to a person with dementia can create these behavioral problems. Here are some of the task-related issues and solutions. So, in terms of issues, if a task is overwhelming to a person, that can be a trigger. If they feel rushed, if it causes them to become overstimulated, if a task is too complicated, if they are not able to focus on a given task, and if they have a poor attention span. So, here's some of the solutions to those issues. Keep things simple. Slow it down. Stay calm and be gentle. Take one step at a time. Always make eye contact. And repeat instructions as needed. Communication can also contribute to a person's behavioral challenges. Without effective communication, the psychosocial quality of life for the resident quickly deteriorates. Now, communication can be verbal, nonverbal, or both. Now, verbal communication is the words we use. Non-verbal communication are your actions, your body language, and your facial expressions. Your tone of voice, expression of emotion, and your inflections are also considered part of non-verbal communication. Effective communication is the key to working with people with dementia. So, when communicating with people who have dementia, it helps to face them directly, speak slowly, use their name, and then wait for a response from them. Don't rush. Repeat it if necessary. Use cueing or modeling behaviors. Smile at them at all times. Then they will not absorb feeling a sternness coming from you or that you're mad or upset with them. And then praise them always and reassure them that everything is fine. Fine and they're doing great. Now, according to the Alzheimer's Association, there are 3 basic steps to assist in identifying common behaviors and causes. Step 1, identify and examine the behavior. You should ask yourself the following questions: What was the behavior? Was it harmful to the individual or to others? What happened just before the behavior occurred? Did something or someone trigger that behavior? Other questions you may consider in order to examine the behavior include: What happened immediately after the behavior occurred? How did you react? The Alzheimer's Association suggests that you should consult your loved one's physician to identify any causes related to medications or an illness that may be developing. So, step 2 is explore potential solutions. The Alzheimer's Association also recommends identifying the needs of the person with dementia and evaluate if these needs are being met. So, some of the questions you may consider in your exploration is: Can adapting the surroundings comfort the person? How can you change your reaction or your approach to the behavior? Are you responding in a calm and supportive way? It is very important to keep in mind that the person with dementia may be using these behaviors to communicate his or her needs in the only way he or she knows how. This is why you, as a care provider or a family member, need to be cautious of your response. It can make all the difference in the world. Step 3: Try different responses. Again, once you attempt new responses, you should evaluate Did your new response help in this situation? The Alzheimer's Association asks, do you need to explore other potential causes and solutions? If so, what can you do differently? There are many, many resources you can use to discover positive solutions to challenging behaviors. And I want to also Remind you again that if your response works at that time for that given situation, and then the same thing happens again and you try that same response, it may not work this next time. So the more responses you have to pull out of your toolbox, the more chances you will have of diffusing the situation. What I'm going to share with you now is a list of what we call 13 Rs, what is called a solution-focused model. And the solution-focused model focuses on what you can do right now to change the person's behavior rather than focusing on the problem. The problem that made the person display a difficult behavior. Now, this approach does not focus on the past, but instead focuses on the present and the future. The 13 Rs are: Number 1, remain calm, your voice and your body language. Number 2, Remove the trigger. So, you want to eliminate the source of agitation, but you have to figure out what that source of agitation is first. Not an easy task. Number 3, redirect the person. So, guide them to another task. Number 4, reassure them by making positive statements. Number 5, Repeat, if necessary. Number 6, revise. Present one step at a time. Number 7, respond, which is listening and paraphrasing their words. Number 8, reference. Validate their point of view. Number 9, remind. Always encourage reminiscing and praising past accomplishments. Number 10, reflection, which is physically acknowledging communication. In other words, one example would be by nodding your head to them. Number 11 is reinforce. You can do this by praising positive behaviors. Number 12, reporting incidents. And what they mean by that is write down, keep a journal of things that trigger behaviors so you will have a reference to look for in the future. And then 13, reevaluate. Establish the root cause and assess it for controlling the situation. So, next I'm going to share with you some very specific behavioral responses that you may see in people with dementia. Each type of behavior you may observe, followed by some suggestions that you can do to help minimize the undesired behavior. When a loved one displays anger or agitation, here's some tips. Do not express impatience. Maintain calmness, smile, and reassure. Speak slowly and offer comfort. Redirect to a quiet area. Engage with them in a favorite pastime. Offer a favorite food or beverage. And whisper. When the person becomes aggressive, it can help to, again, remain calm while you approach them. Get help if necessary. Use what's called change of change of face technique. And what that means is you get a different person to come in and see if that will make a difference to defuse the behavior. Again, called change of face. Attempt to redirect the person. And when you do, redirect them to a safe area, for example, their room or a quiet area. Provide a distraction. You can use a known interest to distract them. When a person with dementia is anxious, it also helps to identify the trigger and time of the occurrence. It's helpful to keep a journal of these things. And reinforce positive behaviors, help the resident— help the person with dementia reduce anxiety, encourage viewing family photos for discussion. That's a great distraction. Keep them busy and use relaxation methods. One of the really effective ones is give them a hand massage. They love that and it's very calming. Now, here are some things you can do when the person has increased behaviors in the late afternoon and evening, often referred to as sundowning. Prepare for raised anxiety. Turn lights on ahead of time. Minimize their distractions. Remove any clutter. Provide a safe place for them to rummage. Offer favorite items of interest. Offer snacks and drinks. And play soft music in the background. That is very effective. When a person is disruptive, you may seek their attention. Approach them in a friendly manner. Redirect them to a private area if possible. Inform them of a change in routine. Encourage an independent activity. Involve them in any plans if possible. And help them gain their coping skills. Here are some things you can do to help with Sleep problems. Monitor their sleep patterns. Determine cause such as hunger or discomfort. Provide daily exercise. Establish routine napping if necessary. Remind them that it's their bedtime. Provide security items such as a favorite picture or stuffed animal. Create rituals such as hand massages, drink, prayer, bed, etc. And wind down activity participation after dinner unless requiring exercise. It's always best to do more stimulating activities earlier in the day and wind down as the day progresses on. Supply nightlights if they're preferred. And reassure them that you will check on them throughout the night. Now, tips for handling agitation include: Address any chaos in the environment by reducing noise levels and the number of other people. Avoid moving household objects around whenever possible. Familiar objects located in the same places provides them with a sense of security. Change the immediate environment when the person with dementia becomes agitated. Again, play soothing music. It's magical. It's powerful. Safety-proof the environment to allow for as much autonomy as possible with the least number of hazards. Handling communication problems include giving reassurance, trying to use touch if verbal support isn't working. Again, limiting outside distractions, turn off radios and television. Listen for the meaning of the feelings behind their words. Speak clearly and loud enough to be heard. And then, of course, use non-verbal means of communication such as body language, facial expressions, and touch. Many people with dementia have ongoing communication problems. This is going to include forgetting words, using repetitive phrases, and other things that you will notice. Now, how to handle delusions, hallucinations, and paranoia. Along with anxiety, delusions, hallucinations, and paranoia are extremely common behavioral issues in people with dementia, and they may occur as a result of changes in physical health, of the brain. So, some tips for handling delusions, hallucination, and paranoia include— probably the most important thing is avoid arguing or trying to impose a sense of truth or reality into the person with dementia. Why? It absolutely does not work. Don't feel the need to play into the lie. You can be honest while still providing dignity and respect. And then reassure that person by saying things like, "I am so sorry you are getting upset by this. Let me see if I can help." And then redirect the person with dementia to divert their attention to something more appropriate. Tips for handling sleeplessness and sundowning. So, insomnia and sleeplessness, also known as sundowning, are again common behaviors in people with dementia. They occur due to a combination of factors and can be worsened by exhaust— by being exhausted after a day's events. So, some tips on handling sleeplessness and sundowning include: avoid giving your loved one alcohol, caffeine, or sugar; considering hiring help at night so you as a caregiver can get enough sleep without having to leave your loved one with dementia unattended; discourage napping during the daytime; Talk to a healthcare provider about natural sleep-induced medications such as melatonin. And turn the lights on and close the curtains well before sunset to eliminate confusion about the time, particularly in the winter months. And then the last tip I have for you today is how to handle wandering. It's not always easy to find out why a person with dementia is wandering, but caregivers can use these insights to help them more effectively deal with that problem. You can add child-safe plastic covers to doorknobs. You can consider having them carry a GPS tracking device. Always have a current photo on file just in case the person with dementia goes missing. Register them with the Safe and Sound program in your local area. Install door alarms and set them to go off if the door is opened. And finally, install locks that require a key, keeping safety issues in mind for all people in the home. So those are hopefully some very helpful and valuable tips. For you to consider while encountering some of these challenging behaviors that will occur. So, in my segment, What's News, I want to share with you an article that I stumbled upon. It was in Fortune Well, presented by CVS Health, and the title of the article is called Cognitive Decline After Retirement Is a Universal Trend. Here Are 4 Ways to Reverse It. The article was written by Aaron Prater, and it was published on May 19, 2023. And this is what the article tells us. Now, it was authored by researchers at the University of Cologne in Germany and the University of California, San Francisco. The researchers interviewed nearly 9,000 European retirees ages 50 and older from 17 countries. Each completed 6 memory assessments over the course of 13 years. Their findings: retirement was generally associated with a moderate decrease in word recall, and memory decline accelerated after retirement. This was true in all countries involved, even in those with more generous welfare systems and higher pension benefits like Germany, Austria, France, and Belgium versus those with low public pensions like Portugal, Greece, Israel, Estonia, Poland, and Slovenia. The study showed that postponing retirement can protect against cognitive decline, especially among the more highly educated. But let's face it, the article says, life is short. For those who can and wish to retire on time, here are 4 tips for staying mentally sharp during what should be the most joyous season of your life. So keep or get connected. A quarter of Americans age 65 and older are socially isolated according to a 2020 report from the National Academies of Sciences, Engineering, and Medicine. While loneliness is miserable, it's also more— it's also more. It poses a health risk as deadly as smoking. Smoking a dozen cigarettes a day, the U.S. Surgeon General, Dr. Vivek Murthy, recently told attendees of Fortune's Brainstorm Health Conference. Retirement often means loss of the community you worked in, perhaps for decades. So, keep connected to others by taking classes, volunteering, hanging out with friends, or picking up a The second recommended advice is to keep active. It's never too late to begin an exercise routine, even if you didn't do it in pre-retirement or if you fell off the wagon at some point. Get up and get going again. The third one, keep your stress to a minimum. There are many, many ways to keep stress at bay. A few of them are to get a good quality sleep and do your best not to introduce any new stressors in your life. And then finally, keep working. Ideally, you're in a situation where you might not have the financial need for a typical 9-to-5 day like you did when you were working Free retirement, but you have just as much to contribute to society as the day before you retired. If it brings you joy, consider volunteering, contract work, or a part-time job in the field you love regardless of pay. You'll reap the benefits of connectedness and cognitive acuity and typically accompanying work hopefully without all the stress. So, I think that's some pretty good advice. I have known a lot of people who have retired and then just seem to cognitively decline within years of retiring. So, I think this is some really sound advice to follow for those of you who want to stay sharp even in your retirement years. So, So that's what I have for you today. I want to thank you again for listening. We always have so much to cover in our current episode and upcoming episodes, and as you know, I'm really— it's so important for me to provide you with information that you will find helpful and valuable throughout this journey. Remember, Lisa Skinner Skinner. And I can't emphasize this enough: dementia awareness occurs every day. The kindness is the ability to speak with love, listen with compassion, and act with patience. These are all very necessary attributes to have in order to outlast Alzheimer's disease. This show is all about you and how my experiences, expertise, and strategies can help you and your loved one have an easier time while struggling through this disease. I know how difficult it is. Therefore, I would love it if you would send me your comments and suggestions on what topics you'd like me to cover on this weekly show. I genuinely look forward to receiving your thoughts and ideas. And in the meantime, take care of you. Talk to y'all next week.

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 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.