by Susan Koons, MSN, RN, CNL
Behavior has meaning. When a baby becomes irritable and cries, we wonder - is he hungry, cold, tired or in pain? If we knew the cause of the behavior, perhaps we could soothe the irritability. As a child grows, we’re relieved when he is able to tell us the reason behind the tears.
For the caregiver of the adult with a progressive dementia, when challenging behaviors surface, the caregiver is often faced with a similar set of questions. Is he hungry, cold, tired or perhaps in pain? Whether the caregiver is a family member or paid staff, they face challenges in determining the reason behind the behavior and how to handle it.
Unlike a child, the person with dementia is unlikely to be able to share the reasons behind their “tears”. And sadly, along with those challenges, comes feelings of frustration, hopelessness, guilt, embarrassment or anger, for both the caregiver and the person with dementia. Challenging behaviors can occur in up to 90 percent of persons with dementia, and can be as upsetting to the person as they are to the caregiver.
Types of behavior
Challenging behaviors can include repetition, resistance, suspicious delusions, confusion, wandering, agitation and verbal or physical aggression. It also includes eating and sleeping schedules.
Behaviors may lead to erratic, unpredictable and uncontrolled outbursts. However, behaviors have a purpose and are often triggered by un-met needs. Persons with dementia may wander aimlessly. Are they trying to find their children, parents or spouse? Are they agitated, because they have a physical complaint and can’t communicate it? Did they become aggressive and raise their fist, when a caregiver they no longer recognize, is attempting to undress them? Is the room too hot, too cold, too noisy, or is a task too overwhelming?
Identifying the triggers may help in offsetting the behaviors and controlling the cascade of events. Collecting information about the behaviors, and the events surrounding them, are necessary. Charting these episodes allows caregivers to actually “see” and track the patterns. While this is time-consuming, it allows the caregiver to see the bigger picture, develop new approaches and prevent the behavior.
Changing the challenging behaviors
Once patterns are determined, caregivers can make adjustments in approaches and routines. The caregiver can introduce interventions specific to the person and the need – interventions that elicit fond memories, and promote distraction, redirection and engagement.
Increasing socialization, introducing therapies such as music, exercise or pets, making subtle changes to the person’s environment, and focusing on the person and not the task, can reduce the likelihood of problematic behaviors. It can be a full-time job, but controlling the process contributes to feelings of accomplishment for everyone.
And finally, a note for the caregiver – Have you taken a break? Do you recognize the emotional burden of care-giving, and the importance of connecting with professionals, support systems, agencies and others like yourself? It’s vital for your own care and quality of life.
Find the time and allow this to happen.
It’s all about changing behaviors!
Susan Koons is a Clinical Nurse Leader for Hospital Based Services, Pine Rest Christian Mental Health Services and an Adjunct Professor at the University of Detroit Mercy. Her background is in Older Adult Services and Hospice care.