by Mohammed Memon, M.D., Carolina Center for Behavioral Health
Families and caregivers of those diagnosed with dementia often struggle with how to handle difficult behaviors. Despite the growing prevalence and public awareness of the illness, there remains a general lack of information and understanding of the disease process as well as managing the issues related with dementia.
The term dementia, now commonly referred to as neurocognitive disorder, means that the individual has significant decline in overall brain functions. This decline impacts memory as well as cognitive difficulties such as impairment in orientation, time, place, person, and situation. Patients with dementia may or may not have awareness of their brain function deficits. This means that they are quite commonly living as if they are functioning fine despite evidence to the contrary.
Symptoms may include language and word-finding difficulties, lack of attention, decline in planning and organization skills (such as failure to manage bills and appointments), problem solving, remembering names, spatial skills and judgment. Spatial skill issues result in difficulty with balance, gait, reflexes, and even driving. Impaired judgment could possibly render the patient vulnerable to danger, engage in poor financial decisions, and culminate in the compromise of personal care.
While there are several types of dementia (Vascular, Lewy body, Fronto-temporal and Parkinson’s type among others), the most common form is Alzheimer’s disease.
Alzheimer’s typically begins slowly and with subtle changes that eventually manifest as dementia later in the disease process.
Dementia frequently comes with changes in personality, confusion, restlessness, depression, anxiety, agitation, aggression, false beliefs (delusions), false perceptions (hallucinations), hostility and non-compliance. Frustration and anger often accompany these changes as the patient becomes aware of personal deficits and a loss of independence. Family and friends may unknowingly contribute to these feelings by being overprotective or overtly controlling of the patient.
So, what are the best ways to safely and successfully get through this difficult time? A team approach involving a primary care physician, psychiatrist, neurologist, and therapists (counselors for the family/patient as well as physical/occupational therapists who deal with day to day functional improvements) is the most valuable and comprehensive approach.
Investigating community resources such as the Alzheimer’s Association and Adult Day Programs, as well as long-term planning related to Powers of Attorney (medical and financial) and educating family members on the disease’s progression, will help everyone in the long-run.
Specific techniques related to addressing the patient’s feelings can also be helpful in reducing behaviors and improving outcomes. Be creative and customize these approaches to the individual living with dementia:
- Use appropriate communication that focuses on support and reassurance. Dementia patients often complain that treating them as if they don’t understand things or as if they are children leads them to feelings of worthlessness and helplessness. Verbal validation of feelings is very reassuring.
- Pay attention while not ignoring or disrespecting your loved one. Appropriate soft, non-intrusive touch and comfort is needed during times of agitation or frustration. Make eye contact and actively engage.
- Take the patient out to eat, to shop, and to enjoy entertainment.
- Play simple physical and mental games. Exercise such as Tai chi keeps the dementia patient stimulated, balanced and motivated.
- Pets, music and aromas can be very therapeutic and soothing. Choose music that is age and noise-level appropriate, as well as animals and scents the patient will enjoy.
- Sun-downing and anxiety can be helped with a ride in a car, meaningful communication, viewing old family pictures, a change in environment, or an increase or decrease of light and/or noise level.
- Discuss pleasant memories and reminisce about “the good old days.” Patients with dementia are often more comfortable talking about past memories. These memories are usually preserved until the much later stages in the illness.
- Redirect the patient if questions and phrases become repetitive. Nicely redirecting to other topics (talking about past weddings in the family, the grand or great-grandchildren, or family trips) may help.
- Give the patient some household tasks. Using a pleasant tone, assign a simple chore that involves a one-step process. Folding clothes or towels is a great exercise.
Finally, be creative in finding ways that work with a particular person living with this disease. While dementia patients may be forgetful, they almost never lose the ability to feel and sense encouragement as well as disrespect. The obstacles they face (and that you face as a caregiver) are there only to be overcome and make the life of a person living with dementia as easy and as happy as possible.
