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POTENTIAL CAUSES OF BEHAVIOR PROBLEMS
Symptoms of dementia can cause a flood of emotions
and physical reactions, which can manifest in
behavioral problems. Understanding the cause and
effect can help family and professional caregivers
cope better with situations that may arise.
Reaction to Loss:
We all rely on input from our environment to guide
us in activities and relationships. An individual
with dementia has lost both the benefit of such
input and the ability to inform us of their internal
world. This absence causes fear, insecurity and
frustration, which may present in the form of
aggression and agitated behavior.
Some Suggestions:
·
Provide reassurance.
·
Speak in a calm voice.
·
Promote a sense of security and comfort.
Inability to Meet Basic Needs:
As a result of cognitive impairment and psychiatric
symptoms, a person's basic needs might not be met.
The resulting hunger, dehydration, elimination
problems and fatigue can produce behavioral changes.
Individuals with dementia may stay hungry because
of, for example, their inability to feed themselves,
depression or loss of muscle coordination. They may
show their discomfort through agitated and
aggressive behavior.
Likewise, they may forget how to pour water into a
cup or never ask for a drink due to their inability
to communicate. Dehydration can lead to urinary
tract infection, constipation and fever—putting
individuals at a high risk for
delirium and
consequently more behavioral problems.
Similarly, an individual may forget where or what
the bathroom is, and eventually may not recognize
the internal cues for urination or a bowel movement.
Elimination problems may manifest in the form of
agitation, aggression,
wandering,
pacing, and
incontinence.
Compounding this, they may develop urinary tract
infections or constipation which, left untreated,
could result in delirium.
Lastly, someone with dementia may get tired easily
because of wandering, pacing and disruption of the
sleep-wake cycle. Fatigue often leads to
irritability and aggression.
Some Suggestions:
·
Offer verbal and physical assistance during meals.
·
Serve foods that the individual likes.
·
Provide adequate snacks and supplements.
·
Prevent distraction during meals by rearranging the
environment
·
Serve pre-cut or finger food if using utensils
becomes difficult.
·
Consult with a healthcare professional about
swallowing problems.
·
Schedule fluid intake to ensure six to eight glasses
of liquid per day.
·
Avoid coffee, tea beverages with caffeine that act
as diuretics.
·
Establish a routine for using the toilet, such as
assisting them to the bathroom every two hours.
·
A commode, obtained at any medical supply store, can
be left in the bedroom at night for easy access.
·
Put up signs (with illustrations) to indicate the
bathroom door.
·
Use easy-to-remove clothing, such as those with
elastic waistbands.
·
Try soothing music or a massage to induce sleep.
·
Reduce environmental stimuli.
·
Encourage short periods of napping to prevent
exhaustion.
Co-Existing Medical Problems:
Pain and discomfort from a medical problem (i.e.,
dental pain, urinary tract infection) or medication
side effects can go unnoticed because of the
individual's inability to report it due to poor
memory and/or loss of verbal skills. In addition,
caregivers may have difficulty gauging the
individual's pain because they do not respond to
questions. As a result, these individuals may not
receive necessary medication or treatment. Those who
are in pain and discomfort tend to exhibit verbal
and physical aggression, restlessness,
wandering and
pacing behaviors.
Some Suggestions:
·
Become familiar with the person's medical history.
·
Assess their non-verbal behavior to help identify
the cause of distress.
·
Watch for signs of urinary tract infection and other
medical conditions.
·
Monitor medications for side effects.
Co-Existing Psychiatric Disorders:
Individuals with a previous diagnosis of psychiatric
disorders, such as schizophrenia,
depression or
mania, and those with mental retardation are likely
to exhibit more behavioral problems when they
develop dementia than other individuals without
psychiatric illnesses. Those with hallucinations or
delusions and who are depressed or manic tend to
exhibit more aggressive and agitated behavior.
Some Suggestions:
·
Consult with your physician about available
medications, such as anti-depressants,
anti-psychotics and other mood stabilizers, to
control symptoms.
·
Provide reassurance.
·
Distract and redirect with other activities.
Environmental Factors:
Excessive noise, poor or glaring lighting and cold
temperature in the home or a long-term care
facility, and overcrowding in a group setting can
increase agitation, screaming and aggressive
behavior. Any change in the environment or routines,
such as
bathing and
eating, can
cause frustration and agitation. As well, boredom
that results from lack of activities, and conflicts
among residents in a group setting can manifest in
behavioral changes.
Some Suggestions:
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Reduce excess stimuli, such as the TV or radio.
·
Elevate the room temperature.
·
Ensure adequate lighting.
·
Carefully and gradually introduce changes in routine
or the environment.
·
Provide activities that are simple and creative.
·
In a group setting, staff should anticipate the
characteristics of each resident and adjust the
environment accordingly.
Sensory Impairment:
Individuals with hearing or visual impairments tend
to be more paranoid, hallucinate more, and feel more
frightened and frustrated. For example, those with
poor eyesight may not eat their food or they may be
at risk for falls.
Some Suggestions:
·
Assess vision and hearing.
·
Ensure that individuals who wear glasses or hearing
aids have them in place.
·
Evaluate problems such as cataracts, glaucoma or
other eye diseases, and correct them with surgery,
if feasible, or by creative environmental changes.
Factors Related to the Caregiver:
A caregiver's attitude and knowledge of dementia
affect the care of individuals with the disease. The
more one knows about dementia, the less likely they
will be to resent certain behavioral problems.
Individuals usually respond to a caregiver's mood
and behavior accordingly.
Some Suggestions:
·
Become educated about the disease.
·
Learn effective
communication techniques
and how to cope with specific behavioral challenges.
·
Use a calm tone of voice combined with physical
touch to convey reassurance.
·
Be patient and kind.
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Take care of your own physical and mental health.
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