Managing those living with Dementia – Tips for families and carers

Dementia includes a range of conditions that cover a global decline in brain function and is estimated to directly affect over 425,000 people in Australia today.*

For family, friends and caregivers of people living with dementia, managing the changed behaviours of the person affected can be confusing and stressful and finding out what works is often a matter of trial and error.

There are a number of ways in which dementia may manifest itself and there are some common categories of behavior that describe these.

We have listed some of the signs to look for, the reasons why these behaviors may be happening and have suggested some possible ways in which you can manage when they occur.

How to Manage Different Types of Behaviour Associated with Dementia

In all cases, the best place to start is with a consultation with the individual’s doctor to find out if there is an underlying illness or whether side-effects of medication may be the cause of the behaviour.

Anxiety

Characteristics: Worried behaviour such as pacing, restlessness, fidgeting, clingyness, following others everywhere including into the bathroom or shower.

Possible causes: Changes within the brain, wanting to seek out familiar people and places from the past, feeling tension or anxiety in others, awareness of loss of cognitive and functional abilities.

Things to try: Provide reassurance and support, respond calmly and gently and do not place demands on your loved-one. Try giving them something to keep their hands occupied such as worry beads, reduce or eliminate caffeinated drinks and make sure they get enough exercise.

Agitation

Characteristics: Pacing, fiddling, constantly talking, constantly asking questions, crying, cursing or screaming.

Possible causes: Fatigue, broken sleep patterns, pain, fever, illness, constipation, physical changes in the brain, side effects from medication, diminished vision or hearing, hallucinations, distress over declining functions, fear from not recognising people and places and attention seeking.

Things to try:  Try and include them in decisions and activities to boost self-esteem, try not to demand things, maintain a steady routine, explain things in a calm, assuring manner, avoid confrontation, suggest alternative activities, ensure they have adequate exercise and make sure they are comfortable.

Aggression

Characteristics: Verbal abuse, threats, lashing out, damaging property or physical violence.

Possible causes: Fatigue, broken sleep patterns, pain, illness, constipation, physical changes in the brain, the side-effects of medication, impaired vision or hearing, hallucinations, feelings of humiliation and frustration at no longer being able to do simple things, difficulty in comprehension and fear at not recognizing people or places.

Things to try: Consult your doctor to find out if an underlying illness or medication may be the cause, try and stay calm, take note of warning signs and look out for them, identify and eliminate causes of stress, develop a consistent routine, keep surroundings the same, communicate at their level in a reassuring voice, avoid confrontation, make sure they get enough exercise, make sure they are comfortable, go for a walk together or have a cup of tea and if they continue being aggressive leave for a while to give them a chance to cool down.

Depression

Characteristics: A depressed mood, loss of interest in previously enjoyed activities, lethargy, sleeplessness, a change in appetite, guilt and feelings of worthlessness, being unusually emotional, crying, anger, agitation and confusion.

Possible causes: The side-effects of medication, physical illness, reaction to a diagnosis of dementia, social isolation, fatigue and environmental factors such as noise or crowds.

Things to try: Incorporate exercise into daily routines, limit noise and people if they are having an adverse effect, avoid placing demands that may frustrate or upset your loved-one, be positive and give frequent praise and try and include the person in conversation.

Dis-inhibition

Characteristics: Includes actions that are offensive and don’t follow social norms including tasteless or rude remarks, inappropriate flirting or sexual comments, taking clothes off at inappropriate times and places, fondling themselves, masturbating in public and urinating in public.

Possible causes: Mistaking other people for someone familiar such as their husband or wife, feeling too hot leading to removal of clothing, itching, urinary tract infections causing handling of genitals, loss of social skills including discretion on dress, forgetting where the bathroom is, loss of sense of time causing them to get ready for bed at the wrong time, brain damage as a result of dementia.

Things to try: React with patience and gentleness, reassure the person with hugging and touch. For inappropriate sexual behaviour gently remind them that their behaviour is inappropriate and lead them to a private place. Distract them by giving them something to keep their hands occupied and consider buying pants without zippers.

Hallucinations and False Ideas

Characteristics: Hallucinations include experiencing things that seem real but cannot be verified by other people. This may include seeing people and hearing voices and noises that are not there. It can mean not recognising a lifelong partner as a person they know or seeing themselves in the mirror and being frightened. They can also misinterpret voices on TV and the radio as spoken by people in the room.

False ideas can include feelings of being invincible or having superhuman powers, feelings that people are out to get them, accusing people of stealing or hiding things from them, accusing partners of being unfaithful or accusations that caregivers are out to harm them.

Possible causes: The brain affected is not accurately interpreting the information it receives. Other causes could be failure to use hearing aids or glasses, the side-effects of medication, an underlying illness or physical condition, inadequate lighting, unfamiliar carers, sensory overload caused by too many things happening and psychiatric illness.

Things to try:  Keep quiet and stay neutral, maintain a familiar environment, maintain familiar caregivers, increase lighting, reassure with physical contact but only if the person is accepting, try distractions such as music or looking at photos, ignore hallucinations that are essentially harmless and do not cause any distress, try keeping spares of things that go missing such as glasses or keys, learn common hiding places and keep a diary of incidents to establish any patterns that may be able to be prevented in future.

Sundowning

Characteristics: Becoming insecure, agitated or restless during the early afternoon or evening. At that time they can also be more demanding, suspicious, disoriented and hallucinate or be more impulsive and have unrealistic ideas of their own abilities that could put them at risk.

Possible causes: Disruption of sleep patterns, lack of sensory stimulation after dark, unsuccessfully trying to restore familiar surroundings causing distress and panic or becoming more anxious as the day progresses causing them to look for familiar people or places for security.

Things to try: Check with your doctor to see if there is an underlying illness or some discomfort contributing to the condition and discuss the side-effects of medication and any possible changes.

Wandering

Characteristics: Leaving the house unaccompanied without notice at any time of the night or day to walk about.

Possible causes: Setting off on a journey to a shop or house and forgetting where they are headed, excess energy, searching for someone or something from the past, staving off boredom, losing track of the time of day or night, continuing a lifelong habit of walking, agitation, discomfort, needing to find a toilet, thinking they have a job to do or having dreams that cause them to respond to the dream as if it was real.

Things to try:  Consider getting them an identity card with an address and phone number, keep a diary to help identify any patterns, remove from sight walking prompts such as keys, overcoats and shoes, consider alarm prompts like bells or buzzers when doors open, encourage walking in the garden or another safe place, notify neighbours and local shopkeepers to keep an eye out for your loved-one, ensure clocks are visible to provide a sense of time, use visual cues to stop walking such as signs on exit doors that say ‘Stop’ or ‘Go Back’.

Colbrow Homecare are Experts at Providing Care for People with Dementia

With over 60 years of experience in caring for people with dementia, Colbrow Homecare has a number of flexible care services ranging from as little as 30 minutes at a time to give you a chance to run some errands right through to 24 hour around-the-clock full-time care.

We understand that each case is unique so we listen to you and always respect your wishes when it comes to decisions about providing care.

And if finances are an issue we can discuss ways in which you can access services such as through Home Care Packages that are subsidized by the government so getting the help you need may be easier than you think.

If you’d like to know more about how we can help ease the burden of caring for your loved- one, call us today on 1300 331 103    or Email homecare@colbrow.com

*www.dementia.org.au

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