DEMENTIA: “NORMAL”
BEHAVIORS
Linda Bliss, RN, QDCP
Kemper House
Goals and Objectives
• By the end of the session you will be able to…
• Identify different types of “normal” behaviors
• Identify what may trigger these behaviors
• Restate what the behaviors are trying to
communicate
• Respond appropriately and effectively to these
behaviors
What is Dementia?
• Dementia is a symptom of a disease process
• Alzheimer’s Disease is the cause of 80% of all
dementias
• The symptoms are such that they interfere with
the person’s ability to function in every day life
• People with dementia no longer have inhibitions
learned in early childhood
What Are “Normal” Behaviors?
• Verbal/physical aggression
• Repetitive questions and actions
• Wandering, exit seeking
• Delusions/Hallucinations
• Catastrophic Reactions
• Sundowning
• Hoarding, rummaging, hiding things
• Mood Swings
“What do you mean that’s normal?”
All Behaviors Are A Form Of
Communication!
WHAT ARE THEY
TRYING TO TELL US?
What Are They Trying To Tell Us?
(Common Triggers)
• They have unmet needs
• They are anxious about an upcoming event
• They have a fear of being alone, looking for a loved one,
•
•
•
•
•
looking for “home”
They feel frightened or humiliated
They feel frustrated
The dementia has eroded their judgment and self-control
Their independence or privacy has been threatened
They are in physical discomfort or having pain
BEHAVIOR MAY BE DUE
TO PAIN!
People with dementia
definitely feel pain!
Verbal/Physical Aggression
• What happened just before the aggressive or
combative behavior?
• Consider the “5 W’s” (where, when, who, what,
why)
• Watch for early signs of potential combative
behaviors
• Know the common triggers
• What works today may not work tomorrow
Early Warning Signs of
Aggressive/Combative Behaviors
• When they say “No” they mean “No”
• Restless, nervousness, agitation
• Annoyance
• Arguing
• Frustration
• Pacing
• Raising a hand
• Throwing something
• Verbal outbursts
Repetitive Questions
Why do they remember the questions and not the answer?
• They repeat themselves because they have
dementia!
• They are seeking reassurance rather than
seeking information!
• Inability to judge time
• Separation from loved ones
• Inability to store and retrieve
information
REPETITIVE QUESTIONS
It maybe the 10th time you are
hearing it, but it’s the 1st time they
are asking it!
Remember, repetitive questions are
“normal”!
Repetitive Actions
• Boredom
• Side effects of medications
• It’s a way of reassuring self, ex: rocking back and
forth
• May be a meaningful task
• May be a task associated with
a former job or hobby
• If it’s not hurting anyone, don’t
fix it!
Wandering, Exit Seeking
• Looking for a loved one
• Looking for “home”
• They have a need unmet
• Looking for the bathroom
• Need to get to work
• Do not open door if someone is standing there
waiting to leave
• Validate and Redirect
Hallucinations
• Caused by changes within the brain
• Experienced through one of the five senses
• Most common are visual or auditory
• False perceptions/misinterpretations
• They see a rabbit on the couch
• They hear a baby crying
• They see a stranger in the mirror
Assess and Respond to Hallucinations
• Is this upsetting to the person or for you?
• Is it leading them to do something dangerous?
• If it doesn’t cause a problem, don’t fix it
• Don’t argue about what they see or hear
• Reassure and redirect
• Walk with them in their world! Validate! Their
reality is not our reality
Delusions
• Something a person believes to be true
• False beliefs caused by deterioration of cognitive
processes in the brain
• Can be influenced by misunderstandings or
misinterpretations
It’s “normal” for someone with dementia!
Most Common Delusions
• Spouse is being unfaithful
• Their home is not their own
• Someone is stealing their money
• Someone is trying to harm them or poison them
• Someone is spying on them
Responding to Delusions
• Don’t argue or try to convince
• Reassure, redirect
• You don’t have to agree, but you do have to
validate
• Let them know you want to help; “Is there
anything I can do to make you feel more safe?”
• Always protect yourself
Catastrophic Reactions
• Making a “mountain out of a mole hill!”
• Over reacting to a seemingly normal,
nonthreatening situation
• Their reality is distorted and overwhelming
feelings are normal
• Most often occurs around dinner time or evening
• Delusions can also make people more fearful
causing catastrophic reactions
Try to Prevent Catastrophic
Reactions
• Don’t argue or try to convince
• Don’t criticize or belittle
• Avoid over fatigue
• Keep tasks simple and one step
• Be aware of the triggers
Sundowning
• A group of behaviors occurring at the time of
nightfall or sunset
• Increased confusion, agitation, aggression,
pacing wandering
• The specific causes have not been proven. Some
evidence suggests that the disruption of circadian
rhythm enhances the behaviors.
Things You Can Try To Manage
Sundowning
• Consistent sleeping schedule and daily routine
• Limit caffeine
• Keep rooms well-lit, try to avoid shadows
Hoarding and Hiding
• Take “collecting” to the next level
• Failing to throw out large numbers of “stuff”
• Hours spent collecting “stuff”
• Were they a “pack rat”?
• Did they grow up in the depression or during wartime?
• Fear of being robbed
• Security “the more the better”
• Everything is fair game! They don’t realize taking things
that are not theirs is wrong. They are not “stealing” they
are merely “shopping”!
What Do People Hoard?
• Food
• Garbage
• Newspaper, magazines, “junk” mail
• Silverware
• Plastic bags
• Old clothes
• Paper products
• Stuff!
Rummaging
• A constant, driven, searching through belongings
and “stuff”
• Hours spent looking for important items such as
keys, bills, money
• Catastrophic reactions when they can not find
what they are searching for
• Forget what they are looking for
• Loss of object identification
Interventions for Rummaging
• Lock valuables in a safe place
• Always check wastebaskets before throwing out
trash
• When you find a hiding place, check it often
• Know where to look, refrigerator, freezer, sugar
bowl, under cushions, in shoe boxes
• When decluttering, provide lots of emotional
support
Mood Swings
• Decreased coping mechanisms
• Decreased self control
• Folks are most often acting out of a sense of fear, feelings
of persecution, a feeling of losing control, frustration
Tackle The Triggers
• Always GREET before you TREAT (Teepa Snow)
• Try to met their needs (do they have enough to eat and
•
•
•
•
•
•
drink, do they need to use the bathroom)
Reduce demands and have a stress-free routine
Give them plenty of time to respond (10 second rule)
Give time outs
Do not be authoritative or criticize
Provide a safe and calm environment
Assess for pain or discomfort
When Do We Need To Treat The
Behaviors?
• When it is distressing to the person
• When it can cause harm to the person or others
• When it impairs self care, social interactions, or
participation
• When it effects quality of life
These behaviors are “normal” for
someone with dementia