Eight Steps for Dealing with Dementia Behaviors

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

senior and caregiver sitting outdoors in fall

One of the painful aspects of Alzheimer’s and dementia is the way it can seem to shift the person you love into acting like someone else. Perhaps you’ve always cherished your father’s gentle nature, but now he is frequently angry and raises his voice at you. Or your wife, who has always been very modest, has made off-color comments or even tried to leave the house in her pajamas.

Alzheimer’s and dementia behaviors can be a terrible shock that hurt, embarrass and anger you.

Crucial to dealing with dementia behaviors is recognizing that the changes you are seeing are a result of the disease and not a fundamental change in your loved one’s personality or identity. We know, for instance, that many people living with dementia experience damage to the frontal lobe of the brain, the area that is responsible for the controlling of emotional responses. Damage to this part of the brain can result in “disinhibition” and a reduction in behavioral and verbal control. Someone without dementia might think “I just want to slap that person!” when they are angry, but they don’t because their frontal lobe puts the brakes on and keeps their actions more appropriate. When dementia damages this area, those brakes may not be there anymore.

It is also important to think of behavioral expressions as just that – expressions that may be the person’s only form of communication. Most people living with dementia will eventually lose the ability to use language when expressing their unmet needs, desires and even pain and physical discomfort. We have to look beyond what they are saying and doing so we can understand what they are communicating. It’s important to search for the emotion that’s at the root of it all and ask yourself as a caregiver, “What are they trying to tell me?”

Untreated pain, frustration related to a complex task or confusion caused by difficulty comprehending communication can spark insults, resistance and lashing out if you are not “listening” to the responses of your loved one. Getting to the root of the problem often requires us to be a detective and to try to get at what is truly behind the behavior.

Here are eight steps for dementia behavior problem-solving:

Rule out any underlying physical or biomedical reason for the behavioral expression. Visit a physician or dentist to rule out undiagnosed illness or an unknown source of pain. People with dementia may no longer be able to tell you they are hurting.
Consider your approach—do you need to adjust how you approach and communicate with your loved one?
Think about whether your loved one might be hungry, thirsty or excessively tired.
Examine the immediate setting – is it noisy, too hot or cold, or uncomfortable in some other way?
Weigh whether your loved one is bored or frustrated with daily activities that have no meaning or have become too difficult.
Consider if he or she is isolated from others or depressed due to unfulfilled emotional and social needs.
Think about whether the desire for physical touch is being satisfied. Even if sexual intimacy is no longer realistic or possible with a spouse, holding hands, hugging and other affectionate touches can be pleasurable and satisfying.
Look at whether the task you are asking your loved one to do has been adjusted for their level of ability and set at their pace.

People with dementia cannot – and should not – be faulted for their behavioral expressions. Rather than reacting negatively, try to remind yourself your loved one is doing the best he or she can with the disease. However, we know that sometimes this just hurts and you shouldn’t ignore your own emotional response to the behavior. Doing so simply makes life and the responsibilities of caring more stressful.

Please talk through your feelings with people who understand and care. Dementia support groups are invaluable in this regard – coping with behavioral symptoms is a very common issue for family caregivers. Speaking with a trusted friend or a pastor could also help. This journey is difficult enough; please don’t try to go it alone. If the situation is more than you can handle, Brookdale Alzheimer’s and Dementia care can help.