Difficult Behaviors and Possible Solutions
Guest Columnist: Janet Caputo, PT, OCS
November is National Alzheimer’s Disease Awareness Month and National Family Caregivers Month. This column is dedicated to the more than 5 million Americans afflicted with Alzheimer’s disease (AD) and the nearly 10 million dedicated, patient and loving family caregivers.
Alzheimer’s disease (AD) is the most common, progressive, irreversible loss of memory and intellect affecting 4.5 million American adults, typically 65 and older. AD changes an individual’s personality, mood and behavior interfering with routine personal, social and occupational activities. The precise progression rate and the exact changes that will occur cannot be predicted. Difficulty thinking, confusion and loss of judgment eventually produce unusual behaviors that are considered safety concerns.
The caregiver must remember that the individual with Alzheimer’s disease (AD) is not being deliberately difficult. Imagine how they feel with such a limited ability to express themselves! Attempt to offer reassurance with touching and holding. Distract them with calming activities: massage, stroking a pet, drive in the country or listening to their favorite music.
- Wandering: Engage in exercise (e.g. walking outdoors or at the mall, dancing). Involve in productive, safe daily activities (e.g. folding laundry, washing vegetables) Consider double locks that require a key. Loosely fitting doorknob covers may discourage opening doors. Install safety devices to limit opening windows. Add security with fences and door alarms. Use a medical identification bracelet and enroll in the Safe Return program offered by the local Alzheimer’s Association. Save a piece of worn, unwashed clothing to assist in locating with dogs. Alert neighbors of wandering behavior. Provide police a recent picture of the person with AD. If a person with AD is missing, look within a one mile radius of the individual’s last known location. Check dangerous areas first. Investigate familiar places. Search in the direction of the wanderer’s dominant side, (right hand dominant people wander to the right and vice versa).
- Nighttime Wakefulness/Sundowning: Try to remind them that it is nighttime. Provide daytime physical activity. Prevent exhaustion with a short nap or relaxation period twice daily. Limit caffeine intake. Create an inviting sleep atmosphere (e.g. warm bath, warm milk, comfortable bed, minimize noise/light, soothing music, stuffed animal, a pet). Toilet before retiring because waking up to urinate might prevent return to sleep. Sleeping pills might be warranted.
- Refusing To Eat: Exercise improves appetite. Some medications reduce appetite. Prepare a favorite food served on dishes that provide a contrast. Reduce mealtime distractions. Offer small spoonfuls. Provide short, funny rhymes to encourage a smile that opens the mouth. Placing a bit of food on the lips may open mouth wider. Dexterity and coordination issues may be solved with finger foods and sipper cups.
- Rummaging /Hiding Things: Simplify immediate environment by removing unnecessary or valuable items. Prevent access to certain rooms. Search home periodically to discover hiding places and frequently check these areas.
- Gathering/Shopping: Provide a shopping bag and a safe place for the person to store “items”
- Hiding and Losing Things: Due to feelings of insecurity and the desire to hold onto the little that they still have.
- Trailing and Checking The Caregiver: Due to insecurity and anxiety. Distract them with an absorbing task. The caregiver can hum, sing or play the radio.
- Repetitive Behaviors, questions, phrases, movements, actions and questions: Due to memory loss, boredom or anxiety. Try to distract them. Encourage independent discovery of answers. Do not mention future events until immediately before their occurrence. Ensure the repetition is not a sign of discomfort by checking if hungry, thirsty, constipated or too hot/cold. Increase contact with people. Start a conversation about the behavior if related to former activity. Encourage activity (e.g. walking).
- Repeatedly Asking to go home: If the current environment is not recognized as their home, then it is not “home” for them. “Home” might be when they felt comfortable and safe. Reassure them that they are safe and loved.
- Lack Of Inhibition: Undressing or appearing naked in public might be due to memory issues or feeling too hot or uncomfortable. Bathroom requirement might be signaled by lifting a skirt or fiddling with a zipper. Distract their attention if swearing, spitting or stroking genitals in public.
- Suspicion: Accusations of stealing and plotting may be due to memory and recognition failure. Adequate explanation will remedy hard feelings. Exploration of accusations is warranted if possibility exists.
- Multiple Phone Calls: Due to memory loss, anxiety or insecurity. Provide the individual with a number recognition display. The caregiver should consider a caller ID or switching ringers off at night.
CONTRIBUTING AUTHOR: Janet Caputo, PT, OCS is clinical director of physical therapy at Mackarey & Mackarey Physical Therapy Consultants, LLC in downtown Scranton where she practices orthopedic and sports physical therapy. She is currently a Doctor of Physical Therapy student at the University of Scranton.