Caregiving for a dementia patient—whether it’s your spouse, parent or some other loved one—is not easy. But the right mind-set will help you defuse and even prevent the troubling behaviors that often occur.

Whether your loved one repeatedly loads and unloads the dishwasher…has conversations with an imaginary friend…or hides the daily mail, you need to respond in a way that will help you change the behavior. You won’t get anywhere trying to reason with the person.

You need to dig deep to uncover the hidden meaning of what’s going on—in the dementia patient’s mind there is always a “reason” for even the strangest behaviors.

What to do: Step back and do a little detective work by reviewing the “Five Ws”— who, what, when, where and why.

For example, let’s say a woman with dementia starts screaming in fear whenever she uses the bathroom at night. She insists that an “old woman” is watching her, but her daughter checks and there’s no one else in the bathroom or at the window. Ask yourself…

Who are the people involved in the problem behavior? Is the behavior triggered by one particular person? Does it only happen when the person is alone? In the example above, the screaming happens only when the mother is alone.

What is the exact behavior to be addressed? Break down large problems into smaller pieces that can be easier to fix. The behavior described above is the woman’s fright reaction to seeing or imagining a voyeur.

When does the behavior occur? Look for patterns in terms of time and antecedents. What’s going on in the environment just before the behavior…a nursing shift change…boredom…seeing others leave the building? Does it happen only at night, or only when it is time to take medication? The woman above screams only at night when sundowning (also known as late-day confusion) is common.

Where does the problematic behavior occur? Is it only in the bedroom, at a doctor’s office, outdoors, etc.? The woman’s screaming occurs only in the bathroom, specifically when she is sitting on the toilet.

Why is the behavior happening? This is often the toughest question to answer because it requires delving into the mind of the person with dementia. Is your loved one uncomfortable, frightened, lonely or looking for a purpose? When the daughter of the screaming woman recreated the scene for herself, she realized that the bathroom mirror is directly opposite the toilet. Her mother was seeing her own reflection…but didn’t recognize the “old woman” as herself, which is common in the later stages of dementia.

The solution to this problem was not to attempt to convince the mother she was seeing her own reflection. Instead, the daughter simply covered the mirror each night (when the woman’s sundowning caused mental confusion).

Important: Medication can often cause or worsen dementia symptoms. Be sure to factor that possibility into any troubling behavior—and consult a doctor for advice.


When interacting with a person with dementia, try these “rules”

Nurture positive emotions. Leave your emotional baggage at the door. Let go of anger, guilt or resentment when you are dealing with your loved one with dementia. This is not always easy between family members, but you will be motivated to do this when you see how much it improves dementia behaviors. For example, people with dementia are attuned to body language and tone of voice, so it’s very helpful if you are able to remain upbeat and loving.

Also, begin each interaction by “bringing the sweetness.” Start with a warm moment—bringing a cup of cocoa in the morning, sitting and holding hands, reading a funny story—before every care task or interaction. It only takes a minute, and it will end up saving you time with the dementia behaviors it prevents or improves.

Work with your loved one’s still-present abilities. Rather than dwelling on what your loved one can no longer do, reconnect with what he/she still can do. For example, people with Alzheimer’s disease tend to lose fine motor control first—making it difficult to button a shirt, for example—but your loved one can still walk. This means you still can take walks with your loved one and perhaps observe trees, flowers and other elements of nature.

Think when you communicate.  Talking to someone with dementia demands attention to details. You need to…

• Remember that body language and emotions often speak louder than words.

• Use simple sentences…and slow down. Allow time for words to be processed. Make sure you have your loved one’s attention before you begin speaking by catching and maintaining eye contact.

• Speak on the same physical level—sitting or standing—and approach the person from the front, not from the back or side, which can startle your loved one.

Be aware of sensory changes. Dementia changes the way our senses work, which can trigger problems. Understanding these changes will often help you explain the “why” of a particular behavior. For example…

• Vision changes can make it difficult to clearly see and identify objects. Brighter lights and contrasting colors are needed. Also be sure that your loved one wears all sensory aides, such as eyeglasses and hearing aids.

• Sounds of favorite music can stimulate memory and keep people with dementia engaged. But ambient noise—traffic or construction—can be irritating and distracting. Helpful: Sit down and listen to the music with your loved one so you can share the experience. If he previously played a musical instrument—even years ago—encourage him to pick it up again.

• Senses of smell and taste can change and are known to become less acute with normal aging—even more so with dementia. Throwing plates of food or refusing to eat may be due to a changing ability to taste, rather than petulance. Eating with another person may help him mimic the proper actions of eating, and the social interaction of breaking bread together is often an encouragement to eat.

The takeaway: By thoughtfully changing the way you interact with your loved one, you can nudge behaviors in a more peaceful direction, allowing the two of you to reconnect emotionally.

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