Alzheimer’s Disease: Caring for Loved Ones with Unpredictable Behavior

Changes in the brain that are associated with Alzheimer’s disease can lead to unusual and unpredictable thinking and behavior. Follow these tips to help you and your loved one with Alzheimer’s disease remain calm and comfortable.

How can I better manage a loved one with Alzheimer’s disease whose thinking and behaviors are changing?

The changes in the brain that are associated with Alzheimer’s disease can sometimes lead to unusual and unpredictable thinking and behavior. For example, your loved one may become anxious around family members, neighbors, or friends whom he or she may not recognize, or in situations that vary from the normal routine. The person with Alzheimer’s disease also may become suspicious and suffer from delusions (false ideas that a person firmly believes and strongly maintains in spite of contradictory evidence). He or she also may begin to withdraw from social interaction, wander, become aggressive, and/or become angry and irritable.

Here are some tips to help you manage the changes in thinking and behavior that often accompany Alzheimer’s disease:

• Be calming. If your loved one becomes agitated or aggressive, try playing music, look at old pictures together, read a book, go for a walk, or engage in another enjoyable activity. Talk about “old times” — stories about the family or activities he or she once enjoyed (sports, hobbies, and so on). Your loved one is more likely to remember events from years ago more than recent times. Talking about old times can be comforting and calming.
• Reassure. Reassure your loved one every day, even if he or she does not respond. Use a soft, even-toned voice, and be protective and affectionate. If he or she has delusions, be reassuring rather than defensive.
• Redirect, do not correct. Do not correct or confront your loved one if he or she is upset. Do not argue or try to convince the person that he or she is incorrect. This will further agitate, irritate, or upset your loved one. A better approach is simply to agree with the comment, change topics, or choose a new activity.
• Identify triggers. Try to identify any actions, words or situations that may “trigger” inappropriate or dangerous behavior. Document any episodes of such behavior so you can try to avoid the triggers in the future.
• Gain attention. Turn off loud radios and televisions and clear the area of other distractions before talking with your loved one. This will help improve attention. Position yourself at the level of the person. If the person is sitting down, sit down too. Maintain eye contact. If your loved one is confused, state your name and relationship (“Hi dad, it’s Karen, your daughter.”)
• Reword statements. It may help to simplify, or reword your statements if the person with Alzheimer’s disease doesn’t seem to understand. Try to be patient and supportive, especially if your loved one is confused and/or anxious. Speak using as few words and short sentences as possible. Use simple words.
• Keep it simple. Follow simple routines and avoid situations that require the person with Alzheimer’s disease to make decisions. Having to make choices can be very frustrating and cause anxiety for a person with Alzheimer’s disease. Avoid open-ended questions.
• Be patient. It may take some time for your loved one to figure out what he or she wants to say. If they are struggling to find the right word(s), offer some suggestions.
• Adapt to your loved one’s communication methods. Try to understand the words, gestures, and body language your loved one uses to communicate. Adapt to his or her way of communicating; don’t force your loved one to try to understand your way of communicating. Keep in mind that negative behaviors – such as agitation, irritation, aggression, pulling at clothing – may indicate the person has a need but simply can’t express what it is. Perhaps the person can’t find something they are looking for; he or she is hungry, thirsty or tired; in pain; or has to go to the bathroom.
• Change your approach. You may have to change an approach or solution to manage a behavior that previously worked. This is because the brain of a patient with Alzheimer’s disease changes as the disease progresses.
• Review medications and watch for side effects. Check with your patient’s doctor when you see changes in behavior. Is your loved one taking his or her medications as directed on the label (the correct amount, correct number of times per day, correct time of day)? Has there been a change in medication or in dose of medication? Side effects of some drugs can include depression, agitation, drowsiness, or memory issues. Is your loved one taking any over-the-counter medicines, herbs or supplements? These products can produce their own side effects or interfere with the prescription drugs your patient may be taking. In some cases, the behavioral problems themselves — especially physical aggressiveness and delusions — may require treatment with medications, such as anti-anxiety or anti-psychotic drugs.
• Adapt the environment. To reduce confusion and anxiety, adapt your loved one’s environment to his or her capabilities. Make adjustments as his or her abilities decline. If your loved one tends to wander, you may need to lock the doors, especially at night. Consider participating in the Alzheimer’s Association’s Safe-Return Program. As part of this program, the person with Alzheimer’s disease wears a bracelet with a toll-free number and code. The toll-free number may be called from anywhere in North America, and the code is used to identify the person and alert his or her family of the person’s whereabouts. See the article, “Alzheimer’s Disease: Creating a Safer Living Area,” for other tips.
• Be honest with yourself. Recognize when the person’s behavior is more than you can handle. Safety — your own and your loved one’s — must be considered at all times.
• Know your limits. Management of problematic behaviors associated with Alzheimer’s disease can be stressful. As a caregiver, it is important to know your physical and emotional limits during these stressful episodes and when to reach out to others.
• Professional help is available. There are programs designed specifically for caregivers to learn hands-on skills in managing difficult behaviors while also learning self-care. Caregivers may also benefit from meeting with a counselor to help deal with the daily stressors of caring for someone with Alzheimer’s disease.
• Join a support group. Lots of other families are caring for a loved one with Alzheimer’s disease and can share successful tips for managing behavior problems.

Other general tips:

• Maintain current status. Don’t try to teach new skills; rather work to preserve your loved one’s abilities, particularly those that affect dignity (such as eating and using the toilet).
• Limit changes. Limit changes in your loved one’s surroundings or to his or her daily routine. Keep furniture and objects in the same location as much as possible. Clear clutter from rooms.
• Gently remind. Help your loved one maintain his or her orientation by naming events for the day; reminding him or her of the date, day, time, place, etc.; and repeating the names of the people with whom he or she has contact.
• Provide a good diet. Because the effects of dementia can be worsened by poor nutrition, be sure to provide your loved one with a nutritious diet and plenty of healthy fluids, such as water or juice.