For people recently diagnosed with dementia, or caretakers, friends, and loved ones of someone with dementia, changes in behavior can be frightening and difficult to deal with. Yet it’s important to understand that the person with dementia is not any less themselves because of their condition. Being able to recognize responsive behaviors and realize what causes them to occur can help bridge the gap between someone with dementia and those around them.
What is Dementia?
Dementia refers to a number of different causes of loss of cognitive functioning, including Alzheimer’s, frontotemporal disorders, Lewy body dementia, and vascular dementia. It is characterized by loss of capacity to remember and reason such that it interferes with a person’s life. Functions such as memory, language skills, hearing, visual perception, focus, and problem solving may gradually become impaired. In some cases, people may lose control of their emotions or display seeming changes in personality.
Despite common perceptions, dementia is not a normal part of aging, and it can be managed with proper memory care. Part of this care is ensuring a secure, stable support network for the diagnosed person, but this can be hard when many dementia behaviors are misunderstood or misinterpreted.
Responsive Behaviors
People with dementia will often display responsive behaviors to stimuli - or lack thereof - for which they do not have a response that is considered “normal” or “acceptable” for others. Yet these behaviors are not intended to upset others, and may be the best way the diagnosed person can convey an idea, wish, or concern. Unfortunately, some common responsive behaviors are misread as rude or inappropriate, creating further communication barriers and potentially, more emotional distress for the person with dementia.
Some common responsive behaviors include screaming, babbling, making strange noises, restlessness, grabbing people, and aimless wandering. It’s important to note that some responsive behaviors, such as swearing, violent contact, and sexual impulses can be distressing to others, and should not be dismissed as normal behavior. However, you should always be mindful of the possible causes of such behavior, and attempt to reach a solution that prevents further harm to either party.
There are a number of factors that could contribute to causing responsive behavior. These include:
Physical:
Is the person hurt, sore, or uncomfortable? Is she hungry or thirsty? What visible changes can you see that could indicate physical distress? Someone who is physically uncomfortable may have less control over her reactions, and resolving the discomfort could help with addressing the behavior.
Emotional:
Have you noticed the person becoming more anxious, teary, or melancholy? Does he seem to be lonely? Has he become suspicious of others, or fearful of something? While shifts in emotion are harder to address than physical needs, distracting the person with dementia could help them regulate negative emotions. Try reminiscing about happy times in earlier life, as long-term memories are more likely to remain readily accessible to those with dementia.
Intellectual:
Have you noticed that the person has had more trouble forming sentences, or loses her train of thought halfway through a conversation? Has she had recent issues with memory, or with performing activities of daily living? In many cases, the person with dementia may be aware of their loss of cognitive functioning, an experience that is frightening, frustrating, and embarrassing. Try not to point out areas of difficulty, and use clear instructions and visual cues to help them perform tasks.
Environment:
Environmental factors can play a large part in the comfort of a person with dementia. For example, if the lights are too bright or too dim, the person may be overwhelmed or unable to see clearly, causing distress. Is the area too noisy? Is there enough stimulation to give him something to focus on? Small changes in environment can ensure the person is comfortable with their surroundings.
Social:
Are there hints from the person’s background that may give insight into their responsive behaviors? Because long-term memories are often more accessible than short-term, people with dementia may draw upon scenarios and behaviors that they learned growing up, routines they learned at school or during their professional life, or cultural or religious practices.
Capabilities:
A natural reaction for caretakers of loved ones with dementia is to attempt to do everything for them, but loss of control and self-management can be distressing and even hurtful to the diagnosed person. As a result, responsive behaviors may be a reaction to underestimating (or overestimating) a person’s ability to perform certain activities of daily living. Enabling them to perform self-care tasks for themselves may help slow loss of function and manage responsive behaviors.
Actions of Others:
Is there anything that you or others are doing that could upset the person with dementia? While asking them to remember something or explaining why a behavior is inappropriate may seem harmless, and indeed necessary to a caregiver or friend, the person may interpret such statements as disappointment, anger, or frustration. Be understanding, offer an apology, and distract them with a new topic of conversation or something to do with their hands.
The most important thing to remember when working towards understanding dementia behaviors is that responsive behaviors are purposeful. While it may seem that the diagnosed person is lashing out or performing behaviors unconsciously, they are actually reacting to a circumstance in a way that seems natural to them. Part of providing memory care - whether formal or informal - is the ability to recognize and work through these responsive behaviors, creating better communication between the person with dementia and their caregivers.
