Dementia Behavior: Sleep Problems
While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.
Common sleep issues may include:
- Difficulty getting and staying asleep
- Agitation and restlessness when trying to sleep
- Thinking its daytime when its night, going as far as getting up, getting dressed and wanting to start the day, Hashmi says
Sleep disturbances are hard on patients and caregivers alike, Hashmi says. Its physically and mentally exhausting to be up night after night.
Common Changes In Behaviour
In the middle to later stages of most types of dementia, a person may start to behave differently. This can be distressing for both the person with dementia and those who care for them.
Some common changes in behaviour include:
- repeating the same question or activity over and over again
- restlessness, like pacing up and down, wandering and fidgeting
- night-time waking and sleep disturbance
- following a partner or spouse around everywhere
- loss of self-confidence, which may show as apathy or disinterest in their usual activities
If you’re caring for someone who’s showing these behaviours, it’s important to try to understand why they’re behaving like this, which is not always easy.
You may find it reassuring to remember that these behaviours may be how someone is communicating their feelings. It may help to look at different ways of communicating with someone with dementia.
Sometimes these behaviours are not a dementia symptom. They can be a result of frustration with not being understood or with their environment, which they no longer find familiar but confusing.
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Devoted Guardians’ Response to COVID-19
Devoted Guardians is actively monitoring the progression of the coronavirus, COVID-19, to ensure that we have the most accurate and latest information on the threat of the virus. As you know, this situation continues to develop rapidly as new cases are identified in our communities and our protocols will be adjusted as needed.
While most cases of COVID-19 are mild, causing only fever and cough, a very small percentage of cases become severe and may progress particularly in the elderly and people with underlying medical conditions. Because this is the primary population that Devoted Guardians serves, we understand your concerns and want to share with you how our organization is responding to the threat of COVID-19.
We are following updates and procedures from the Centers for Disease Control State Department of Health, local and county authorities, the Home Care Association of America and other agencies and resources. Our response and plans may adjust according to the recommendations from these organizations.
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Tips For Managing Dementia Wandering
The No. 1 priority is to keep your loved one safe, Hashmi says. He suggests the following actions:
- Secure all doors. Be especially vigilant about doors that lead outside.
- Use technology. Tracking devices and surveillance systems are widely available and affordable.
- Enlist a team. Neighborhood watch groups and local police are often happy to help keep an eye out for your loved one.
What You Can Do About Medications And Difficult Dementia Behaviors
If your relative with dementia is not yet taking medications for behaviors, consider these tips:
- Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
- Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
- For all medications for dementia behaviors:
- Monitor carefully for evidence of improvement and for signs of side-effects.
- Doses should be increased a little bit at a time.
- Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.
If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.
The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.
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Clean Up The Environment
One of the mysteries of the aging process is why do dementia patients hoard? Dementia can cause an accumulation of mental clutter that takes years to get out of. This mental clutter can be a symptom of the disease or an indicator of it.
Along with a noisy surroundings you also want to simplify and declutter the surroundings as well.
Ive spoken quite a bit about decluttering and the benefits of that for all seniors but for the ones who are living with dementia it holds significant importance.
The reason that a decluttered environment is more important for seniors with dementia is because of the effects that this disease seems to have on someones perception meaning that their ability to distinguish one object or color from another may become distorted.
What makes decluttering a home of someone with dementia a bit more difficult is that hoarding is a fairly common symptom of dementia.
Persons with dementia experience memory loss, mental confusion, disorientation, impaired judgment andbehavioral changes. One of these changes may include hoarding. While hoarding is often harmless, it can become a health and safety issue for the person with dementia.
Ways To Calm Agitation In A Person Living With Dementia
While a person living with dementia may be still very much themselves, there are times when an always-gentle parent or a kind and loving spouse will suddenly become angry and lash out. What can you do to help?
The answer is to meet them where they are: stay calm, offer respect and validation, and gently assist them in re-focusing.
Here are ten well-tested tips for calming agitation in a loved one living with dementia.
1. Stay Calm
Agitation and aggression are contagious. When you are talking to someone who is upset, it is natural to feel upset yourselfpsychologists call this phenomenon mirroring, and you can use it to your benefit.
When you stop and take a deep breath to calm yourself, you are demonstrating calmness. This helps to make your loved one feel safe and reassured. Take a step back and see if you can identify a cause for the agitation, for example, a tense mood in the room. Remember that your loved one is not trying to give you a hard timehe or she is struggling as much as you are.
2. Slow Down
A person with dementia might be overwhelmed by overstimulation or frustration. Instead of rushing in with more ideas or words, just take a pause. Silence gives your loved one time to think and figure out what they are trying to say.
3. Focus on Feelings, Not Facts
4. Offer Respect and Validation
Try saying, That must be frightening! Would you like me to go check why he is there?
Other bridging phrases are:
- It would be so lovely to do that.
5. Limit Distractions
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Planning For When Your Loved One Does Wander
In case your loved one does wander, its a good idea to have a plan in place.
- Notify neighbors and local police about your loved ones tendency to wander, and circulate your phone number.
- Have your loved one wear an ID bracelet or labels in clothing. Digital devices using GPS technology can track your loved ones location.
- In case a police search becomes necessary, have a recent photo of your loved one and some unwashed clothing to help search-and-rescue dogs.
- In the U.S., sign up for the Alzheimers Associations Medic Alert and Safe Return Program, an identification system to help rescue lost Alzheimers patients.
How to find a missing Alzheimers patient
A person with dementia may not call out for help or answer your calls, even when trapped somewhere, leaving them at risk for dehydration and hypothermia.
Check dangerous areas near the home, such as bodies of water, dense foliage, tunnels, bus stops, and high balconies.
Look within a one-mile radius of where the patient was before wandering.
Look within one hundred feet of a road, as most wanderers start out on roads and remain close by. Especially look carefully into bushes and ditches, as your loved one may have fallen or become trapped.
Search in the direction of the wanderers dominant hand. People usually travel first in their dominant direction.
Investigate familiar places, such as former residences or favorite spots. Often, wandering has a particular destination.
Dont Be Shy Ask For Help
Finally, dont be afraid to ask for assistance. That means getting some respite care. It may be helpful to ask for help at various stages of your caregiving journey. This could be something that a professional such as a therapist or even your doctor can help you with.
There are also many online support groups that you can look into for help.
The bottom line is that while you need to know how to help someone with dementia, you do not have to do it alone. It is important to realize that the longer you wait to do something, the harder it will be. Once you begin to find a solution, the person with dementia will likely be able to feel better and to function properly again.
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Five Tips For Safely Managing Aggressive Behavior In Someone With Alzheimers
Kathleen Allen, LCSW, C-ASWCM
Senior Care Management Services, LLC
- Expert Advice
Learn the possible reasons for aggressive behavior and some helpful tips for managing the immediate situation.
Mr. and Mrs. Sanchez* , currently living in an assisted living facility, are both in their 80s, and have been married for over 60 years. During the last decade, each has had health issues, but they always work hard to maintain their highest level of independence. They each use a walker for balance and safety take daily medications for various conditions and gave up driving without needing too much convincing. They ask very little of their nearby children.
Alzheimers is changing that. Mrs. Sanchezs behavior has changed with her Alzheimers. While the children have watched the behavior changes, especially during the last year, Mr. Sanchez, after becoming fully aware of what was happening, only then revealed other unusual behaviors that his spouse exhibited when the children were not around. Behaviors included screaming at him in the hall of the facility where they live and in the emergency room, or shaking her cane at him It was so out of character for her. Mr. Sanchez would just carry on, letting the emotional storm pass.
Imagine How You Would Feel
Perhaps one or more of those scenarios sound familiar to you. Maybe you’ve seen your loved one or resident look at you warily and then become combative, pushing you away. Looking at it from the other perspective can often help caregivers be more compassionate and understanding of why people with dementia might resist care or become combative.
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Do Not Keep Correcting The Patient
People with dementia do not like it when someone keeps correcting them every time they say something that may not be right. It makes them feel bad about themselves and can make them drift out of the conversation. Discussions should be humorous and light and one should always speak slowly and clearly using simple and short sentences to capture and keep the interest of the dementia patients.
How To Manage The Anger
The key to managing anger issues is to be proactive and look for early signs of aggression, anger, or agitation. Do not assume that these episodes are just a one-time event because if you do not do anything, they can progress and continue to get worse. Here are some tips on what you can do when Alzheimers patients get angry.
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Do Not Try And Alter Undesirable Behavior
Lack of understanding may push one to try and change or stop any undesirable behavior from patients who have dementia. Keep in mind that it is almost impossible to teach new skills or even reason with the patient. Try instead to decrease frequency or intensity of the behavior. For instance, respond to emotion and not the changes in behavior. If a patient insists on always asking about a particular family member reassure them that he or she is safe and healthy as a way of keeping them calm and happy.
Dementia And Agitation: 11 Ways Of Dealing With Agitated Behaviors
Agitation is a catch-all term used to describe excessive movement and speech. Agitation is sometimes but not always aggressive. It is not intended to harm other people. However, agitation is disruptive to care routines and burdensome to patients and caregivers alike.
Agitation is more common in “major” neurocognitive disorders than it is in “minor” neurocognitive disorders. It usualy occurs in the middle stages of dementia, when it is clear that the person who has the disorder is no longer capable of self-care. Agitation may manifest as pacing, masturbation, twirling hair, doodling, wandering, aggressive speech, out-of-character use of profanities or racial slurs, and sometimes physical combativeness.
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Following A Partner Or Carer Around
Dementia makes people feel insecure and anxious. They may “shadow” their partner or carer as they need constant reassurance they’re not alone and they’re safe.
They may also ask for people who died many years ago, or ask to go home without realising they’re in their own home.
- have the person with you if you’re doing chores such as ironing or cooking
- reassure them that they’re safe and secure if they’re asking to go home
- avoid telling them someone died years ago and talk to them about that period in their life instead
Dont Be Afraid To Ask For Alzheimer’s Support
“Knowing how to detect, defuse, and prevent anger is one of the most important skills for Alzheimers care providers, says Larry Meigs, CEO of Visiting Angels. Its one of the skills we value most in our Alzheimers caregivers.
If you find that you need support in handling a loved ones dementia or Alzheimers care, help from an Alzheimers care provider can be invaluable. To discuss your options for professional, in-home Alzheimers care, call your local Visiting Angels office today.
If you are concerned about sudden changes in your loved ones behavior or have questions about caring for your loved one, please also contact your loved ones healthcare provider for information and support.
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Do Not Try To Stop A Person Who Wants To Leave A Room
Staying in one place for long periods may result in behavior problems in the dementia patient. It is essential to have a safe environment where they can enjoy the outdoors without any problem. When someone tries to leave a room, do not force them to stop. Doing this may result in an extreme reaction such as severe distress or injuries.
Instead, it is best to accompany the patient so that they are safe. You can even suggest going for a drive around the block so that they can experience a new environment for a short period. If they do not want company, just let them go but stay close by to make sure that the patient is safe at all times.
Can Cognitive Behavioral Therapy Help
CBT is a specific type of talk therapy that works to help the patient become aware of their thoughts and feelings as well as their physical sensations and how all of these are promoting the negative thoughts and feelings that they are experiencing.
CBT practitioners are specifically trained to help their patients to change these negative thoughts and attitudes into positive ones.
Basically, CBT works to change your outlook from a glass half empty to a glass half full type of thinking. It does not work for everyone but it has been useful for many adults.
About the Author: Esther Kane
Esther Kane is a certified Senior Home Safety Specialist through Age Safe America. She also graduated from Florida International University with a BS in Occupational Therapy. She practiced OT in Florida, Georgia and North Carolina for 10 years. She specialized in rehabilitation for the adult population. Her expertise in home assessments and home safety issues for seniors will help you to make the best possible decisions for your elderly parent or senior that you are caring for.
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