Alzheimer’s Education Event: Coping With Challenging Behaviors

Jule Koch | Oct 10, 2013

On Sept. 25, Caitlin Norwich-Stevenson of the Alzheimer’s Society gave a valuable seminar in Sharbot Lake on coping with the challenging behaviors that are sometimes exhibited by people with Alzheimer’s.

Although Alzheimer’s sufferers may look normal outwardly, dramatic changes and cell death have occurred in their brains. The disease is fatal, though its progression can be from 2 to 20 years (average 7 – 8 years), and people will often die from other causes.

The first thing Caitlin stressed is that all behavior has meaning. What caregivers see as random, irrational and confusing behavior usually has a cause - it can be from emotional or physical, internal or external causes, or is an attempt to communicate. She gave several examples of things that can be irritating to someone with Alzheimer’s, but which caregivers can be unaware of, such as the itching caused by tags on the back of clothes, or the flickering of fluorescent lights.

The person may also be suffering from fear or anxiety caused by something in their past. She told of a man who had been in a concentration camp, who freaked out whenever he saw someone in green scrubs, because that is what camp staff wore. Also, because the person is reverting to things from their youth, even their family can be unaware of the reasons for their behavior. She gave another example of a woman who when she became an adult had completely rejected her ethnicity, so much so that her family was astonished when their mother started to feel a strong need of certain cultural and religious traditions.

As people lose their language skills and ability to communicate, behavior is often the only way left to them to express their preferences and needs. For example, normally adults make their own decisions about eating and showering, but someone who is being cared for doesn’t have those options, and the only way they can express their feelings is by physically refusing to cooperate, which causes extreme frustration for caregivers.

The world of an Alzheimer’s sufferer is very confusing and if anxiety is not dealt with, it escalates into agitation, which can manifest itself as: hiding objects; inappropriate dressing or undressing; repetitive mannerisms or vocalization; or physical aggression, screaming, cursing, or violent outbursts.

Caitlin said that such catastrophic reactions can be anticipated when anxiety, agitation or misperceptions are not relieved. She called these behaviours “responsive” behaviors – meaning that they are in response to something.

The challenge for caregivers is how to respond to these behaviors and Caitlin outlined several strategies:

Caregivers must go slowly, as Alzheimer’s sufferers are surprised by every movement, often despite being told in advance. Redirection – giving the person something to do, eat or drink - is often all that needs to be done to relieve anxiety.

Caregivers need to constantly reassure the person that they are safe and that the caregivers are there to help them. They can also use the “out of sight, out of mind” tactic, such as removing shoes and clothes from view to help prevent wandering, and covering IVs with flesh-colored bandages to prevent patients from tearing them out. One creative approach that was employed by an institution was to cover an exit door with a mural to prevent assaults by patients on the door. Caregivers also need to be flexible – if there is resistance and a test can be run later or questions asked later, then they should wait.

Caregivers should not attempt to argue or drag Alzheimer’s patients back into the “real world”; it is not necessarily better unless the hallucination or delusion is causing the person to harm themselves or others.

Attempts to physically restrain the person should also be avoided unless they are in imminent physical danger, as this can lead to violent outbursts.

Caitlin summarized by stressing that each Alzheimer’s patient has unique physical, emotional and social needs that can only be met by an individualized approach. It is up to caregivers to gather as much information as they can to try to understand the behavior, and to use creative strategies – often by trial and error – to try to meet the person’s needs and calm them down.

It is exhausting and difficult in the extreme to cope with the challenging behaviors caused by Alzheimer’s disease, and caregivers often experience burnout, but the good news is that there are different strategies that can help.

The Alzheimer’s Society runs monthly support groups, in Sharbot Lake on the first Wednesday of each month from 1 to 3 p.m. at the United Church hall, and in Sydenham on the last Thursday of the month, 7-9 p.m. at the Grace Centre. Anyone who needs help in coping with a loved one, friend or family member with Alzheimer’s, please contact Caitlin at 613-544-3078, ext 202; toll free: 1-800-266-7516; This email address is being protected from spambots. You need JavaScript enabled to view it..