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Dos And Don’ts Of Dealing With Difficult Behaviors In Dementia

Managing Behaviors In Alzheimer'sWhen many people think of someone with Alzheimer’s disease or dementia, they picture a harmless, often confused and incoherent elderly person who repeats themselves.  These would fall under the “pleasantly confused” But, there is a whole spectrum of other types of behaviors associated with the disease that many of us wouldn’t describe as “pleasant!” 

What Are Difficult Behaviors In Dementia And Alzheimer’s Patients

Difficult and challenging behaviors in dementia are those that go beyond “bizzare”  or simply “annoying.”  These are behaviors that will result in harm, that is dangerous and often life threatening.

Difficult and challenging behaviors tend to manifest in those with Mid-to-late stage dementia and Alzheimer’s disease.  Patients and residents often display as a result of what they are experiencing;

  • anger,
  • sadness,
  • paranoia,
  • hallucinations
  • confusion and fear
  • progressive forgetfulness

Sadly, this can result in defiant, aggressive, and sometimes violent speech or actions. It is vital that ALL caregivers become familiar and practice strategies are most effective in dementia behavior management.


The root cause of challenging behaviors in those living with dementia; is tied to the dementia/alzheimer’s patients diminished ability to communicate their needs effectively.

Situation #1: Aggressive Speech And/Or Actions

People with Dementia are more likely to kick, act out and become verbally abusive because they are afraid.  Fear is the defining character of those suffering with the disease.  Often you will hear phrases such as “No!” “Don’t Touch Me!”  “Let Me Out!”  “F&%@ You!” Aggression is usually triggered by something—often physical discomfort, environmental factors such as being in an unfamiliar situation, or even poor communication.

Do: Redirect.  Work on understanding their patterns.  Knowing what triggers the behavior is helpful.  Is there a time of day that difficult behaviors manifest as is the case with Sundowning?

Don’t: Engage them in a fight or tug of war.  Certainly avoid forcibly restraining them, unless they are a danger to themselves and others.

Situation #2: Confusion About Time And Place

Behavior Management In Dementia PatientsTime and place present the greatest challenges to those with Dementia and Alzheimer’s.  Common statements include: “Why am I?” “I Want To Go Home!” What Day Is It?  I Want To See My Son/Daughter!” “No One Comes To Visit Me!”

Alzheimer’s is characterized by the progressive damage to cognitive functioning.  This progressive damage is what leads to confusion and memory loss.  The sudden loss of independence for a Dementia Patient is troubling for them.  Psychologically they want to go back to a place where they have autonomy and control. This type of behavior is most common for those Dementia and Alzheimer persons living in a memory care facility. Remember that Alzheimer’s causes progressive damage to cognitive functioning, and this is what creates the confusion and memory loss.

Don’t try to reason with an agitated Dementia patient.  Refocus their attention.

Situation #3: Unfounded Accusations And Cognition Problems

These often start with the phrase “You Stole My … Money, belongings” Also unexplained hoarding or stockpiling and repetition of statements or tasks.

Do: Listen to their concerns.

Don’t ask questions in the heat of the moment, because these questions make them defensive.   Dementia patients are painfully aware of their diminished cognition and often try to hide it.  They tend to perceive questions as attacks.

Dealing With Difficult Behaviors In Dementia: Dos And Don’ts

  1. Practice separating the disease from the person.  Remind yourself that it is not the person, it is Dementia.
  2. Join them wherever they are in their reality, trying to persuade them otherwise is a major cause of strife.
  3. Remember the 3R’s. Wherever possible, Reframe, Redirect and Refocus.  Persons with dementia are easily distracted.  Use this to help them move on to something else.
  4. Consider Respite Care.  Use respite care whenever you need a break. Caregiver attitude, stress level, fatigue and flexibility play a key role in preventing, managing and reducing difficult behavior.



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