Behavioral Problems Among People with Dementia

People with dementia may experience short-term memory impairment, which can cause them to forget things they have recently said or done, leading to repetitive questioning or actions.

Boredom, agitation, anxiety, or a sense of loss of control may also cause repetitive behavior.

Advice for coping

• Distract the person through conversation on a topic that interests them, or engage in a mutual activity, such as board game
• If answering a person’s repetitive questioning provides them with a sense of comfort or reassurance, you can write down the answer and display it in a noticeable and easily accessible location

People with dementia may become dependent on their primary caregivers, usually regardless of whether they are family members or professional nursing staff.

The reasons for dependence stem from lack of confidence, which is a common side effect of dementia, and from a sense of general loss of control.

This behavior can be challenging for you and has a negative impact on their quality of life.

Advice for coping

• Try to keep the person with dementia busy before leaving the house
• Try to align your leaving time with the periods when the person is either in a calmer state or asleep
• It is recommended to consider permanent planned activity options outside the home, such as day centers for the elderly. You can consult with the Welfare Department or any other department taking care of older adults in the local authority of the locality where you reside. You can inquire about the available activity and leisure options

Refusal to Shower  

Typically, people with dementia are reluctant to wash and clean themselves, and many refuse to take a shower or change clothes for various reasons.

Rather than trying to find logic, it is important to determine the underlying cause of their reluctance to shower. The moment you find the reason, you can try and deal with it successfully. Occasionally, you will not be able to do so, and you will have to examine other options until you find the most appropriate and efficient solution for you.

Reasons and solutions 

• Reluctance of nakedness: If the person is reluctant to be naked, you can suggest that they bathe in their underwear and then allow them to wash their private parts independently at the end of the shower
• Refusal to bathe with the help of a stranger: Many times, it is more efficient to allow a person to get help from someone they know well, or at least, a caregiver of the same gender
• Fear of water or from washing the hair: You can help them by purchasing a shower cap for them and assisting them in putting it on. You may also use a small towel to cover their face or head, as long as it does not cause additional anxiety
• If a person believes he or she has already taken a shower: Instead of arguing, try to explain why they need a shower now. You can tell them, for example, that they need to take a shower before going to the clinic
• If the person completely refuses to take a bath: you can bath the person with a sponge and a bowl of water or wet washcloths or baby wipes, outside the bathroom, for example in the living room or the bedroom
• Pleasant bathing: You can try to create a pleasant atmosphere during the bath/shower by incorporating enjoyable elements such as playing music, using body washes that the person likes, and adding calming colors like green and blue to the bathroom
• No pressure: If bathing is stressful for a person with dementia, and you are in a hurry, skip the shower. Bear in mind that you, also, must be as relaxed as possible when you face a difficult task. An additional approach to alleviate stress is to select a bathing time when the person is typically more relaxed or calm, or when they usually prefer to bathe
• Safety: It is suggested to use a washing chair that you place in the shower, handrails, or other aids to prevent slipping
  For further information on safety in the home environment

Wearing inappropriate clothing or refusal to change clothes

A person with dementia may find it difficult to choose or change clothes. Getting dressed relates to cognitive and sensory activity and especially sensory modulation. They may experience discomfort from clothing that is too hot, too cold, scratchy, or otherwise irritating.

Furthermore, they may feel less in control because they lose the sense of time and forget the sequence of actions. Getting undressed may seem a complete loss of control for people with dementia.

Advice for coping

• Suggest a limited number of options for changing clothes. Offer the most convenient and favourite clothes
• Arrange the clothes in sets: shirt with pants, a dress with a matching vest, etc.
• Once the person has removed their dirty clothes, it's recommended to conceal them or place them in the washing machine to prevent the person from putting them on again
• If a person is struggling to reach the toilet in time, it is recommended that you offer them easily changeable clothes in advance, such as pants with an elasticized waistband

A person with dementia may frequently refuse to do something as a means of expressing their wishes, possibly due to the challenges of communicating their experiences effectively. As people with dementia struggle to recall descriptive words, they may find it increasingly challenging to express themselves. This can result in them resorting to refusing to avoid the difficulty of describing what they want or need.

Instead of saying: “give me the glasses on the dresser”, they will say: “that with the glass circles”. As a result, forgetting to provide them with their glasses can lead to a person with dementia refusing to read or watch television, as they may have difficulty communicating their needs.

Advice for coping

• Consider whether the action being refused by the person is essential
• In any case, avoid using commanding or condescending language, or forcing your will on the person you treat
• Check if there are environmental factors that affect the person’s refusals. For example: if the person refuses to eat, check whether their eating environment is convenient for them; if not, find a pleasant and convenient eating environment. It is highly recommended that you sit and eat with them
• Offer dignified assistance while performing a task and try to anticipate all the details. For example, ensure the person has their glasses before reading and help them use designated eating aids, as necessary

What should you do if a person resists medications

Food, drink, and clothing are very important; however, medication may be critical. Therefore, before you seek solutions to get someone to take their medicines, check with their doctor whether their medications are compulsory and whether they are available in liquid form.

Sharing with the doctor about the person's resistance to medications and working together to find solutions is crucial. For example, you can inquire with the doctor about the medication schedule and explore the possibility of adjusting it to a time when the person is more likely to cooperate.

Sometimes people with dementia suffer from hallucinations, therefore they believe they are being poisoned. In such a case, try and explain to them about each medication or schedule a visit to the doctor, who can provide clarity on the purpose and significance of each medication.

Sometimes, individuals may feel ashamed to ask for the location of the restroom or may delay responding to their urge to use the restroom or undress on time. The result may be that they soil their clothes and feel discomfort, both physically (being wet) and emotionally (embarrassed), because they lost control of the sphincters.

Advice for coping

• Find ways to assist the person in navigating the environment, such as providing clear signage for the restroom and ensuring adequate lighting to make the path to the restroom visible at night
• Adapt the clothing choices by selecting garments that are easy to put on and take off, such as pants with an elastic waistband or a dress (for a woman)
• Ensure that the person is taken to the toilet at regular intervals, even if they do not express the need to go
• Consult the healthcare team and consider using adult absorbent products, such as adult underwear and diapers, especially at night

Walking is indeed a healthy activity and part of maintaining a person’s adequate functioning is encouraging them to be independent. However, if a person is experiencing both agitation or wandering behavior, along with disorientation in time and space while walking independently, it may be a dangerous situation.

Wandering behavior can be a sign of pain or physical discomfort when sitting, or boredom.

Advice for coping

• Agitation may arise due to various factors that cause discomfort to the person, as well as due to the progression of dementia. It is important to distinguish between the two. It is important to identify the source of discomfort and eliminate it. Some common causes of discomfort for people with dementia include constipation, urinary retention, pain, hunger, thirst, uncomfortable clothing, or itching.
• Check the reason for wandering: agitation may be caused by a state of fixable discomfort. If the reason is boredom, consider engaging the person in a meaningful and repetitive activity, such as creating art, knitting, singing, dancing, or having a conversation.
• If the reason a person is wandering is a search for the restroom, it is important to provide clear signage directing them to the restroom, remove any obstacles that may impede their movement or cause them to fall, and ensure that the path to the restroom is well-illuminated.
• Consult the doctor regarding drug treatment for agitation. Drug treatment for agitation combined with a behavioral disorder usually includes low-dosage atypical antipsychotic drugs, compatible to the other prescribed medications

When a person leaves the house on their own

• Prevent unsupervised exit from the house by locking the doors, removing the keys, or installing electronic measures that activate an alarm
• Ensure that the person with dementia has a means of communication, such as a phone or a smart watch attached to them, and obviously, simple measures such as notes with important phone numbers (for example, of the primary caregivers)
• Always make sure you have an updated photo of the person with you in case he is getting lost

If a person with dementia is getting lost

• Inform the police immediately
• If a person with dementia goes missing or gets lost, search for them in places, such as their previous residence or places where they grew up
• You can also spread the person's photo on social media or in local WhatsApp groups
• Do not leave a person with a wandering tendency unsupervised. In such situations, it may be necessary to provide care and supervision around the clock

Dementia deterioration may cause people to lose items and to accuse others of stealing them. For that reason, they can also hide objects that are dear to them or wrap them.

Advice for coping

• Place the items which are meaningful for the person in an accessible location. For example: if they have a watch or a ring with sentimental value, place it on the bedside table
• Prepare duplicates of important items, such as keys, glasses, etc.
• If a person becomes distressed while searching for a lost item, you can help in the search while redirecting their attention to other objects. For instance, if you are searching for a watch and come across a night lamp, draw their attention to it
• Arranging the house familiarly for the person may help reduce the phenomenon of searching for lost items. It may also be helpful to lock up valuables in a secure location, such as a safe.
• To be on the safe side, check the garbage cans before throwing away the garbage
• No point in arguing with the person accusing others of stealing. However, to be safe, always check whether items have been stolen from the house

People suffering from dementia may also experience hallucinations, time and place disorientation and impaired judgment. They may perceive visions that are not there or hear nonexistent voices.

This can lead them to engage in conversations with people from their past who have passed away. It is not advisable to correct them as long as these situations are not causing harm to the person or interfering with their ability to function.

Advice for coping

• Check whether the reason is medication or environmental reasons, such as background noises
• Consult the family doctor regarding modification of medication intake
• It is recommended to reduce stimuli such as television background noise, telephone conversation around the person, etc.
• Try to change the atmosphere: play pleasant music, change the lighting, provide some activity

Individuals with dementia may display extreme changes in their sexual behavior, such as a loss of interest in sex or, conversely, an uninhibited, increased interest in sexual activities, including displaying this behavior in public.

Advice for coping

• Check if the reason a person often touches intimate parts of their body is caused by pain, inflammation, or physical discomfort. In addition, during the shower, it is important that you allow the person to wash their intimate parts by themselves
• If excessive sexual behavior embarrasses the environment, it is recommended to distract them and give them some activity to keep them busy. Try to approach the person with dementia in an assertive or humorous manner and gently explain to them that the behavior they are exhibiting is not appropriate
• In extreme cases, medication may be considered in consultation with the medical team

People with dementia are prone to suffer from anxiety and depression. As a result of their mental difficulties, they may also experience appetite loss, weight loss, sleep disorder and changing sleep habits, as well as concern for people who have passed away.

Advice for coping

• It is recommended to consult the family doctor about appropriate drug therapy
• Preserving the person's dignity and autonomy in their daily routine should be prioritized as much as possible
• It is advisable to promote a positive self-image and enhance self-confidence. This can be achieved through various methods, including compliments on their accomplishments and appearance, or individual or group activities
• It is important to avoid criticism or testing the person
• Try making eye contact, using gentle touch, and speaking in a positive manner when interacting with the person
• It is recommended that the person participates in activities that have meaning for them, such as staying connected with friends and family

People with dementia may display passivity and apathy towards society. Sometimes this behavior may last many hours of the day.

Advice for coping

• It is important to consult a doctor to rule out a medical cause, such as inflammatory disease, pain, bowel, or urinary disorders. Confusion due to changes to familiar surroundings, such as after a medical procedure or an acute illness, may also cause passive or apathetic behavior. At this stage, it is essential to diagnose depression
• It is recommended to encourage the person to take part in daily activities according to their personal ability and their preferences.
• It is advisable to maintain a regular and active daily routine, which includes regular activities such as attending an elderly day center. If the person needs assistance in reaching the center, provide the necessary support
• It is important to maintain social connections, taking part in conversations and in social activity