Handling Problem Behaviors Successfully
Caring for clients with Alzheimer’s Disease has its own unique challenges, which – in order for you to be a successful caregiver – you need to prepare yourself for and be able to professionally deal with as they arise.
Overall, when caring for those with Alzheimer’s, you should keep in mind the following Alzheimer’s Disease realities – each of which will have an impact on your caregiving and how successful it is:
You cannot expect the client to improve. They will have their ups and downs but their decline will be ongoing.
You can expect a steady reduction in your clients’ abilities to remember things, think and act appropriately.
You cannot expect your clients with Alzheimer’s to learn effectively, if at all.
What this means, is that you’ll need to repeat your actions over and over again in response to their various problems, needs and behaviors.
This can be frustrating to caregivers, but it is a reality of Alzheimer’s Disease that you need to accept, and effectively deal with.
There is no way to predict how their individual disease will progress.
You will not know, much ahead of time, what type of pattern their disease will follow, or what types of symptoms will be presented.
This means that you will have to be a very versatile caregiver, ready to change your caregiving practices quickly and easily, accepting this as a normal part of your caregiving.
Each client will have their own unique set of problems and challenges as their disease progresses.
A technique that worked well for one client may not work at all for another. This means you have to learn and as you go and make necessary changes in your approach as you learn about the individuality of each of your clients.
Again, this is where your versatility becomes one of your best caregiving assets.
Some Alzheimer’s clients will be easy to care for as they decline, others much more difficult.
For those who are difficult, there are often no proven caregiving techniques that work all the time with these problems.
You can only do the best that you can do, and not always expect that everything will work properly all the time.
This means you’ll need to be a very versatile and resilient caregiver.
Remember that your clients’ problems are due to damage in their brains, which is beyond your control. So do not take their actions personally. Their actions are the result of their disease.
Your compassionate attitude is key. You need to always keep in mind that compassion is extremely important to the welfare of these clients.
More than any others, these clients depend upon their caregivers for support, help with activities of daily living, and help with maintaining a good quality of life. Much research shows that, even though they may not show it, compassionate caregiving does have an extremely positive impact on these clients, often up until the very end of their lives. Your caregiving is very important to these clients, so do it the best that you possibly can.
SOME QUICK TIPS
Learn to be very patient. Patience is a necessity for caregivers working with clients who have Alzheimer’s.
Be very understanding. You’ll need to be very understanding of their disease, and their individual needs.
Be compassionate. Being compassionate is what caregiving is all about, and your clients with Alzheimer’s have a great need for your compassion, every day.
Be a diligent observer. Being a good observer and recording and reporting changes, behavior situations, and so on, can be one of the best things you can do to make your caregiving more effective. It’s these observations that will allow you to learn about your clients, what they need, and what type of caregiving response works best.
In addition, your observations and reporting of changes can be of great assistance in getting the clients the proper medical care that they need. This is especially true for those in the advanced stages of the disease, who often cannot tell you what is wrong and what they need – your observations are one of the most important factors of all in getting them proper care.
Don’t be afraid to ask for help and advice. Everyone caregiving for someone with Alzheimer’s needs help, and often lots of it, many times. Always ask for help whenever you need it, for whatever reason.
Learn as you go. Because Alzheimer’s Disease results in many unexpected changes in behaviors, and with each client being different in how the disease progresses and the response to it, your learning is never over. The more you learn, the better your caregiving will be, and the better you’ll be able to cope effectively with this disease.
Keep your clients on a dependable, regular routine. Change can be very disturbing to those suffering with Alzheimer’s, as they get used to a routine and depend on it to keep stability and understanding in their lives. It can be one of your best caregiving tools in preventing problem behaviors.
Always respond with kindness. No matter what the situation or how disturbing it is, responding with kindness is always the best way to go. Remember that these clients cannot help the way they are, and need your kindness more than ever during troublesome episodes.
Break down activities with your clients into small steps. People with Alzheimer’s cannot process and comprehend large amounts of information, and too much can make them very frustrated. All activities should be done in small steps, with lots of encouragement and suggestions at each step. This includes things like eating, bathing, oral care, dressing and scheduled activities. This is a very important caregiving tool that can help keep a lot of problem behaviors and frustrations from developing.
Keep the environment as calm as possible, according to each client’s needs. Many problem behaviors can be attributed to undue noise and activities – shift changes, TVs that are too loud, unexpected visitors, and so on. Some with Alzheimer's are bothered more by these things than others, which you will learn as you go. But quietness and calm can sometimes work to resolve problem behaviors when all else fails.
Be ready to use favorite distractions at a moment’s notice. Researchers recommend this as one of the most effective tools you have to help resolve problem behaviors. To use these effectively, you need to learn all you can about your clients – their likes, dislikes, hobbies, professional interests, children, grandchildren and so on. Have these areas of interest ready to go in case of any types of problems.
This “distraction chest” will include things like photo albums of them and their family, pictures and books in areas of their hobbies and other interests, favorite objects that they like to hold, favorite music, favorite exercises, and so on. It is worth noting that researchers have found that favorite music is one of the most powerful tools of all, so have music ready ahead of time.
Give them something to hold, such as a favorite stuffed toy. This can often work with many types of problem behaviors, and is quick and easy to do.
Use “Comfort Touch.” This can be something as simple as holding their hand or putting an arm around their shoulders. Many respond very quickly and favorably to this type of caregiving touch. Use it often. One precautionary note: A few of your clients may react badly to being touched, especially when they’re in a state of agitation – you’ll want to avoid it with them until they have calmed down.
Always think of safety. As the disease progresses, safety becomes an extremely important concern.
HELP PREVENT FALLS
Clients in the advancing stages of this disease can get themselves in trouble, and cause themselves serious injury in a hurry. Falls are one of the biggest problems, plus there’s potential injury with objects, food, medicines and so on. Frontline caregivers are the best protection these elders have against serious injury.
Make yourself aware of the procedures you need to follow in order to prevent falls, and keep them from other injurious situations.
COPING WITH AGGRESSIVE BEHAVIOR
Remain calm. Your calm demeanor and soft reassuring voice may well be all that’s needed to calm down the client.
Do not argue.
Talk in a low, soothing voice.
Give reassurances that everything is okay.
Turn off the TV or remove other loud noises.
Try and distract with a favorite activity.
Be a careful observer and see if you can determine a cause. These observations may help you avoid similar situations in the future.
Use preferred bathing methods. Bathing often triggers aggressive outbursts. Much research has shown that these outbursts can be reduced if you allow the client to wash up in the same manner that they did in their younger years, such as preferring a shower instead of a bathtub. If a shower is preferred, use a shower nozzle holder to keep water from spraying over them. Let them have privacy. Play their favorite music.
Think safety. You’ll need to do all you can to prevent injury. Get help immediately if needed for this.
Use distraction. This is where your knowledge of your clients can help you considerably by using the technique of distraction.
Often you can distract them with a favorite activity such as looking at picture books, albums, taking a walk, or listening to their favorite music.
Be gentle and reassuring. Always use a very gentle, reassuring tone of voice, assuring your client that you are there to help and that everything will be okay.
Protect yourself, and others. If the violence is extreme, stay out of range until the client calms down so that you or others do not get injured. Get help immediately, if needed.
WANDERING AND RESTLESSNESS
Wandering is a common problem in those with Alzheimer’s. It can take many forms, including efforts to get outside and go home, or may simply be expressed in excess activity and restlessness inside the facility.
In some cases, researchers believe this is caused by excess energy that builds up in the elders or can be due to frustrations and other problems related to the disease. In other cases, this type of activity may simply be a reflection of things they did in their previous lives – such as taking walks, jogging in the evenings, being very active at their jobs, and that sort of thing – and they are just attempting to return to that type of activity.
In many cases, researchers advise that wandering is not necessarily a bad thing; that it’s okay to let your clients do it, as long as they are not endangering themselves or others.
Try regular exercise. Research has shown that regular exercise can be of significant help in reducing wandering, restlessness and sleeplessness in your clients. Plus, there is some evidence that exercise may improve cognitive behaviors as well.
Also helpful: Giving your client work assignments during the day.
These can include things like dusting, sweeping, carrying trash and that sort of thing. Not only does this supply valuable exercise, but it can make the client feel valuable – just like they did in years past.
If possible, take walks with your client during the day, especially if walking is one of their preferred activities. These walks can be inside or outside if you have plenty of assistance.
Limit the number of naps in the daytime, so they sleep better at night.
Serve their major meal at midday, with only lighter meals in the evening. This can help with sleep.
Limit the amount of drinks that the person has in the evening, to help reduce night-time awakenings to empty their bladder. Make sure the client uses the toilet before going to bed. Also, try limiting the amount of caffeine consumed later in the day, from things like coffee, tea and colas.
Make sure the temperature is satisfactory in the client’s room.
Check for pain. Elders with Alzheimer’s often don’t understand what pain is and wander around in an attempt to walk away from it.
Try music. Much research has shown that playing the elder’s favorite music can help resolve many types of behavioral problems.
Do they need the bathroom? Mayo Clinic researchers report that many cases of wandering are elders looking for a bathroom.
Provide a safe place to wander. Mayo Clinic researchers suggest providing a safe place for your clients to wander, such as a circular trail through a room and so on. Wandering outside can be a very dangerous activity for elders with Alzheimer’s. Camouflage doors that you don’t want them to go through with wallpaper or curtains. Child-proof doorknobs and locks. Use an alarm system.
This can allow them to wander around, get valuable exercise, and satisfy some of their frustrations. Just make sure their path is safe.
Keep the client safe. Make sure they cannot get outside. Consider having your wondering elders wear medical alert bracelets.
SEXUAL BEHAVIOR PROBLEMS
Sexual behavior problems can take several forms, and lead to public embarrassment and other problem situations. This type of problem may be brief or last for a long time, or it may come and go.
Researchers say that this type of behavior, however, is relatively rare in Alzheimer’s elders, but when it occurs, it can be a major challenge for caregivers. There is no consistently effective treatment available for inappropriate sexual behaviors that works for all elders, all the time.
However, you should report such behaviors to the office as there are medications that may help the situation with some elders.
Get advice from others who have had this experience with elders in the past. They may well have some suggestions that can be of help to you. Develop a plan ahead of time for how you will handle the various behaviors if they occur in an inappropriate place. This will keep you as prepared as possible.
Stay calm. Many researchers recommend dealing with these types of behaviors in a calm, matter-of-fact way. And, if it’s not in a public place and no one is being harmed, simply letting them proceed. Remember, this is caused by severe brain damage and loss of thought processes. The elders are not doing it on purpose, and it may well be a regression back to a time when they were children.
Distraction can work well, especially if you can begin the distraction ahead of the inappropriate behavior. This is where your alert observations may become very valuable – if you can learn when such behaviors will occur and get your client distracted ahead of time, you may be able to avoid many of them. Again, these distractions can include exercise, walking, music, looking at picture albums or books, reading stories and so on.
Gently ask them to stop. In some cases, this may work with some elders, but not always.
Special clothing. Use clothing with no fly opening in the front, and that is difficult to remove. Or, put their clothing on backward.
Be compassionate and reassuring. Do not scold your client or make them feel ashamed. Do not be confrontational, as it may only make the situation worse. React with patience and compassion.
Get help immediately, if necessary. Sometimes, in rare instances, the sexual behavior may manifest itself in aggression toward a caregiver or other person. This can be a dangerous situation that needs resolving immediately with extra help, as necessary.
Need a bathroom? Researchers report that frequently these behaviors are caused by elders simply looking for a bathroom.
HALLUCINATIONS AND DELUSIONS
Hallucinations are when an elder sees, hears, smells, tastes or feels something that is not there. Delusions are false beliefs from which the elder cannot be persuaded otherwise.
Do not argue with your client about what they think is happening. To them, the situation looks like it is really happening; they actually think they are seeing or feeling their delusion or hallucination. You cannot convince them otherwise.
Give them lots of gentle reassurance that everything is okay and that they are safe. You can say things like, “Yes, I know it must be frightening, but I’m here with you and you are safe.” Or, “It is sad that your mother has just died. Let me hold your hand and maybe that will help.”
Turn off the TV. Sometimes, loud or violent TV programs can trigger delusions and hallucinations in your clients. You should check for other loud noises as well.
Use distractions. Again, distractions to their favorite activities can often help this situation considerably. Playing their favorite music has also shown to be very effective in some of these cases.
Be very compassionate, kind and understanding at all times. Remember that your client may be very frightened as their situation looks very real and frightening to them. Also, always remember that a major part of your caregiving job is to provide compassionate, understanding care.
That’s why you became a caregiver in the first place.