One of the greatest difficulties in caring for someone with dementia are the behavior changes that can – and often do – occur. People living with dementia often behave in ways that can feel incredibly challenging, leaving us as caregivers bewildered and unsure how to respond..

Why do behaviors occur?

Behaviors are typically communication of a need. Dementia can damage the part of the brain that controls the person’s ability to express their needs, wants, discomfort or distress through words. What we see as anger, aggression, etc., is quite often physical, emotional, or environmental distress that the individual is trying to communicate, but is unable to do so.

What we see as anger, aggression, etc., is quite often physical, emotional, or environmental distress that the individual is trying to communicate, but is unable to do so.

How to respond to challenging behaviors

Discover the need.

When a challenging behavior occurs, the first thing you can do as a caregiver is try to discover the possible need, beginning with physical needs. Check for the following:

• Pain
• Illness
• Hunger/thirst
• Restroom needs

Quite often taking the person to the restroom, resolving pain, or giving them a snack/drink will alleviate the distress. If it does not, check for the following environmental needs:

• The individual feels too cold or too hot
• They are wearing clothing or shoes that are too tight, or uncomfortable
• The environment is loud/noisy
• Glares or shadows

People living with dementia have difficulty controlling their emotions or expressing them in a reasonable way and may be experiencing:

• Confusion
• Frustration with a task that feels too complicated
• Lonely/sad
• Fearful or anxious
• Angry or agitated

Behavior Basics

While every individual is unique, there are some basic guiding principles when responding to challenging behaviors.

Approach the individual in a calm, caring manner. Ensure they have seen you and you have connected with them before you touch them or enter their personal space. Touching someone with dementia when they haven’t seen you can startle them and escalate the behavior.

Don’t argue, correct or scold the individual. Remember, the behavior is not intention, it is communication of a need.

Join their reality. People living with dementia can be living in a reality very different than ours. They may be connected to a time frame in their early years. They may believe things that are not happening or see things that are not there. While your natural instinct may be to correct the person and try to drag them back into reality as you know it, it’s much more effective, comforting, and honoring to agree with them and validate their reality. While you don’t have to agree with the content that is being presented to you, you can agree that it is the individual’s truth – and validate their truth.

Agree with the person. Mirror back to them what they are saying. This will reassure the person that they have been heard and someone cares. “Yes, someone took your purse; I’m so sorry that happened” is far more effective than correcting them and saying, “You are imagining things, no one took your purse.”

Discover the need and meet the need. Check for physical, environmental, or emotional causes of distress and make the needed changes to restore the person to a feeling of calm and well-being.

Keep a behavior log. Try to identify possible triggers of behaviors and work towards prevention.

Use person-centered approaches; this means, knowing the person’s preferences, history, likes and dislikes – the things that calm them and the things that cause them distress.

Ways to prevent behaviors.

Although dementia related behaviors can’t be avoided altogether, there are things we can do to significantly lessen the frequency or severity.

Remain calm. Studies have shown that many behaviors could have been avoided by a using a calm, caring, and dementia aware approach. If you find yourself become frustrated, remove yourself from the situation.

Establish a daily routine that includes structured mealtimes, hydration, exercise and rest . By creating structure and predictability for the individual with dementia, you will minimize distress and ensure key needs are being met. Learn how to create a daily routine by clicking here.

Establish a restroom schedule. Guide the individual to the restroom every two hours. Not only will this lessen incontinence episodes – and therefore stress for you as a caregiver, but it will minimize discomfort and anxiety in the individual.

Maintain a calm environment. An environment that is loud or chaotic can quickly trigger a behavior. Learn more about creating a dementia aware environment by clicking here.

Reach out for support. Dementia is a challenging disease, and caregivers need the support of others who understand. Connect with a support group in your area, or a virtual support group. 

By responding with patience, empathy, and understanding, you can help make the journey of caregiving a little easier, both for you and for your loved one. Your care and compassion can make all the difference in their well-being.

Engaging individuals with dementia is one of my favorite topics to discuss. I’ll never forget my first visit to a memory care facility and the profound impact it had on me. Residents were either sleeping in wheelchairs, slumped at tables with their heads resting on their arms, or staring at blank walls. I remember thinking, “There has to be a better way.”

And there is!

Simply placing an individual in front of a television is not real engagement. While it may seem like the easier option, in the long run, it can make caregiving more difficult.

Engagement—helping someone experience a meaningful and purposeful day—is vital for individuals with dementia. There are many reasons why this is so important:

1. Engagement helps maintain function.
Studies show that engagement in activities can help individuals maintain both cognitive and physical abilities for longer periods. The longer someone with dementia can maintain their abilities, the better it is for both them and their caregivers.

2. Engagement reduces challenging behaviors.
Participating in activities can significantly reduce anxiety and stress, which in turn helps manage challenging behaviors. A person with dementia who is engaged in enjoyable and purposeful activities will be less likely to express difficult behaviors. Coupled with a structured routine and a dementia-aware environment, life becomes much easier for everyone involved.

3. Engagement encourages better rest at night.
When someone is engaged and active throughout the day, they are more likely to have a restful night. The body and mind need the stimulation of meaningful activities during the day to encourage quality sleep.

4. Engagement boosts self-esteem.
When someone is involved in activities they enjoy or feel successful doing, they experience a strong sense of accomplishment and well-being. This can help improve their overall mood and self-esteem.

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Types of Activities to Try

1. Physical Exercise
Exercise should be a daily part of life for someone with dementia, and many activities can be adapted for those in wheelchairs. Here are a few ideas:

• Going for a walk
• Chair exercises (YouTube is a great resource)
• Chair dancing or standing dance
• Chair yoga
• Stretching exercises
• Stationary bike (consult a physician)

2. Cognitive Activities
Just as we work our bodies, we should also exercise our brains. Consider these cognitive activities for your loved one:

• Large-print word search
• Simplified crossword puzzles
• Reading the daily newspaper
• Playing checkers or dominoes
• Playing Uno or “War” with large-print cards
• Reading a book or reading aloud together
• Identifying states on a map
• Playing matching games
• Playing “Finish the Phrase”
• Saying prayers or reading the Bible together

3. Outdoor Activities
Being outside can be very stimulating and enjoyable. Try these:

• Gardening or planting flowers
• Going to a park
• Feeding birds
• Raking leaves
• Watching dogs at a dog park
• Sipping a beverage on the porch
• Tossing a ball or playing cornhole/horseshoes

4. Music and Art
Don’t be afraid to try new activities. A daughter once said, “My dad will never paint – he’s not into that.” But I watched as he created a beautiful sunset painting, completely absorbed in the colors. Here are some other ideas:

• Listening to music
• Playing “Name That Tune”
• Attending a virtual music event together
• Singing
• Painting or coloring
• Taking photos together
• Knitting, crocheting, or rolling yarn
• Creating collage art or making cards
• Making jewelry with large beads

5. Sensory and Personal Care
Engaging the senses can be calming and soothing. Here are a few activities to try:

• Smelling essential oils
• Giving hand massages with lotion
• Doing a “mini-makeover”
• Brushing hair or giving a manicure
• Creating a “rummage box” filled with safe items to explore

6. Purposeful Activities
Involving someone in everyday tasks can make them feel useful and needed. Some activities include:

• Baking or cooking together
• Snapping beans or shucking corn
• Setting the table
• Washing or drying dishes
• Folding laundry
• Sorting socks or buttons
• Shelving books
• Clipping coupons

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Best Practices for Engagement

• Use invitations carefully. Instead of asking “Do you want to?” say “It’s time to…” This can make it easier for someone with dementia to understand and participate, rather than defaulting to “no” because they are unsure. Sometimes, simply starting an activity and inviting them to join can be effective.
• Focus on the experience, not perfection. The goal of any activity is not to do something perfectly, but to have a positive experience. Encourage your loved one to try and praise their efforts, never redoing their work in front of them.
• Keep it short. Limit activities to 20-30 minutes, as this is often the ideal length for someone with dementia.
• Be flexible. If an activity doesn’t work, try something else or try again later. What doesn’t work today might work tomorrow.
• Prioritize safety. Know your loved one’s safety needs. For example, someone who puts non-food items in their mouth should not engage in jewelry making or use modeling clay unsupervised.
• Adapt activities to their abilities. Almost any activity can be modified to suit a person’s abilities. For example, when baking cookies:
  • Early stage: Help set out supplies, read the recipe, or measure ingredients.
  • Middle stage: Pour, stir, or roll dough.
  • Late/end stage: Engage the senses by allowing them to smell, touch, or taste the ingredients.

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By incorporating these activities and strategies into daily life, you can provide individuals with dementia a more engaged, meaningful, and fulfilling experience.