Disruptive Behaviors - Dementia Caregiver Web Support
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Disruptive Behaviors

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Problem behaviors, including sudden changes in behavior or disruptive behavior, may cause stress for the person with dementia and the caregiver. Before reading the content on this page, it may be beneficial to review the following video(s) from the Office of Rural Health (ORH).

Understanding the ABC’s of Dementia Behaviors
Length: 14:44 (Link opens new window)
Teri attends a workshop to learn the ABC Model, a method used to eliminate or reduce a behavioral problems in dementia.


 

Changes in Behavior

When Alzheimer’s disrupts memory, language, thinking and reasoning, these effects are referred to as “cognitive symptoms” of the disease. “Behavioral” or “psychiatric” symptoms describe a large group of additional symptoms that may occur to some degree in many individuals with dementia; these symptoms are referred here to as problem behaviors.

Mental health issues like depression or anxiety are common for people with dementia, especially in the early stages of the disease.  Hallucinations, such as seeing or hearing things that aren’t there, paranoia, and other behavioral/ psychiatric symptoms may occur in later dementia stages.  These symptoms, or disruptive behaviors, may be problematic if they make it difficult for the caregiver to provide the care their loved one needs.

Many caregivers find that disruptive behaviors tend to be the most challenging and stressful effects of Alzheimer’s disease, and are often the deciding factor to placing a loved one in residential care.

If you are concerned that your loved one might
be suffering from any of these symptoms,
talk to his or her healthcare provider.

Disruptive Behaviors

Examples of disruptive behaviors may include the following:

Anger/ Aggression/ Combative Behaviors

Paranoia, delusions and hallucinations are common as dementia progresses, and can lead to combative, or self-defending, behaviors

Anxiety/Restlessness

A person with dementia who feels anxious or agitated may become restless, causing a need to move around or pace. They may even become upset in certain places or situations.

Depression

Depression is very common in persons with dementia, especially during the begining stages. Symptoms of depression may include loss of interest in activities, isolation, and trouble concentrating.

Hallucinations

When a person with Alzheimer's disease hallucinates, he/she may see, hear, smell, taste, or feel something that isn't there. Some hallucinations may be frightening, while others may involve visions of people, situations or objects from the past.

Forgetfulness/ Confusion

A person with Alzheimer's disease may not recognize their own family, familiar places or things. He/she may forget the purpose of everyday items, such as a pen or fork. These situations can be difficult for caregivers and the rest of the family.

Repetitive Actions or Words

A person with Alzheimer's disease may do or say something over and over again; they may even pace or undo what has just been done. These actions can be stressful for the caregiver. 

Sleep Issues/ Sundowning

Sundowning is reviewed in depth in the Sleep Issues section

Suspiciousness and Delusions

Memory loss loss and confusion may cause a person with Alzheimer’s to perceive things in unusual ways, making them suspicious of those around them. He or she may accuse loved ones of theft or improper behavior. It is also common for a person with dementia to misinterpret what he/she sees or hears. 

Wandering/ Getting Lost

Wandering, which also poses a serious safety risk in person’s with dementia, is discussed in depth here.

Not every person with dementia will experience the behavioral problems discussed in this section.  If your loved one is experiencing disruptive behaviors, try to identify possible “triggers” causing these behaviors.  If you can identify the “trigger” and change your loved one’s environment, the behaviors may change as well. 

If the caregiver can avoid, or remove, the precursor to the behavior, you can potentially avoid worsening the behavior.

Identifying the Trigger

To help you understand the problem behavior, it may be helpful to review the situation using a three part system, which is discussed in greater detail in the following ORH video:

ABC’s of Dementia Behavior: Scenario #3
Length: 9:42 (Link opens new window)
Teri applies the ABC Model to Frank’s behavior.

A: Antecedent or trigger- What caused the situation to happen? What occured just before the behavior began?
B: Behavior:-How did your loved one respond?
C: Consequence- How did the caregiver/others react? What occured after the behavior?


Putting the ABC (or BCA) system into action

George, a usually pleasant elderly man with mid-staged Alzheimer’s disease, began shouting and pushing his wife as she was helping him get dressed.

1. This first step is to describe the behavior in detail, which is the B in the ‘ABC’ scenario.

What was the Behavior? Agitation, indicated by shouting and pushing his wife

2. The next step is to describe the consequence, all the responses that could occur after the behavior. 

This behavior may make it difficult for the wife to dress and groom her husband, could cause them both frustration, and even threaten her safety.

3. The final step is to determine the antecedent, what comes before the problem behavior, or what triggers the behavior.

Ask yourself these questions: What likely caused George’s outburst? Could he be in pain? Was he overstimulated by his surroundings? Was he angry because his routine was changed or interrupted?


Potential Triggers

Sudden changes in behavior may indicate that your loved one has a medical problem or is experiencing pain. Some of these potential problems may include:

Reactions to new medications

Many medications cause cognitive effects in the elderly, with and without the diagnosis of dementia. Combining certain medications may also cause negative cognitive effects. Always discuss your loved one’s medication list with his/her physician prior to taking new medications. You will find more information about medications to avoid on the Medication Safety page.

Constipation or dehydration

Make sure your loved one is eating a balanced diet, including plenty of fruits and vegetables, and drinking enough water to keep things moving.

Illness, such as urinary tract infection (UTI) and pneumonia, pain or injury

Illness and pain may go hand-in-hand. For example, penumonia can cause chest pain during breathing, which could cause your loved one to act out.

Change in your loved one’s routine or environment

Any change, including travel, having houseguests, hospitalizations, etc., could cause your loved one with dementia to become overly stressed or overstimulated.

Stress or fatigue

As dementia progresses in your loved one, he or she may be unable to recognize that they are getting tired.

Overstimulation or boredom

Loud music, electronics (such as the television or iPad), and loud children may affect your loved one’s senses in a negative way, leading to overstimulation. Overstimulation can cause your loved one to become stress, anxious and agitated. Similarly, a lack of structure can also lead to anxiety and uncertainty. Establishing a routine, taking care to avoid excessive downtime, may help prevent boredom.

Difficulties with communication
    Being unable to communicate your needs or desires can be very stressful for the person with dementia and the caregiver. However, communication is not a one-way street. The caregiver should also consider the way they communicate towards their loved one (verbally and non-verbally). Are you being hasty and unkind? Your loved one may mirror your communication methods.

    If your loved one's behavior suddenly worsens you should
    contact his or her health care provider to evaluate the situation.


    Additional Resources  Collage of photos with pictures representing computers and the

    VA Resources

    US Department of Veterans Affairs
    VA values your commitment as a partner in our pledge to care for those who have "borne the battle." We have several support and service options designed with you in mind. The programs are available both in and out of your home to help you care for yourself and the Veteran you love.

    Geriatrics and Extended Care Services (GEC) is committed to optimizing the health and well-being of Veterans with multiple chronic conditions, life-limiting illness, frailty or disability associated with chronic disease, agining or injury. This VA site reviews information on delirium, dementia and Alzheimer's care, decision making, home and community based services, and advance care planning, among many other important topics that may be important for you as a caregiver.

    Veteran's Crisis Line Phone: 1-800-273-8255 (Veterans Press 1)

    The VA does not endorse the following resources or guarantee that their information is 100% accurate.  However, you may be able to find some helpful information by visiting the following pages:

    Alzheimer's Association
    Alzheimer's and Dementia Caregiver Center: Information and tips on how to deal with difficult behaviors.


    References: Information adapted from Alzheimer’s Association and Office of Rural Health
    If you have any questions or concerns, contact us.