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Dealing With Dementia Behaviors: Expert Tips for Understanding and Coping

Merritt Whitley
By Merritt WhitleyApril 19, 2021

Anger, confusion, and sadness are a few symptoms a person with dementia may experience regularly. The result of these feelings is a range of unpredictable behaviors including using poor judgment, aggression, mood swings, and repeated questioning or manipulation.

Even though you know your loved one’s dementia behaviors are symptoms of a disease and not intentional, dealing with them is often emotionally and physically challenging. Learn more about typical dementia behaviors in the elderly and expert tips for managing them.

Common dementia behaviors

A person with Alzheimer’s disease or another type of dementia may become irritable and even belligerent without being provoked. They may go in and out of confusion and disorientation or attempt to manipulate those around them. Here are examples of common dementia behaviors and phrases you may hear:

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Aggression

People with dementia may become cruel, lash out, or use combative statements such as “I don’t want to take a shower!” or “I don’t want to eat that!” Sometimes this type of anger may escalate to physical violence. However, it’s important for caregivers and families to keep in mind that this dementia behavior is often the sign of an underlying, unmet need their senior loved one is trying to communicate.

Aggression can be a way of conveying:

  • Physical pain. A person who doesn’t have dementia can go to the dentist for a toothache, or make an appointment with a physical therapist if they’ve pulled a muscle. Individuals who have dementia may not be able to reach out for help—often, aggression is their way of doing so.
  • Emotional pain. Sometimes, agitation can be a sign that someone with dementia feels lonely, depressed, or isolated.
  • Discomfort with a specific task. Does aggression come out specifically at bath time, bedtime, or while your loved one is getting dressed? These tasks may be triggers for aggressive behavior.
  • Reactions to medications. Has your loved one recently changed medications? Do they experience difficulties with medication management? This might be interfering with their dementia diagnosis, leading to aggression.
  • Vision or hearing loss. Issues with vision or hearing can compound the typical disorientation of dementia, causing seniors to act out in confusion or as a cry for help.
  • Agitation at a certain time of day. Oftentimes, hostility can be attributed to sundowner’s syndrome. Does your loved one become aggressive around sunset in particular?
  • Fear. People often react confrontationally when approached or touched by someone they don’t know. For seniors with dementia, who may not recognize caregivers, doctors, and community residents, many daily interactions can alert a “fight or flight” response.

Confusion

Confusion is one of the most common dementia behaviors in the elderly. This could mean saying phrases like:

  • “I want to go home!”
  • “This isn’t my house.”
  • “When are we leaving?”
  • “Why are we here?”

Like many other dementia behaviors, confusion can often be attributed to triggers or root causes. Disorientation can stem from:

  • Problems with wayfinding and changes in the environment. Did your senior loved one just move to a new place? Often, dementia behaviors like aggression peak shortly after an individual with dementia moves to a memory care community, as this can disrupt their routine.
  • Paranoia and hallucinations. Dementia leads to complex changes in the brain, which can result in delusion. Seniors may see things that aren’t really there, develop false beliefs, or become suspicious of caregivers and loved ones.

Poor judgment

Is your loved one neglecting to pay bills, making lavish purchases, or wearing clothes that are inappropriate for the season? These questionable decisions, a common dementia behavior in the elderly, may signal a larger problem with their mental state.

Manipulation

A person with dementia may invent truths to get what they want. They may say things like “You told me I could drive to the store,” or use bargaining methods such as “If you let me drive to the store, I will take my medicine.” Other displays of manipulation include refusing to listen to family members and caregivers or having emotional outbursts.

Tips for dealing with difficult dementia behaviors

Managing dementia behaviors in the elderlymay be difficult, but it’s not impossible. Your words and actions have the power to quickly deescalate intense situations.

Follow some expert do’s and don’ts for calmly and effectively dealing with these four common types of dementia behaviors:

1. How to handle aggressive or combative behavior

“A lot of times, aggression is coming from pure fear,” says Tresa Mariotto, a social services supervisor in Bellingham, Washington, and certified trainer in dementia and mental health. “People with dementia are more likely to hit, kick, or bite in response to feeling helpless or afraid.” Managing aggression can be stressful for both you and your loved one.

DO: 

  • Try to identify the behavior’s cause.
  • Keep your tone light and supportive.
  • Redirect your loved one by involving them in another activity or conversation.
  • Remove your loved one from surroundings or environments that may be overstimulating during an outburst.

“This is where truly knowing your loved one is so important,” says Ann Napoletan, writer at the blog “The Long and Winding Road: An Alzheimer’s Journey and Beyond”. “In my mom’s case, she didn’t like to be fussed over. If she was upset, oftentimes, trying to talk to her and calm her down only served to agitate her more. Likewise, touching her — even to try and hold her hand or gently rub her arm or leg — might result in her taking a swing. The best course of action, in that case, was to walk away and let her have the space she needed.”

Natural reactions to dementia behaviors can be ineffective or make the situation worse.

DON’T: 

  • Physically restrain your loved one unless absolutely necessary.
  • Respond to aggression with similar behavior. For example, yelling at an angry loved one may raise tension and emotions.
  • Approach your loved one from behind, as this can make them fearful or anxious.

2. How to manage repeated questions and confusion

Asking questions over and over again, as well as not being able to understand why things are happening are symptoms and behaviors that come with dementia, according to the American Psychological Association.

DO:

  • Communicate with simple, direct language.
  • Use photos and other tangible items as props to explain situations.
  • Remain calm and supportive.
  • Use tools such as alarms, calendars, and to-do lists to help them remember tasks.

 DON’T:

  • Rely on lengthy explanations and reasoning, as this may further overwhelm your family member.

3. How to help with poor judgment

The deterioration of brain cells caused by Alzheimer’s disease can lead to poor judgment and errors in thinking. Some of these symptoms are obvious and apparent, such as hoarding household items, accusing a family member of stealing, or forgetting how to do routine tasks.

Some signs are more subtle, making it difficult for your aging loved one to realize they’re struggling. “If you’re curious and don’t want to ask, take a look at a heating bill,” suggests Mariotto. “Sometimes payments are delinquent, or bills aren’t being paid at all.”

It’s important to minimize frustration and embarrassment for dementia patients, so know what works for your loved one and incorporate it into your caregiving strategy.

DO: 

  • Listen and offer subtle help.
  • Work together to fix the problem.
  • Simplify a task or routine by breaking it down into smaller steps.

This is what Napoletan did for her mother: “As I sifted through records to complete her tax return, I gently mentioned noticing a couple of overdraft fees and asked if the bank had perhaps made a mistake. As we talked through it, she volunteered that she was having more and more difficulty keeping things straight, and knew she had made some errors. She asked if I would mind helping with the checkbook going forward. I remember her being so relieved after we talked about it.” From there, over time, Napoletan was gradually able to gain more control over her mother’s finances.

DON’T: 

  • Blatantly question your loved one’s ability to handle tasks and decisions. This could further alienate your senior family member.

4. How to deal with manipulation

Your loved one may have lost the ability to distinguish between truth and falsehoods, and they may no longer have a sense of morality around lying. These symptoms can be especially difficult for a caregiver to handle, as it may feel like a complete change in personality. In fact, a person with dementia may not realize they’re lying.

Manipulation is often the root behavior for trust, control, and security. Sometimes, it can even be a cry for help.

DO:

  • Separate the behavior from the person.
  • Set limits when possible.
  • Remain aware of your personal responses. Do you feel angry, hurt, or frustrated? Acting on these emotions can bring more distress to an already stressful situation.

DON’T:

  • Hold dementia behaviors against your loved one.
  • Bring up events to prove or disprove statements.
  • Use accusatory language such as “you’re lying” or “you’re being manipulative.”
  • Engage in heated arguments.

Dealing with dementia behaviors can quickly wear out a caregiver or family member. If you care for a person with dementia and are feeling resentment, anxiety, or depression, don’t hesitate to seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.

Although there are no treatments to stop dementia behaviors in the elderly, there are medications, dementia therapies, and memory care communities that may help.

Sources:

American Psychological Association, Living Well With Dementia.

John Hopkins Medicine, Facing Dementia in the Family.

National Institute on Aging, Alzheimer’s and Hallucinations, Delusions, and Paranoia.

Merritt Whitley
Author
Merritt Whitley

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