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As many as 90 percent of people who have dementia behave in ways that challenge or worry their caregivers. For example, a person who has dementia may become agitated or aggressive. Or, they may wander off and get lost in their confusion or during a bout of sleeplessness. These troubling dementia behaviors test caregivers to the core.
If this sounds familiar, know that “you are not alone,” says Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi. Behaviors like aggression, confusion, sleep problems, and wandering are common, but they can be managed, Hashmi says.
Read on to learn more about these common dementia behaviors in the elderly and to get Hashmi’s advice on how best to handle them as a caregiver — for your sake as much as that of your loved one.
Memory loss and confusion become more common as dementia progresses.
Memory loss can lead to confusion and confusion often manifests as a senior asking the same questions over and over, not recognizing formerly familiar people or places, or becoming disoriented. Caregivers who spend many hours with their loved one may hear phrases and answer questions on repeat: “I want to go home!” “This isn’t my house.” “When are we leaving?” “Why are we here?”
Like many dementia behaviors, confusion can have a number of triggers or root causes. Factors that may contribute to disorientation include the following:
“Simplification is key here,” Hashmi says. To help minimize confusion, he suggests several ways to simplify both the home environment and your interactions:
Deliberately use simple, short sentences and ask yes/no questions.
Lastly, Hashmi says, it helps if you can learn to accept the confusion. In the moment, he says, whatever your loved one thinks is real is in fact their reality. For example, they might think they’re at work when they’re really at home. If that belief isn’t hurting them or anyone else, it’s OK for you to play along a little bit. Confronting or trying to change the belief often leads to agitation and aggression.
“For us as caregivers, we have to be OK with that confusion,” Hashmi says.
Verbal threats and physical aggression can be among the more serious of the dementia behaviors. These verbal or physical outbursts may occur seemingly out of nowhere. They tend to happen in the latter stage of dementia, when patients can’t communicate their needs.
One study found that more than a third of caregivers reported abuse from a patient in the three months prior.
“I hear very palpably how upsetting that is, how distraught they feel,” Hashmi says of caregivers. “They are trying to make sense of it — ‘Why me? I’m the one who’s here for you? Why are you angry at me? I’m trying to help.’”
Aggression can stem from:
Most importantly, try not to take the aggressive behavior personally, Hashmi says.
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“The classic line I always use is that this is the disease talking. It is not the person,” Hashmi says. “There is a lack of awareness in that moment. It’s not your mom or dad or spouse saying that. It’s the disease.”
When you are faced with a loved one’s aggression, Hashmi suggests employing these 4 Rs:
When they’re feeling calmer, Hashmi says, you can try asking yes/no questions to help determine whether an unmet need is causing the behavior. Ask: Are you hungry? Are you thirsty? Are you in pain? Are you tired?
While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.
Common sleep issues may include:
Sleep disturbances are hard on patients and caregivers alike, Hashmi says. “It’s physically and mentally exhausting to be up night after night.”
Troubled sleep is thought to be a dementia risk factor as well as a behavioral symptom. Here are some factors that may contribute to your loved one’s sleep problems:
There are ways to help your loved on get a better night’s sleep, Hashmi says.
Avoid things that disrupt sleep.
Create a routine that supports sleep.
Sixty percent of people who have dementia will wander. As their memory declines, they might leave a confusing situation or suddenly try to find someone and become disoriented and lost.
Such wandering can be dangerous, even life-threatening, yet caregivers often feel guilty for putting in place measures that will keep their loved one safe. The classic quandary that caregivers express is: “I don’t want my mom or dad or spouse to be a prisoner in their own home, and yet this is what I feel I’m doing,” Hashmi says.
The No. 1 priority is to keep your loved one safe, Hashmi says. He suggests the following actions:
In addition to aggression, confusion, sleep problems and wandering, symptoms of dementia can also include delusions, hallucinations, paranoia, depression, apathy and sexual inappropriateness. And, behavioral dementia symptoms tend to occur more frequently as the dementia progresses.
Up to 90% of patients have one or more of these symptoms during the course of their disease, studies show. It is important to discuss all dementia symptoms with your loved one’s physician to rule out or treat any medical conditions that could be causing the behavior.
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Dealing with dementia behaviors can quickly wear out a caregiver or family member, causing caregiver burnout.
If your loved one’s dementia behaviors have progressed to the point where you cannot manage them alone, help is available. Senior care options like home care or memory care can help relieve some of the caregiving burden while also helping to keep your loved one safe.
If you are feeling resentment, anxiety, or depression, seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.
“Other families, other caregivers, are going through the same thing,” Hashmi says. “They have a lot of common challenges and common solutions to share. And often those are the most effective, because they’re going through exactly the same process.”
This article was developed in conversation with Ardeshir Hashmi, MD, section chief of the Cleveland Clinic’s Center for Geriatric Medicine, as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.
Alzheimer’s Association. “Dementia-related behaviors.”
American Psychological Association. “Living Well With Dementia.”
Johns Hopkins Medicine. “Facing Dementia in the Family.”
National Institute on Aging. “Alzheimer’s and Hallucinations, Delusions, and Paranoia.”
UpToDate. “Management of neuropsychiatric symptoms of dementia”
UpToDate. “Sleep-wake disturbances and sleep disorders in patients with dementia”
UpToDate. “Recognition and management of behavioral disturbances in dementia”
UpToDate. “Safety and societal issues related to dementia”
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