Karen McPhail, RN, MSN
Managing Repetitive Behaviors
“I want to go home!"
"I want to leave this place!"
"I need to leave now!"
"I miss my family...”
These are common phrases heard by family members, caregivers and friends of those with dementia. These repetitive phrases if not addressed and acknowledged will often times lead to and escalate into more difficult situations and anxiety for all involved. There is always a reason for what is being expressed. Understanding the non- verbal and verbal cues of the individual will help in managing their behavior and your understanding of their needs. How can one address these behaviors and help to move things forward in a positive way?
FAACE the issues head on!
The FAACE APPROACH:
Focus on the feeling: They may be feeling lonely, frustrated, bored, scared, anxious, or even excited thinking about home, lost family, or the past. Some aspects of communication and redirection will depend upon what they are reflecting back to… either career, childhood, work, or time as a homemaker or mother. Try to connect and establish the time period and situation then model communication around that area.
Approach: It is all about the approach. The approach makes all the difference and will effect the person. If the person becomes startled by movements, move at a slower pace. If a noise upsets them, reassure and adjust the noise level if possible. Remember your perception will not be theirs perhaps. They will perceive things differently and it is important to understand and adjust things based on their perceptions of reality. Adjust your approach to things when anxiety or behavioral triggers occur.
Acknowledge: Acknowledge all communication even if repetitive, as if ignored, it can lead to anxiety, sadness and frustration. All communication has a purpose in some way. Offer help if the person is asking the same question over and over. Talk about something that sparks a happy thought. Start a meaningful activity such as looking through a photo album or making a craft. Talk in general about the day, tell a story or even sing softly to or with the person while doing tasks. Sometimes the sound of your voice and knowing someone is there can be all it takes to create trust and comfort.
Comfort and reassure: Trust is critical and needs to be frequently reestablished due to cognitive issues. If acceptable give a hug, hold their hand, or give a soft pat or light rub on the back from time to time. Appropriate touch is often times soothing and the key to developing trust and security. Make eye contact to let them know that your listening and understand what they are saying. Reassure the person that you are there for them and that you understand. Sometimes explaining this can make them feel better. You may have to repeat this several times throughout the day to reinforce and remind. Also if they leave the room or you are away from them for some time, they may forget who you are and why you are there. This can be very scary and lead to anxiety. Calmly start from scratch to reestablish the connection / relationship when away from the person and then move forward with connecting and forming their trust again.
Environment: Create and maintain a calm, consistent, structured, environment. This will provide the individual with security, visual cueing, and lessen anxiety. Have a set, basic daily routine. Use soft, relaxed, and gentle tones when speaking. Never rush! Identify triggers for anxiety and issues. Most of the time something will prompt a change or cause behavioral issues to begin. The time of the day, a noise, a change of routine, a change of environment, frustration over wanting to do something that they cannot do, or something else that perhaps causes frustration, fear, anxiety can all trigger behavior issues. Try to avoid triggers when possible and redirect behavior when they occur.
Some approaches to take and try for common repetitive phrases:
"I want to go home, I want to go away, I miss home."
“I understand that you miss your home in ___________, can you tell me more about it?" " I also loved the flowers in the yard, etc" Give them a chance to talk about their home, family, find out more about what home feels like to them, what time period in their life it is, and help them to recreate that positive feeling from the past.
"I miss my daughter, my mom, my husband."
“Tell me about when your daughter was born, our trip to the country, your wedding day, your mom's cooking, the holidays at home.” Let them talk about a favorite memory to spark that positive feeling.
I want to leave... , I need to go."
“Everyone is planning to stay here this afternoon, so you won’t be alone.” “I will be here with you, I am not leaving.” Help them to feel comfortable where they are and make time positive to them and secure.
“Let’s take a walk in the garden, do some crafts, make a project for _______ or prepare a snack for everyone.” Try to redirect the behavior and focus with an activity that they enjoy. Ask them to help you. “ You are such a great worker, wife, daughter or mother; you always take time to help others. Could you help me organize these things? I really need your help. I just cannot seem to do this the way you do”
Ask them to assist in preparing simple aspects of a meal or snack, provide them with different colors of patch squares or papers to sort into piles, have them assist with sorting laundry with you.
Give them a purpose and help them to connect with feeling helpful again. Have them do what they can. Reinforce what they can do or what they do well.
Stay on track and encourage...
Focus and comment on their present abilities and achievements!
“ I know that you can do this, you always do this so well.”
“I really like the way you…..” Keep a positive and interactive focus always! Be realistic with your expectations and be patient. Remember the focus is on them and how they are perceiving things. Connect with them on their level and move forward. This approach will work the best and help you to feel less frustrated at times too.
Source: FAACE Approach to Dementia, McPhail, K, 12/ 2016.
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