Karen McPhail, RN, BSN, MSN, CCM, CDP
Managing Challenging and Repetitive Dementia Behaviors
Repetitive behaviors can be one of the most frustrating challenges to manage for loved ones of those with dementia. We all understand that this is beyond their control as often times with short term memory loss and other changes they are no longer able to remember recent events, make new memories, or even track their daily actions. Having patience, an understanding of the disease process, and remembering that all behavior is purposeful is truly the key to effectively managing these challenges. Here are some helpful guidelines to assist in moving forward in a positive way! It is time to put on your detective hat as this is what it takes to be effective in assessing and managing these behaviors! Taking a holistic approach is best!
1. Assess their overall condition when repetitive or challenging behaviors emerge. Could they be in pain, hungry, thirsty, uncomfortable, needing to be repositioned, wet, soiled, in uncomfortable clothing, or has a new medication been recently started and this could be a side effect that their medical team needs to know about? Try to assess the root of the change.
2. While assessing tap into their emotions! If they cannot convey things well verbally try to tap into words expressed in fragments or through noises conveyed. Examine their body language, posture, facial expressions to take cues. How do they appear emotionally? Do they seem sad, scared, frustrated, anxious? Are they fidgeting, picking at clothing or exhibiting other behaviors that convey anxiety? All of these aspects bring you closer to forming a plan to move things forward. The goal is to connect at their level and bring the behavior positively forward in a satisfying way for the individual and in a manner that stops the repetitive cycle. Replacing dysfunctional patterns and manifestations of anxiety with functional ones are helpful - for example if fidgeting try adding a fidget apron or blanket. If wanting their cat from years ago try a stuffed animal. Try to ensure that their feelings are acknowledged and brought forward in a way that brings them happiness or resolves their anxiety.
3. How has their day been? Was there a change in their routine of schedule? What is their current environment like? Is it noisy? Do they have a new caregiver? All of these things can make an impact on their behavior. Try to create a safe, calm, and consistent environment and routine to support comfort and security. Having customized daily routine to follow is also helpful and will provide structure and security. Visual cueing throughout is helpful and will help to limit frustration which can lead to behavioral challenges.
4. Consider that they could simply be bored and need some additional attention. Everyone needs and desires purpose. Try involving them at their level in activities within the home such assorting and folding laundry, napkins, ripping lettuce for a salad for dinner, setting the table if able, etc. This will give them purpose by tapping into longer term memory activities and keep them busy and distracted. It is nice to also have some pre made activity boxes and activity lists that can also be pulled out as a diversion when needed. I always recommend that a small, designated area of the home become a simple activity space to house these items and have a table and chairs for use. Having a CD player, echo dot, or other mechanism to play music is also very helpful as rhythm is one aspect that stays intact longer term and can be of great comfort, foster positive therapeutic communication, and bring moments of joy. Consider some other simple interventions such as a walk, a drive, singing a favorite song, playing a simple game, or even giving them a hug. Connecting at their level is the most important part and acknowledging their feelings and outward displays of emotion.
5. Are they ovetired? How are they sleeping? Sleeping issues are common in those with dementia. Consider a an afternoon rest period as they may be taxed cognitively and need break in the afternoon to limit challenging behaviors from emerging in the evening. Consider that a medication adjustment may also be needed.
6. If you are having challenging or repetitive behaviors with a family member at home or in a care community please reach out. Our staff are happy to assist with these aspects and others. We even offer individualized daily routines and programming within the home.
Please reach out at any time as we are here to help! We are happy to share with you a copy of our FAACE approach to dementia and other guidelines to make life easier and happier!