Author: Swikruti Kar

Dementia patients often have a “sense of reality” that differs from our own. However, what does this actually mean for the way you treat the individual? Consider this scenario: Alice, the person you are looking after, is trying to find her mother, who passed away a long time ago. In this scenario, before responding you should know.

“Reality Orientation” Reality orientation dementia is often ineffective and might lead to negative emotions such as sadness, anger, or agitation.

“Joining with” Feedback: Joining the person in her reality can be quite beneficial and calming for the person suffering from dementia. A lot of caregivers choose this method.

“Focus on Feelings” Feedback: This is another approach that works well. Listen carefully to how the person feels about what they are saying or doing. For example, why is the woman with dementia looking for her mother? Is she sad, hungry, lonely, or depressed? recognizing the person’s emotions will help you respond to them in a way that fulfills their needs.

Supporting Emotions with Empathy in Dementia Care

When someone exhibits a behavior needing attention, like crying or being upset, the first step is to acknowledge their feelings. For example, say, “You look upset. I’m so sorry. What’s going on?” Recognizing emotions helps people feel understood and valued.

If they share a specific concern, such as losing a purse, take steps to help:

• Ask where they last saw it.

• Retrace their steps together.

• Offer a replacement if possible.

Similarly, if someone is angry, acknowledge it by saying, “You look mad. What’s bothering you?” Listen to their response and try to address the issue. Jumping into redirection, like suggesting unrelated activities, often worsens the situation.

For individuals with dementia or Alzheimer’s, respect their feelings and reality, even if it involves unusual preferences, such as wearing lots of makeup or jewelry. Avoid judgment and focus on making their experience easier.

Ultimately, everyone desires love, understanding, and to be heard. Recognizing this and using those dementia care tips can make challenging moments more manageable.

There are often multiple reasons behind a single behavior. Some common causes of dementia behavior changes include:

• Physical discomfort (such as feeling hungry, cold, tired, sick, or needing to use the toilet)
• Background noise (like a television)
• An unfamiliar or busy place (such as an airport, shopping mall, or crowded restaurant)
• Vision or hearing loss
• Being asked to do something that’s not understood or is too difficult
• Dementia confusion
• Feeling overwhelmed

Health and Comfort: Recognizing Pain in Dementia

Pain is a common yet often overlooked cause of dementia behavior changes, especially in long-term care residents. Up to 80% of nursing home residents experience pain, much of it unaddressed. Since individuals with dementia may struggle to express their pain, it often manifests as:

• Aggressiveness
• Agitation or anxiety
• Facial grimacing or muscle tension

Unmet needs like hunger, thirst, or discomfort (e.g., being too hot or cold) can also lead to behaviors. Emotional pain, such as sadness or fear, may surface through actions like restlessness, vocalizations, or seeking contact for comfort. Addressing physical and emotional needs is important when it comes to managing behavior changes in dementia

Impact of Environment in Dementia

The environment plays an important role in how people with dementia feel and act. If the space is too noisy, bright, or crowded, it can overwhelm them, leading to agitation. On the other hand, if it’s too quiet or boring, they might feel restless or frustrated.

Pay attention to things like:

• Noise levels, lighting, and temperature.
• Whether the room feels too busy or empty.
• Any physical challenges, like slippery floors or confusing layouts.

Creating a balanced, calm space can help reduce stress and make them feel more at ease. This can also help in managing dementia agitation, which can often be triggered by environmental factors.

Frustration in Dementia

Frustration is common in people with dementia because they may want to communicate or do something but can no longer do it. This frustration can stem from:
• Not being able to express themselves.
• Inability to complete tasks.
• A lack of control over their surroundings.

This frustration can lead to agitation, anxiety, or upset, but it’s often not aimed at the person they’re interacting with—it’s about the situation they’re in. Recognizing these dementia behavior changes is key in helping dementia patients with confusion and offering comfort.

End-of-Day Confusion and Fear in Dementia

At the end of the day, many people with dementia experience increased confusion and distress. They use a lot of energy throughout the day to process information, complete tasks, and make sense of their surroundings. By the time the late afternoon arrives, they can feel exhausted, and this leads to a lack of energy to manage their behavior or emotions. This is often referred to as “sundowning.”

A key point to remember with dementia behavior changes is that many individuals are scared. They live in a world that no longer makes sense to them, and they feel uncertain about who to trust. They seek reassurance that they are in the right place and that someone understands their needs. Recognizing these signs of dementia confusion helps in managing their emotional and behavioral challenges.

To truly understand people suffering from dementia and their behavior, you must first get to know them. You need to learn what is typical and what is “out of the ordinary” for them. For example, if they usually enjoy morning walks but start refusing to go outside, this could be a change worth noting.

To connect with dementia patients, spend time with them and talk to their family. Learn about their likes and dislikes, what upsets them, and what comforts them.

Dementia Caregiving Tips

Families can share important information about the person with dementia, no matter where you work. Some of the things you can learn from families include information about: For instance, knowing that the person loved gardening can help you integrate small plants or gardening activities into their routine for comfort and familiarity.

• The person’s childhood
• Brothers and sisters
• Activities they like to do now
• Food preferences
• Pets
• High school
• Hobbies
• Jobs
• Sports
• Travel
• Awards
• Children and grandchildren
• War or trauma experience (such as the loss of a child)

Try This: The next time you are around a family member or friend of someone with dementia, ask them to tell you a few things about one of the topics above. For example, you could say, ‘Can you tell me about their favorite hobby or a memory they often talk about?’ This can help spark a meaningful conversation.

Talk with a family member or friend about the person. Explain that this will help you better care for someone with dementia.

Getting to know the person and building a connection is key to understanding their behavior. By observing their actions closely, you can find behavior clues in dementia that help you understand what they might be thinking or feeling. To learn more about what their actions mean, you need to know how to assess them. This can be tricky when caring for someone with dementia, as behavior analysis for dementia care takes patience and attention. Your job is to watch closely and try to understand what they’re telling you.

Look for Behavior clues that can help you figure out what they’re thinking or feeling and why they’re acting the way they are. Understanding behavior is important for creating a connection, and it’s important to take time to assess the behavior and the situation so you can find the best way to help.

Ask the following questions:

1. Who is the person? Why is she like this? What happens? If you use the CARES® Approach from our program, you will know a lot about the person.

2. What happened before, during, and after the behavior? Before you decide why something happened, make sure you really think about what happened in as much detail as you can.

3. Where? Think about where the behavior occurred. Sometimes places can give you clues, because certain places or areas may trigger certain behavior.
When? What time of day and day of the week did it happen? Is there a clue here?

4. With whom? Who was around the person when the behavior happened? Was a family member or caregiver involved? Other staff members?

After considering these important questions, and considering behavior clues in dementia, you can start to understand why the person acted a certain way. Once you have this understanding, it becomes easier to figure out how to help them.

Understanding Behavior

Dementia changes how people think and understand their surroundings. As time goes on, it becomes harder for them to process and respond to the world around them. This can leave them feeling overwhelmed, confused, or scared. Their emotions and behavior are often ways of communicating how they feel. For example, in dementia communication can be challenging, as people living with dementia might not react well to the care you provide. They may repeat the same question, say unkind things, or become upset. In some cases, they may even hit, bite, or kick. These actions are not intentional or meant to cause harm—they are simply the person’s way of responding to their situation.

Every behavior is a form of communication, and this includes both challenging and positive behaviors. Understanding dementia behavior involves recognizing that while people with dementia may act out in frustration, they are also capable of smiling, laughing, holding your hand, or giving hugs. These are all ways they communicate, too. Taking the time to learn about the people you care for—their history, preferences, and needs—will help you better understand their behavior. It can also give you ideas on how to make them feel more comfortable, less anxious, and more at ease in their environment.

Behavior as Communication

The first thing you have to know is people with dementia aren’t trying to cause problems; they’re struggling to communicate due to their condition. in dementia communication often reflects pain, discomfort, or unmet needs. For example, a sore shoulder might lead to pushing or hitting when they can’t verbalize their pain. Behavior in dementia care should be seen as a form of communication, and it’s important to investigate causes, such as medical issues, environmental factors, or emotional needs. Addressing behavioral triggers in dementia, like overstimulation, loneliness, or boredom, can help alleviate challenges and improve their quality of life.

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