Category: Understanding Behavior as communication

COVID-19 has significantly changed how we provide care, especially for people living with dementia. It’s a tough time for everyone, but the challenges are even more pronounced for those who might already be confused or frightened by the world around them. Even with all the changes, one thing is clear: Dementia care during pandemic requires more attention than ever.

Challenges in Dementia Care During COVID-19

Caring for someone with dementia during the pandemic comes with its own set of challenges. One of the biggest is communication. Wearing a mask, although necessary, can be overwhelming for someone who may not fully understand why it’s required. They might not recognize you behind the mask, and this can make them anxious or upset. The trick here is to keep things familiar. Even though you’re wearing a mask, try to engage with them the same way you always would—calling them by name, speaking in a calm, reassuring voice, and showing kindness through your eyes and body language.

Another major concern is the impact of COVID-19 on dementia care, as lockdowns and restrictions have disrupted routines, making daily activities more difficult for patients and caregivers alike. The effects of isolation have made Dementia care during pandemic even more challenging, requiring caregivers to find new ways to maintain connection and comfort.

Adapting Person-Cantered Care

The CARES® program, which focuses on person-cantered care, offers practical ways to handle situations like this. One simple but effective approach is to gently explain why you’re wearing a mask. It might take a little patience, but letting them know that the mask is for their safety can help calm their worries and make them feel more comfortable.

A key part of Managing dementia patients during COVID-19 is adjusting how we interact with them. Small efforts, like maintaining eye contact and using a familiar tone, can provide a sense of stability even when routines are disrupted. With limited physical contact and changes in daily schedules, Dementia care during pandemic requires even more patience and creativity from caregivers.

Additional Considerations

Another important aspect to consider is their emotional well-being. Some patients may find comfort in staying in their rooms, where they feel safe. Encouraging them to step out, even if it’s just to sit in a chair nearby, can help break the isolation. It’s okay to take small steps and don’t force them to do anything too quickly.

Safe caregiving during the pandemic also means making sure they feel emotionally supported. Something as simple as a comforting routine or familiar music can help in improving patient comfort and easing anxiety. Since Dementia care during pandemic can feel unpredictable, maintaining familiarity in their surroundings and interactions can help reduce stress for both patients and caregivers.

And when it comes to TV, it’s important to be mindful of what’s on. If there’s something distressing happening in the world or something that might trigger anxiety, consider switching to something more calming. The goal is to help them feel as comfortable and secure as possible during these uncertain times. That’s why caregivers must recognize the pandemic effects on daily care and adapt their approach accordingly.

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You are an important part of creating a safe environment for those you care for. Safety isn’t just about physical spaces—it includes emotional well-being and protection from neglect or abuse. The goal is to ensure safety while helping them thrive.

Safety is especially important for individuals with Alzheimer’s or dementia, as they face risks like:

• Falls

• Wandering prevention or getting lost

• Elopement (physically leaving a long-term care facility)

• Medication-related adverse events

• Cooking, appliance, or power equipment problems

• Spoiled food or lack of food

• Getting lost driving

• Financial mismanagement

• Attending medical visits alone

• Difficulty responding to a crisis or an emergency

• Unsafe storage or use of firearms

As a caregiver, observe the person’s environment and behavior regularly for any of these risks. If you spot something concerning, report it to a supervisor or another trusted person. You play a key role in identifying hazards and ensuring the person’s safety.

Safety and Assessment

Assessments help identify safety risks and areas of concern, whether the person is living at home or in a long-term care facility. These evaluations cover various aspects like abilities, home environment, and potential threats to safety. Formal assessments are done by professionals, but caregivers can also contribute valuable observations.

Stay engaged in the assessment process. If you notice issues, communicate with a supervisor or healthcare professional. Your firsthand experience and observations are essential in identifying areas that may need improvement.

Reducing Risks in Dementia

A safety plan is essential for people living with dementia. It plays a key role in Reducing risks in dementia, helping them feel more comfortable and independent. The plan should address areas like wandering prevention, medication management, and kitchen safety.

Work with the healthcare team to develop a safety plan tailored to the person’s needs. Be proactive in adjusting the environment to minimize risks and support their independence as much as possible.

Reducing Risks in Dementia While Supporting Autonomy

Balancing safety with autonomy is crucial. People with dementia should be able to maintain their independence, but safety must always come first. Sometimes, this requires making adjustments to how they live their day-to-day life, ensuring their safety without completely restricting their freedom.

By Reducing risks in dementia, caregivers can foster an environment that allows independence while ensuring safety. For instance, accompanying them during walks or cooking with them can help maintain both their safety and emotional well-being.

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If you have tried everything to understand a person’s behavior but still feel uneasy, elderly abuse in dementia could be the cause.

As Alzheimer’s disease progresses, it impacts thinking abilities, leaving elders with dementia more vulnerable to abuse than those without it. Recognizing elder abuse can be challenging, but certain signs can help you identify it.

Physical and Emotional Abuse

Both physical and emotional abuse can have severe effects on an elder’s well-being. Physical abuse includes actions like hitting, slapping, kicking, pinching, or pushing. It also includes improper use of physical or chemical restraints. Rough handling can cause bruising or skin tears. Physical abuse and emotional abuse can be part of elderly abuse in dementia. Emotional abuse targets an elder’s mental health.

This can include:

• Yelling, name-calling, or bullying

• Isolating or intimidating the elder

• Ignoring or belittling them

In care facilities, even residents can emotionally harm others, so policies should be in place to prevent this.

Sexual Abuse

Sexual abuse is a hard thing to think about. It’s any “non-consensual” sexual contact with an elderly person, whether that’s from a family member, caregiver, staff member, or even another resident. Sexual abuse can include:

• Unwanted touching or groping

• Sexual assault or coercion

• Exposing the elder or taking inappropriate photographs without consent

Any sexual act with an elder who cannot consent due to physical or mental limitations is considered abuse.

Financial Abuse and Exploitation

Financial abuse is when someone unlawfully takes money or property from an elder. This could involve:

• Stealing money or possessions

• Misusing credit cards or bank accounts

Sometimes exploitation expands to such extends that it include scams, such as:

• Phony investment schemes or fraudulent sales

• Overcharging for repairs or services

Financial abuse in dementia care can involve scams, like phony investments or overcharging for services.

Neglect and Abandonment

Neglect is the most common form of elder abuse. It happens when a caregiver fails to provide basic care, such as food, shelter, or medical assistance. It also includes failing to ensure the elder’s hygiene or safety.

Self-neglect occurs when an elder with dementia is unable to care for themselves due to physical or mental limitations, even if they resist help.
Abandonment happens when a caregiver leaves an elder in unsafe situations, such as:

• Deserting them in a hospital or care facility without proper arrangements

• Leaving them in public places or at home without support

Note: Many definitions of elder abuse also cover abandonment. This happens especially in elderly abuse in dementia care, when an elderly person is left behind by someone who is supposed to be caring for them. Examples include leaving an elderly person at a hospital, long-term care facility, shopping center, park, or any public place. If you think someone has been abandoned, you should report it to Adult Protective Services or call 911.

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As you know, dementia leads to confusion and affects how well people can manage things, which then influences their behavior. Since people with dementia can’t adapt to these challenges, it’s up to you to make the changes. By adjusting your approach or modifying the environment, you can more effectively guide or influence the behavior of someone with dementia when needed. Small changes, like simplifying tasks or creating a calmer atmosphere, can make a big difference in how they respond.

Adjusting Your Expectations

Before changing your approach or the environment, take a moment to evaluate the behavior itself. If the behavior isn’t causing harm or posing a safety risk, it might not need to be changed at all. Instead, you may just need to shift your perspective or reconsider what is defined as “appropriate” behavior. Sometimes, creating a supportive environment means being flexible with what you expect from the person. As someone living with Alzheimer’s progresses through the stages of the disease, the care you provide will need to adapt.

• You may need to adjust the care environment to fit their needs.

• You may need to communicate with the person in a different way.

• Focus on the person’s strengths. Even someone in the late stage can be involved in their care in some way.

• Help them continue to be involved with as many daily care activities as possible. This helps bring purpose and meaning to their life.

Creating a Supportive Care Space

Managing behavioral challenges in caregiving often involves small, thoughtful changes. Adapting the care environment to be more supportive can help reduce frustration for both the person with dementia and the caregiver. Making small adjustments, like changing the lighting or minimizing distractions, can create a supportive environment where everyone feels more at ease. This type of care space ensures that the person with dementia has the best chance to thrive, while also making it easier for the caregiver to manage.

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A Person living with dementia may struggle to understand the words you say, but they will understand How you communicate—the tone of your voice, your facial expressions, body language, and overall attitude—has a significant impact on how your message is received. Even if the words are unclear, your feelings and intentions can still be understood.

Understanding Emotional Intelligence in Caregiving

Understanding emotional intelligence is essential when caring for someone living with dementia. It helps you recognize and manage both your emotions and of the person you are caring for, ensuring your communication is more effective and compassionate.

Give Your Full Attention

If you’re a caregiver, focusing solely on tasks like ensuring the person living with dementia has eaten or taken their medicine is not enough. It’s important to provide person centered care.

Consider these options:

• Engage in conversation: Include the person with dementia in meaningful exchanges, even if the dialogue is simple.

• Use non-verbal cues: Smile, make eye contact, and adopt an open posture to communicate warmth and care. The importance of body language in dementia care cannot be overstated as non-verbal cues speak volumes..

• Show patience and empathy: Be understanding and supportive, even if the conversation or activity takes longer than expected..

Avoid distractions like texting or checking your emails during these interactions. When you give your undivided attention, it shows that you value them as a person, not just as someone to care for. Small gestures of connection can make a big difference in creating a sense of comfort and understanding.

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Caring for someone with dementia involves understanding a variety of behaviors, such as repeating phrases, hoarding items, or wandering. These behaviors and others are normal and how people living with dementia communicate. While these behaviors can be challenging, they are not intentional and there are many effective strategies that can be used to respond to them.

Responses to Dementia-Related Behavior

Physical aggression often signals distress. A person may feel scared, confused, or frustrated, expressing these emotions by hitting, biting, or scratching. Since verbal communication can be difficult, these actions should be seen as a cry for help from those displaying challenging behaviors in dementia. Providing reassurance and emotional understanding can help caregivers address the root cause of the behavior.

• Hoarding behavior: Moving or hiding items stems from a desire to keep things safe. Instead of confronting them, caregivers can retrieve items later when the person is distracted.

• Paranoia: Suspicious thoughts, like believing someone is stealing or harming them, are common. Avoid arguing; instead, offer reassurance and redirect their focus.

• Hallucinations: These can range from comforting to frightening. Gently acknowledge their feelings and guide their attention to something calming.

Wandering: A Form of Communication

Wandering is one of the more common challenging behaviors in dementia, often reflecting underlying needs, such as boredom, hunger, or a desire for companionship. It can even provide benefits, such as promoting mobility and reducing restlessness, as long as it’s done safely.

Caregivers should focus on understanding the reasons behind wandering while ensuring safety.
Ask yourself:

• Is the person looking for a friend or family member?

• Do they feel unsafe or insecure?

• Could they need companionship or reassurance?

• Are they restless, bored, or in need of a physical outlet?

• Might they be hungry, thirsty, in pain, or in need of the bathroom?

By considering these possibilities, caregivers can better respond to wandering in a compassionate and helpful way.

Responding with Patience and Understanding

Every behavior is a form of communication. For instance, repetition in dementia or wandering often signals unmet needs or emotions. By recognizing the meaning behind these actions and staying calm, caregivers can create a supportive environment. Nonverbal communication, like a warm smile or gentle touch, can also help convey reassurance and patience.

Focusing on safety, emotional understanding, and providing comfort can transform caregiving into a more positive experience for everyone involved.

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Understanding the Situation

People living with dementia often express a desire to “go home,” even when they are in a place they consider their home. This can be an emotional reaction stemming from feelings of loneliness, confusion, or nostalgia. Reassuring dementia patients during such moments is crucial to providing comfort and security.

Immediate Responses

When a person living with dementia says, “I want to go home,” it’s important to focus on the emotional needs underlying the statement:

• Loneliness or Fear: “I know you miss your beautiful home in the country. Tell me about it.”

• Comfort and Familiarity: “Everyone’s staying here tonight, so you won’t be alone. Let’s go look at your room—it’s very nice.”

For other statements, such as “I’m leaving for work now,” the person might feel anxious or confused about their routine:

• Redirecting with Purpose: “You’re such a good worker. Would you help me organize these papers?” This creates a meaningful task and redirects focus.

Similarly, if a person says, “My purse was stolen,” they may feel scared or upset:

• Offering Reassurance: “Oh no! Let me help you look for it.” Reassuring dementia patients and offering assistance calms their anxiety.

What It Means and How to Respond

In many cases, behaviors like rocking in a chair and saying “Help me” are not necessarily distress signals but comforting, repetitive actions. Understanding emotional reactions and needs is key:

• Sit and Observe: Try sitting down with the person, holding their hand, and gently asking, “How can I help?” Even if they cannot provide an answer, your calm presence may be all they need.

Ultimately, the goal is to connect with the emotional experience behind their words and provide reassurance. Reassuring dementia patients in this way helps create a sense of home, focusing on comfort rather than the physical location.

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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.

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There are often multiple reasons behind a single behavior. Some common causes of dementia related 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. People living with dementia may struggle to express their pain. Pain often manifests as:

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

• Unmet needs like hunger, thirst, or discomfort

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 understanding behavior changes in people living with dementia.

Impact of Environment in Dementia

The environment plays an important role in how people living 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.

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To truly understand people living with 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.

Would you like to earn your certification in CARES® Dementia 5-Step Method?

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