Managing Dementia Do's and Don'ts

Anger, confusion, and sadness are a few symptoms a person with dementia may experience regularly. Even though you know your loved one’s dementia behaviors are symptoms of a disease and not intentional, dealing with them is often emotionally and physically challenging. Learn more about typical dementia behaviors and expert tips for managing them.

Common dementia behaviors

A person with Alzheimer’s or another type of dementia may become irritable and even belligerent without being provoked. They may go in and out of confusion and disorientation or attempt to manipulate those around them. Here are examples of common dementia behaviors and phrases you may hear:

Aggression

This behavior includes being mean, lashing out, or using combative statements such as “I don’t want to take a shower!” or “I don’t want to eat that!” Sometimes this type of anger may escalate to physical violence.

Confusion

This could mean saying phrases like:

“I want to go home!”
“This isn’t my house.”
“When are we leaving?”
“Why are we here?”

Paranoia and frequent mood swings also often result from a person with dementia feeling confused.

Poor judgment

This can include unfounded accusations such as “You stole my vacuum cleaner!” Struggling to balance a checkbook or calculate a tip at a restaurant can also be the result of dementia. Other examples include hoarding, stockpiling, and repeating statements and tasks.

Manipulation

This usually involves inventing truths to get what they want. A person with dementia may say things like “You told me I could drive to the store,” or use bargaining methods such as “If you let me drive to the store, I will take my medicine.”

Tips for dealing with dementia and difficult behaviors

Managing dementia behaviors may be difficult, but it’s not impossible. Your words and actions have the power to quickly deescalate intense situations.

Follow some expert do’s and don’ts for calmly and effectively dealing with these four common types of dementia behaviors:

1. How to handle an aggressive or combative loved one

“A lot of times, aggression is coming from pure fear,” says Tresa Mariotto, a social services supervisor in Bellingham, Washington, and certified trainer in dementia and mental health. “People with dementia are more apt to hit, kick, or bite in response to feeling helpless or afraid.”

Do: The key to responding with care to aggression caused by dementia is to try to identify the cause. What is the person feeling to make them behave aggressively?

Are they in pain?
Is their mind just wandering?
Have they been triggered by something?

“This is where truly knowing your loved one is so important,” says Ann Napoletan, writer at blog “The Long and Winding Road: An Alzheimer’s Journey and Beyond”. “In my mom’s case, she didn’t like to be fussed over. If she was upset, often times, trying to talk to her and calm her down only served to agitate her more. Likewise, touching her — even to try and hold her hand or gently rub her arm or leg — might result in her taking a swing. The best course of action, in that case, was to walk away and let her have the space she needed.”

Don’t: “The worst thing you can do is engage in an argument or force the issue that’s creating the aggression,” Napoletan says. “Don’t try to forcibly restrain the person unless there is absolutely no choice.”

2. How to manage repeated questions and confusion

Do: When your aging loved one is confused about where they are or what’s happening, try these tips from the American Psychological Association:

Communicate with simple explanations
Use photos and other tangible items to help explain situations
Remain calm and supportive, and don’t take their confusion personally
Use tools such as alarms, calendars, and to-do lists to help them remember tasks

Don’t: Lengthy explanations don’t work. “You have to figure out what’s going to make the person feel the safest,” says Mariotto. “Even if that ends up being a therapeutic lie. You can’t reason with someone who has Alzheimer’s or dementia. It just can’t be done. A lot of times, we’re triggering the response we’re getting because of the questions we’re asking.”

3. How to help with poor judgment

The deterioration of brain cells caused by Alzheimer’s disease leads to poor judgment and errors in thinking. Some of these symptoms are obvious and apparent such as hoarding household items, accusing a family member of stealing, or forgetting how to do routine tasks. These tasks can include balancing a checkbook or paying bills on time.

Some signs are more subtle, making it difficult for your aging loved one to realize they’re struggling. “If you’re curious and don’t want to ask, take a look at a heating bill,” suggests Mariotto. “Sometimes payments are delinquent, or bills aren’t being paid at all.”

Do: A caregiver can often minimize frustration and embarrassment for dementia patients by:

Listening and offering subtle help
Working together to fix a problem
Simplifying a task or routine by breaking it down into smaller steps

This is what Napoletan did for her mother: “As I sifted through records to complete her tax return, I gently mentioned noticing a couple of overdraft fees and asked if the bank had perhaps made a mistake. As we talked through it, she volunteered that she was having more and more difficulty keeping things straight, and knew she had made some errors. She asked if I would mind helping with the checkbook going forward. I remember her being so relieved after we talked about it.” From there, over time, Napoletan was gradually able to gain more control over her mother’s finances.

Don’t: Blatantly questioning the person’s ability to take care of the situation at hand or arguing with them isn’t helpful. You may risk alienating them. “Any response that can be interpreted as accusatory or doubting the person’s ability to handle their own affairs only serves to anger and put them on the defensive,” says Napoletan.

4. How to deal with attempts at manipulation

Your loved one may have lost the ability to distinguish between truth and falsehoods, and they may no longer have a sense of morality around lying. These symptoms can be especially difficult for a caregiver to handle as it may feel like a complete change in personality. In fact, a person with dementia may not realize they’re lying.

Manipulation is often the root behavior for trust, control, and security, according to Understanding Difficult Behavior, a guide by Maine’s bureau of mental health. Manipulative behavior can be used to fulfill one of these needs, and sometimes it’s a cry for help.

Do you notice certain situations trigger this behavior? If so, try to identify the person’s need and work together to find a solution. Perhaps the trigger is driving. If your loved one wants to drive but isn’t able to, try to find other ways to make them feel independent.

Do:

Separate the behavior from the person, and do not hold it against them
Set limits when possible, communicate expectations clearly, and work together to find a resolution when you’re able to
Remain aware of your own personal responses. Do you feel angry, hurt, or frustrated? If so, do you act on these emotions around your aging family member? Acting on these emotions can bring more distress to an already stressful situation

Don’t:

Bring up events to prove or disprove statements
Use accusatory language such as “you’re lying” or “you’re being manipulative”
Engage in heated arguments

Dealing with dementia behaviors can quickly wear out a caregiver or family member. If you care for a person with dementia and are feeling resentment, anxiety, or depression, don’t hesitate to seek help. A caregiver support group, counselor, friend, or family member can offer support and advice.