How to Keep Patients Safe and Caregivers Sane

by Luciana Mitzkun Weston

Part two: Preventing Difficult Behaviors

Dementia creates a highly disorienting feeling. Patients often feel confused regarding date, place, time, and what actions others expect of them. Consequently, they have an elevated risk for anxiety, frustration, and agitation, which are feelings that often manifest in form of difficult behaviors.

We cannot predict which patients will present difficult behaviors and exactly what behaviors will there be. However, it is safe to assume that without the implementation of supportive strategies every dementia patient is at risk of presenting difficult behaviors. Studies indicate that as many as 8 in 10 dementia patients do develop behavioral symptoms that interfere with their care and their own safety. Therefore, all caregivers are advised to adopt preventative strategies starting at early stages of neurodegenerative conditions.

There are several supportive strategies that can be utilized to help prevent the development of difficult behaviors. Which strategies are most effective for a particular patient clearly depends on who the patient is. Dementia affects each one of us differently, and we all face the condition armed with our own individual set of abilities and strengths. Everyone of us is unique. We have unique interests, history, desires, connections, and memories. The adoption of supportive strategies must take in consideration the patient’s individual needs.

Basically, the goal is preventing your loved one from becoming confused while allowing him to engage in activities that can be accomplished within his current abilities. In other words, keeping the patient in the zone: above from boredom and below over stimulation.

When considering a care plan, make sure to include those supportive strategies that are compatible with your loved one’s lifestyle and personality, always trying to integrate personal interests, likes and dislikes. The more preventive strategies you adopt, the better equipped the patient will be to combat the disorienting symptoms of dementia.

Here are some possible strategies used to prevent future difficult behaviors:

• Establish a routine schedule: Waking up, eating meals, enjoying activities, having nap breaks, and retiring to bed at the same time every day can greatly minimize confusion and provide the patient with a sense of security and wellbeing. Meals served at regular times anchor the day, and even patients who have their circadian rhythm disrupted will benefit from a stable, consistent meal schedule.
• Simplify all rituals: From personal hygiene and grooming to all other activities of daily living, simplify as much as you can. For patients with dementia, less is more: fewer options present a lesser challenge than having a big array of choices demanding decision making. Keeping this in mind, make his favorite items available, and avoid presenting a large variety of options. One shampoo on the shelf will indicate its use better that having four or five different bottles to chose from. A table setting with salt and pepper will be less confusing than one with a caddy offering a wide variety of condiments. In the same fashion, a wardrobe with fewer options is more functional than one with multiple possible combinations of garments and choices.
• Declutter the home: Clutter creates an insurmountable challenge for a person affected with dementia. It not only makes organizing impossible, but also presents an additional hazard to those who have a compromised sense of perception. Clutter creates confusion and increases the risk of falls. Make sure rooms are neat and devoid of clutter, passageways are unobstructed, and counters are clear. It is also useful to illuminate dark spots and install motion lights in corridors, bathrooms, and kitchen.
• Provide opportunities for physical exercise: Whether it be a walk around the block or a session with a personal trainer at the gym, exercise is essential to promote wellbeing and cognitive health. It is also the best way to prevent falls. Make sure your loved one has plenty of opportunities to exercise within his abilities, and that an exercise regimen is included in his daily routine.
• Allow for access to nature: Whether it is a walk in the woods or sitting in a garden, being in nature is soothing and lowers stress and anxiety. Patients who have access to nature settings are less prone to develop anxiety and are less likely to need psychotropic medications.
• Use music to support activities: A musical background that is complementary to the activity at hand promotes concentration and helps patients to stay in the zone. This principle can be used by selecting a soothing classical piece to play during meals or by playing a more upbeat modern melody during exercise. Just keep in mind that personal preferences must be observed when selecting a musical background: play songs that HE likes.
• Install a white message board: Using a white message board to leave messages and reminders for your loved one is the best way of enhancing communications and avoiding confusion. Use it to keep him informed of the events of the day, such as “2 pm: visit w/Dr. Thomas,” or leave short messages such as “I’m getting a haircut, be back at 11 am.” Only write information that is relevant to the present day and instruct your loved one to read it frequently. The board will become a great tool in avoiding confusion even as dementia progresses.
• Check your own body language: Dementia patients do not respond well to reasoning and explaining. However, they are experts in reading body language. Make sure your body language is free of reproach and conveying a message of friendliness. Smile a lot. Moderate your tone of voice. Address him with affection and understanding. If you allow fatigue or frustration to modulate your actions, your loved one will pick up on it and react accordingly, even if he does not know what is motivating you. And you won’t be able to explain to him why you are feeling in such ways. Avoid reflexive negative actions by controlling your own body language around him. Look for ways of taking respite breaks if you feel it is becoming hard to control your own frustration.

There are many other therapeutic strategies that could be considered as preventatives for difficult behaviors. A dementia expert could help you identify other more individualized ways of caring for your loved one.

Start identifying and implementing preventative strategies in the early stages of the disease: do not wait for behaviors to appear. The more successful you are in keeping your loved one from becoming confused and disoriented the less problems with difficult behaviors you will have as the disease progresses.

Part I: Identifying Difficult Behaviors

Coming soon:
Part III: Treating Difficult Behaviors