Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
ANGER, AGITATION, AND AGGRESSION As the disease progresses, the person will recognize changes but may not be able to express themselves. They may be embar- rassed and frustrated with toileting and bathing. Stress can impact communication. Make sure that the person does not have access to items that can be dangerous. • Do not take behavior or outbursts personally. • Find a meaningful method of distraction—soft music, taking a walk, or engaging in conversation or a favorite activity can minimize outbursts. • Make sure the patient is not hungry or thirsty, that they are clean and do not need toileting, and that there are not stressful distractions. • Do not engage in physical contact that may exacerbate the situation, as you don’t want the person to feel threatened or violated. • Give the patient time and space to work through their anger in a safe place. Ensure that they are not in danger and then let it run its course—again, this is not personal. REPETITIVE ACTIONS A patient may develop unusual compulsive, repetitive actions. These repetitive actions can be picking something up in their hand, putting it down, and repeating these steps, while mum- bling intelligibly (or unintelligibly). Other repetitive behav- iors include pacing, appearing to be looking for something, emptying tissues from a tissue box, and emptying drawers. If the patient is safe and not engaging in self-harm, perhaps the repetitive behavior can persist. If repetitive behavior becomes distressing, disruptive, or harm- ful, the caregiver can: • Minimize confusion—maintain consistent calm, daily structure; have a “safe space” with familiar items for the person. • Address stress and anxiety—respond with comforting reassurance to defuse the situation; this may need to be repeated. • Attempts at distraction may help, as can familiar music and an activity that is tactile and repetitive. WANDERING At any time, people with AD can wander, if they are mobile. Wandering can be considered a repetitive action, or it may indicate boredom, a desire to find something, or the need to see someone familiar. They may also be thinking they have an appointment and somewhere to go. Planning, preparation, and awareness can minimize wandering. • Avoid stressful, disorientating environments. • Stick to daily routines, minimize changes, and maintain structure.
• Patients lose their sense of time and may wander to work or the grocery store. They can inadvertently attempt to engage in old activities. • Address issues that can cause pain or discomfort. The patient may walk and move for comfort. Recognize signs of pain. • Provide meaningful mental stimulation and exercise, and keep the person engaged. • Maintain minimal noise levels in the home, as loud noises and disruptive sounds can cause anxiety, stress, and the need to move. • Put personal items (keys, wallet, umbrella) in a closet or other storage place. • Lock the doors to the outside and install notification Ring on all doors. HOARDING, HIDING, AND RUMMAGING A person with AD may hoard, hide, or rummage for a sense of control. They may like an item, forget they have it, and hoard more in their personal space. These activities are rooted in confusion and familiar items may provide comfort, control, and security. • As critical thinking skills diminish, the person may not be able to discern items that should be disposed of, thinking throw-away items are important. • A lack of security and/or stimulation may cause the person to find items and hoard them. • The person may forget they’ve stored items in a specific spot, may no longer remember where they’ve placed things, and be unable to recall and communicate. • Rational explanations may only increase stress. To keep the person safe and comfortable, remove only those items that can be harmful. • Recognize there may be an attachment to hoarded or hidden items, and there can be options to “trade” items so that removal is easier. Negotiate with the person; don’t rationalize. • See if the person would donate surplus items to charity, giving them the opportunity to help others. HALLUCINATIONS As sensory processing becomes impaired, the person with AD can experience paranoia and hallucinations, and this should be shared with their physician. Altered senses can cause distorted perceptions. It is important to understand what is causing the hallucination or perception and ensure that the patient is safe. • Collaborate with the physician to identify the cause of the hallucinations and paranoia. Identify any visual cues or shadows in the space.
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