Behaviors of persons living with mid- and late-stage dementia

The reality of persons living with dementia can cause challenging behavior.

As dementia progresses, your loved one’s perception of reality will change. S/he may no longer recognize his/her closest friends and relatives. S/he can suddenly have an urge to visit a friend who passed away long ago. The person may overestimate his/her physical ability and want to pick up a weight that is too heavy or attempt to get out of the wheelchair without the cane that would keep him/her from falling. 

David Petherbridge talks about his feelings when his wife could not recognize friends and family anymore.

As a caregiver, you need always to show that you respect your loved one even when they are clearly asking for something that is unrealistic and even when what they want to do is not safe. If you can enter their reality with an excuse or a distraction, you may avert a confrontation. 

Marilyn tells how she came to accept that her mother’s dementia was advancing to the point that Marilyn’s mom did not remember the death of her spouse (Marilyn’s father) decades earlier.

Here are five tips1 that can be helpful in redirecting your loved one to a safer place. 

  1. Stay calm and radiate confidence. Do not argue with them—logic does not work. Though your first reaction may be to panic, count to ten. Smile. Make eye contact. If it is appropriate, put your arm around your loved one.
  2. Assess the situation. Is there a trigger for their behavior? Talk about it—find out what is going on. Are they bored, upset, or reacting to something real or imagined? Offer to help: “Dad, can I get you something?”
  3. Enter their reality. Divert them from actions that are inappropriate or unsafe by offering an alternative. “We should feed the cat,” or “I wonder if the mail has come,” or “We should find a picture of Grandpa.”
  4. Move to another room; express an idea: “I know! It is a nice day; we should go for a walk!” Offer a snack: “I wonder if there are any grapes left from lunch. Take a look!”
  5. The more engaged your loved one is in whatever they are doing, the less likely it is that they will lapse into inappropriate behavior. 

Finally, keep your sense of humor. Pull out your Joy Plan. If you can find a way to laugh with your loved one, you may get past a difficult moment.