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Ideas for dealing with difficult behaviors

Ideas for dealing with difficult behaviors

Sundown syndrome. Many patients with AD are more agitated, confused, or restless in the late afternoon or early evening. Research shows the following things help:
• Leave lights on and shut out the darkness by closing blinds and shades.
• Provide more activity earlier in the day. This will use up energy, reducing stress.
• Schedule essential activities and appointments early in the day.
• Encourage an afternoon nap every day. This reduces fatigue and agitation.
• Play classical music on a portable radio or music player through headphones or earpieces. This shuts out disturbing noises and soothes the patient.
• Warm, relaxing baths, foot soaks, or massages may help.
• Reduce activity and distractions toward the end of the day.
• Discourage evening visits and outings.
• Avoid overstimulation. Turn off the television or radio before speaking to a patient.
• Keep the patient well hydrated by offering plenty of water throughout the day.

Hiding, hoarding, and rummaging. These common problems can be disturbing to caregivers and to others, the AD patient lives with. Try the following strategies:
• Lock doors and closets.
• Put a sign that says “No” on places you want to keep the person out of, such as certain rooms, closets, or drawers.
• Watch for patterns. If a patient keeps taking the same thing, give him one of his own.
• Don’t leave things lying around in the open; put things away neatly.
• Make duplicates of important items like keys and eyeglasses.
• Keep the person’s closet open so she can see her things in plain view. When the patient can see at all times that she still has her everyday items, she may not feel the need to go looking for them.
• Designate an easily reached drawer as a rummage drawer. Fill it with interesting, harmless items like old keys on chains, trinkets, or plastic kitchen implements. Allow the patient to rummage freely in this drawer.
• Look through waste cans when something is lost and before emptying them.
• Patients with AD tend to have favorite hiding places for things. Look for patterns.

Most behaviors have a reason. Look for the reason for the behavior before responding.

Repetition. A person with AD can become fixated on a task and repeat it over and over without stopping. Pacing, turning lights on and off, or washing hands repeatedly are examples of this. As long as the activity isn’t dangerous, there is nothing wrong with letting the person continue doing it. When the time comes that the patient must be asked to stop, try these tips:
• Say “stop,” firmly but quietly.
• Touch the person gently.
• Lead the person by the arm away from the activity.
• Point out something distracting.
• Say, “Thank you for folding all those towels. Now let’s go to dinner.”

Confusion. Don’t try to enter the person’s world by pretending to see or hear the things he seems to see or hear. Help the person stay grounded in reality by patiently using some of the following techniques:
• Ask questions with yes/no answers.
• Make positive statements that let the person know what you want. For example, say “stand still” instead of “don’t move.”
• Give the person a limited number of choices.
• Lay out clothes in advance. Keep the wardrobe simple, and try the following things:
–– Avoid buttons and zippers if possible
–– Use Velcro fastenings and elastic waistbands
–– Limit the number of colors in the wardrobe
–– Eliminate accessories
• Use memory aids, such as posting a list of the daily routine or putting up a large calendar and clock.
Other aids include:
–– Put name tags on important objects.
–– Use pictures to communicate if the person doesn’t understand words.
–– Make memory books with pictures of important people and places.
–– Post reminders about chores or safety measures.
–– Put a sign that says “No” on things the person shouldn’t touch.
–– Paint the bathroom door a bright color, and put a brightly colored seat cover on the toilet. These will remind the person where to go.
• Give simple, precise instructions. Reduce distractions during a task. Give only as much guidance as necessary.
• Say the person’s name and make eye contact to get his attention before touching him.
• Reassure the person if needed, but don’t needlessly distract a patient who is doing a task.
• Each step of a process should be handled as a separate task. Instead of saying, “It’s time for your bath,” say, “Take off your shoes. That’s good. Now take off your socks.”
• Allow plenty of time for every task.
• If the person can’t complete a task, praise her for what she has accomplished and thank her for helping you.

Wandering. First, find out if the patient needs something. Look for patterns in the wandering and possible reasons, such as time of day, hunger, thirst, boredom, restlessness, need to go to the bathroom, medication side effects, overstimulation, or looking for a lost item. Perhaps the patient is lost or has forgotten how to get somewhere. Help meet the patient’s needs and keep him safe by trying the following things:
• Remind the patient to use the bathroom every two hours.
• Have healthy snacks and a pitcher of water readily available.
• Provide a quiet environment away from the noise, distraction, and glaring light.
• Provide a purposeful activity such as folding clothes or dusting.
• Provide an outlet such as a walk, a social activity, a memory book, or classical music played through headphones.
• Give the patient a stuffed animal to cuddle with.
• Keep lights on at night.
• Try using different shoes on the person. Some people wander when they are wearing shoes but not when they are wearing slippers.
• Use alarms, bells, or motion sensors. Bed alarms are flat strips laid under the sheets that sound when the person gets up. Outside doors should have bells or alarms that sound when opened. Motion sensors can be used in hallways.
• If the patient is in a home or agency with stairs, porches, or decks, child safety gates should be used to block these. Two gates can be used for height.
• Use child-resistant locks on doors and windows.
• Put a black mat on the ground in front of the outside doors, or paint the porch black. Patients with AD often will not step into or over a black area.
• If possible, the person should carry or wear some form of identification, such as an ID bracelet that looks like jewelry but is engraved with the person’s name, address, and phone number.
• Educate neighbors on what to do if they find a wandering patient.
• Call the police if an AD patient wanders away.

Aggression and agitation. First be sure that the person is not ill or in physical pain, such as from an infection or injury. Then try the following suggestions:
• Maintain a calm environment.
• Reduce triggers such as noise, glare, television, or too many tasks.
• Check for hunger, thirst, or a full bladder.
• Make calm, positive, reassuring statements. Use soothing words.
• Change the subject or redirect the person’s attention.
• Give the person a choice between two options.
• Don’t argue, raise your voice, restrain, criticize, demand, or make sudden movements.
• Don’t take it personally if the person accuses or insults you.
• Say, “I’m sorry you are upset; I will stay until you feel better.” Don’t say, “I’m not trying to hurt you.”
• Encourage calming activities that have a purpose. Sorting and folding laundry, dusting, polishing, vacuuming, watering plants, and other quiet, repetitive tasks can be soothing.

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