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5 Easy Strategies To Cope With Challenging Dementia Behaviors

Have you ever wondered how to handle challenging behaviors in your loved one with dementia?

Today’s episode offers practical strategies to help.

Understanding "Challenging Behaviors"

The term "challenging behaviors" often refers to normal human behaviors magnified by dementia. Instead of seeing these behaviors as problematic, understand them as expressions of unmet needs or frustrations due to limited communication abilities.

This perspective shift is crucial for compassionate caregiving.

Strategy 1: Stay Calm and Be Patient

Patience is vital. Proverbs 15:1 says, "A gentle answer turns away wrath." When faced with a difficult behavior, count to ten and take deep breaths. Remind yourself that your loved one is not acting out intentionally.

This patience helps you respond more thoughtfully and calmly, which can de-escalate situations.

Strategy 2: Redirect and Distract

Gently steer your loved one’s attention away from problematic behaviors. Think of it like slowly turning a large ship. Ask questions about their thoughts or feelings to engage them.

For example, if they insist on leaving the house, ask about their home and loved ones. This gentle redirection can shift their focus without causing frustration.

Strategy 3: Understand and Address Root Causes

Behavior often signals unmet needs. Use the PEACE framework:

Person: What’s going on with them?

Environment: Is something in their surroundings affecting them?

Activities: Are they bored or overstimulated?

Caregiver: How might your actions influence their behavior?

Evaluate each factor to find and address the root cause of their behavior.

Strategy 4: Use Simple and Clear Communication

Dementia affects processing abilities. Use short, clear instructions and give them time to respond. Break tasks into simple steps. For instance, instead of saying, "Let’s go to the bathroom," say, "Stand up," then wait before the next instruction.

This helps them understand and follow through without feeling overwhelmed.

Strategy 5: Check Your Emotions at the Door

Your emotions greatly impact your loved one. They are sensitive to your stress and frustration. Before engaging with them, take a moment to center yourself.

Practicing emotional control can prevent escalating the situation. If you feel overwhelmed, step away briefly to regain composure.

Finding Support

Caregiving is challenging, and you don't have to do it alone.

Joining support groups, like the Christian Dementia Caregiving Facebook group, can provide community and additional resources.

https://www.facebook.com/groups/1301886810018410

Consider scheduling a free Dementia Flight Audit to receive personalized advice for your caregiving challenges.

Conclusion

By staying calm, redirecting gently, understanding root causes, communicating clearly, and managing your emotions, you can better handle challenging behaviors.

Remember, these strategies are about enhancing the caregiving experience for both you and your loved one.

Your efforts bring moments of joy and create lasting memories, despite the challenges.

Listen to the Podcast

Listen to the episode on the player above, click here to download the episode and take it with you or listen anywhere you normally listen to podcasts.

137. 5 Easy Strategies To Cope With Challenging Dementia Behaviors

[0:00] Have you ever heard them talk about challenging behaviors related to dementia? Well, today's episode is five easy strategies to cope with challenging dementia behaviors. And we are going to look at it in a little bit of a different way because I contend that what the medical model calls challenging behaviors are really normal human behavior magnified. We have all experienced and seen these normal behaviors magnified at different stages and places in our life. We just don't call them that because the person's not living with dementia. So I invite you to episode 137, Five Easy Strategies to Cope with Challenging Behaviors. Well, welcome back to the newly rebranded Christian Dementia Caregiving Podcast, where this is a podcast for Bible-believing Christians who are really wanting to make their journey easier for themselves. We look at using your God-given strengths, because we all have God-given strengths, to make this journey easier.

[1:25] And we do this through the lens of hope and help and realizing and recognizing that despite a dementia caregiving journey, you can still have moments of joy and you can still make good memories. So welcome to this next episode, where today we're going to talk about five easy strategies to cope with what is called in the world, quote, unquote, challenging behaviors. And we are going to talk through a little bit why I hate the term, quote, unquote, challenging behaviors, because it really doesn't describe truly what is happening because my contention is who does it challenge? Does it challenge really the person living with dementia or does it challenge me as the person helping the person living with dementia? So episode 137, five easy strategies to cope with quote-unquote challenging behaviors. So what are these challenging behaviors? Well, in the medical model, there are two vastly different viewpoints related to the behavior.

[2:55] That we see a person living with dementia exhibit. The one is called Behavioral and Psychological Signs and Symptoms of Dementia, and the other one is called Unmeant Needs. So both have truth, both have validity to them, both have certain things that are certainly commonly common. I mostly prefer the one that talks about the unmet needs.

[3:28] But I wanted to explain briefly just the differences between the two. So in the medical model, the medical model looks at behavioral and psychological signs and symptoms of dementia as being a result of the dementia, right? The unmet needs framework looks at all of the, quote, behaviors, the things that we see people doing as the result of them not being able to communicate something going on. And so I tend to lean towards the unmet needs, that a person has an unmet need, but we're actually going to take it a step further today. Because what I really have started to believe and recognize is that it is normal human behavior that's magnified. The things that we see occurring with a person living with dementia.

[4:38] We see in every person at every age when we are not able to necessarily get our way, when we are frustrated or tired or hungry or all of these different things that happen to a person under normal circumstances.

[5:02] But when they happen to a person living with dementia who now has.

[5:09] More and more limited ability to express what it is that they need or want or cannot put their finger on what's going on or they cannot tell you what they're experiencing now we're being slapped with a medical term because the thing that this adult who has always managed to control their own emotions or whatever behavior they have, they've mostly been able to control it with the level of veneer of society. And now they're losing the ability to do those things. And what we see has always been there. It's just magnified. So we'll use for an example, a gentleman that I I worked with many, many years ago. And he was living with his wife in a very rural part of South Carolina.

[6:09] And they lived on a farm and they had a beautiful home with two bathrooms. And he was having lots of issues with making it to the restroom in time. His wife was having lots of frustration because her life had changed. And now because of his inability to make it to the bathroom in time. He would use both the bathrooms and it meant that she had to clean two bathrooms because he missed the loo and all sorts of stuff that was frustrating to him, but also frustrating to her. And so what we worked through together, what I worked through together with her because one of the things that she tried on her own to stop him from using the bathroom was putting a sign on the door that said, so-and-so do not use this bathroom.

[7:10] And he would get livid because he's like, this is my house. This is my bathroom. I don't know why I cannot use this bathroom. And so we worked on some strategies because there was a real problem. And the problem was she had physical limitations too. So when he missed the loo and she had to clean the bathroom and then the other bathroom, and then this happened on a daily basis, it was legitimately impactful. her daily life. And so it was a reasonable thing for us to work through. But at the same time, he was demonstrating normal human behavior. It was just magnified because if I was in my own home and I knew it was my own home, and there was a sign on my bathroom door that said, don't use this bathroom, I probably would get mad too. And that was a normal behavior, but we had to solve this problem.

Addressing the Problem: A Case Study

[8:09] So how did we solve this problem? Well, we tried some different strategies, and we'll talk about that a little later on in this episode.

[8:20] If you are a struggling Christian dementia caregiver and you need a little bit more support because you're at your wit's end, then I invite you to email me at Lizette at ThinkDifferentDementia, where you can sign up with me personally for a free dementia flight audit, where we will sit down in 20 to 25 minutes and get you unstuck in your biggest caregiving challenge today. And I would love to invite you, if you're one of these really, really struggling family caregivers, take me up on this offer. It is entirely free and it's called a Dementia Flight Audit. And you can sign up by emailing me at Lizette at ThinkDifferentDementia.com. And I pray that you will take me up on one of these slots. I only do one of these per month, so sign up and let's get you on the right flight path.

Strategy 1: Stay Calm and Patient

[9:38] So strategy number one is, and this is the hardest thing I will own for me because I am not the world's most patient person. But the first strategy is to stay calm and be patient. And so Proverbs 15, verse 1 says, a gentle answer turns away wrath, but a harsh word stirs up anger, right? So absolutely, as stupid as this is going to sound, a strategy to help yourself stay patient is counting to 10.

[10:25] Bite your lip, count to 10, and just breathe. Just take a couple of deep breaths and not immediately, immediately respond to whatever is happening unless it's an unsafe situation. Then you got to jump in. Somebody's doing stupid and putting, you know, a knife into a toaster, you're not going to count to 10 and wait. You're going to run and go take the stuff out of their hand or switch the toaster off. But count to 10 and deep breathing. Stay calm and be patient. You have to really work on framing your mind. That is one of the hardest things to learn how to do, is to constantly remind yourself that this person is not thinking the same way that they always have. We are creatures of habit. We follow the habit paths and the easy road, right? The road that everybody has traveled down. Our communication, our interactions with one another are formed over decades.

[11:43] So the way I speak to my husband now is the way we've formed these patterns over the last 31 years. The way I speak with my children are formed over patterns of 27 years. So we have these patterns of communicating with people, and when we are not putting it in the forefront of our mind, then we go into the normal habitual way we communicated for all these decades well when you're helping somebody with dementia you cannot communicate with them the way you always did it doesn't work as well so stay calm and be patient count to 10 take a couple of deep breaths and keep it in the forefront of your mind. And then pray, not necessarily at that moment, but praying through your day before your day starts that you be more aware of the potential triggers. We all know ourselves.

[12:48] We know what things get under our goat. It's the same stuff usually over and over again. For me, with my dad, it's the car. I took the car away. It's been over a year and a half. And guess what? I still get lamb blasted about the stinking car. And if I don't go into that conversation immediately when he brings it up, by putting it in the front of my mind, I step in it every single time.

[13:21] And I work very hard on really trying not to get irked, but it's hard. And so I recognize it. And so you do have to stay calm and be patient and put it in the front of your mind and know that despite doing all of these things, that sometimes you're going to fail. And guess what? It's okay. We are going to fail. We're going to make mistakes and then we regroup and then we try it again because this is an ongoing process. This is an ongoing communication.

Strategy 2: Redirect and Distract

[13:59] So that's the first strategy to cope with challenging behaviors. Just stay calm and be patient. The second strategy is to redirect and distract the person. So what do I mean by redirect and distract the person? So I want to use this as an example.

[14:24] I want you to imagine that you're driving 60 miles an hour down the highway, and you are going to a certain location, and that is what you are planning that is where you're going.

Gentle Redirection Techniques

[14:39] And then all of a sudden, you're the passenger in the car. The person that's driving the car with no warning, they know that you need to go in a different direction. And without slowing down the car or anything, they pull a U-turn on the highway, and now you're going in the other direction. So that is a way to redirect a person, but that's not the right way to redirect a person. Because when you're redirecting somebody who is going in a certain direction, they have a certain thing in mind. They're trying to get out the door. They're trying to do something you don't want them to do. If you try to redirect them as a hard 180 U-turn, you're going to get a backlash. So we do want to redirect a person, but we want to redirect them gently. And what I mean by that is you don't want to, like, when you're trying to turn a boat going like a huge cruise liner.

[15:53] You cannot pull a 180 as quickly as that because it takes a longer time to turn a boat around. You have to turn and turn and turn and turn and kind of steer, steer, steer until you make the U-turn. That is what I want you to do when you're trying to redirect somebody. You want to just get them a little bit off track and a little bit off track and a little bit off track until you get them off of the thing that they were on. So a hard redirection would be somebody's trying to go out the door because I'm going home. I'm going home.

[16:32] It's time to go home. And you come up to them and you say, but you are at home. Well, now I'm going to argue with you because obviously if I think I need to go home and you tell me I'm at home, I'm not going to believe you because this isn't home. I don't know what home might it be. It might be, I think I need to go to where my parents are and my parents have been deceased for 50 years, but I don't know that, but I need to go to this place that I feel safe. So maybe I'm not feeling safe in that particular situation. Maybe I just don't, maybe I'm in a different time in my life where home is where my children were when they were little. I may be in a lot of different places when I say, in mind space, in my head, when I say it's it's time for me to go home. But if you come up to me and you tell me, but you are at home, I might react to that because I don't believe it. So a way to redirect the person could look like asking a question such as, well, tell me about home. Tell me more about your home. And trying to get them to talk about what home is. And then based on what they say to you.

[17:49] You keep going down the line. Oh, well, that's great. Tell me more about your children. Where would your children be right now? And get the person to talk about it. And then slowly try to redirect them off of the thing that they've got in their mind without being a 180-degree turn and totally making things worse. So a very gentle redirection. The best way to do redirection is to go to the emotions, to ask questions, to say, tell me more about that. Well, tell me about home. Who's at home? Well, tell me what that looks like. Well, tell me what that makes, maybe ask, how does that, how does home make you feel? Tell me what you feel about home. Just ask questions and slowly redirect and then try to get the person to little incrementally turn away from the topic that you don't want them on and give them something to help you do. And gently take their hand and maybe walk them to the kitchen and open the drawer and give them some utensils and say, I'm super tired today. Can you maybe help me put these away? It doesn't matter if they're in the right spot. It doesn't matter if it's done well. It's just to try to redirect and distract the person.

[19:16] Remember when you are helping somebody who is living with dementia, at a certain point the quality goes away, but we want the engagement, we want the participation. That is way more important than whether it is done well.

[19:34] Folding laundry can be bundling it up because that might be all I can do. Well, then have them help you and do what they can, even if they're folding the same thing 17 times in a different way.

[19:51] It's a way to engage the person in a meaningful activity.

Strategy 3: Understand Root Causes

[19:56] So strategy number three is understand and address the root causes of what is going on. So Proverbs 20 verse 5 says, A plan in the heart of a person is like deep water, but a person of understanding draws it out. So what on earth does Proverbs 20 verse 5 have to do with challenging behaviors? Well, if you understand, if you think back to the beginning where we were talking about unmet needs being normal human behavior, magnified, then when you understand and address the root causes of what you see, you can draw it out.

[20:50] A man of understanding draws it out. So I have a very easy framework that I teach people. It's called the PEACE framework. Person living with dementia, what's going on with them? The environment that it's happening in, what is going on in the environment? Whether the person is being engaged in activities or not, which is the A, how you as the care partner contributes to the misunderstanding that results in the magnified normal human behavior. And then we evaluate and run it through this framework all the time. That's like the deep well. So whenever something is happening, I want you to think of what's maybe happening with the person. Look at the environment. Try to figure out what's contributing. Is it noise? Is it light? Is it hot? Is it cold? What can be making this worse? Look at whether the person has been highly engaged all day and their brain is just too much. I cannot do another thing. I'm overwhelmed or I've been distracted.

[22:09] All alone and not at all engaged in anything and I'm bored and I can't tell you? Or have you come home and you're super stressed because you've just, you know, kicked the dog and had a fight with the boyfriend or whatever? How do you contribute? Can they sense your stress and overwhelm? Are you pacing up and down and that's causing the person that you're helping to pace up and down. Look at everything and then start to find the root causes. I promise you there is a reason and you can be a person of understanding and draw it out. That is how you learn to speak dementia. And guess what? You can. It is a skill that people can learn.

Strategy 4: Simple Communication Techniques

[22:58] Absolutely a skill that people can learn. The fourth strategy today is use simple and clear communication. So what I find fascinating is that I speak a lot, and I know I do. I'm very vocal and never loquacious is a good word for me. But I have the ability to shut it off when I'm helping somebody living with dementia. So, clear and simple communication. That means not long, drawn-out sentences.

[23:36] That means starting to go from the way cueing or verbal prompting works, is you start with telling somebody something. Then after that, if telling them is not enough, you tell and you You point to the thing. So you'll say, and you want to go for the action. So you need somebody to go to the bathroom, but they won't get up out of the chair. You don't say, let's go to the bathroom. You say, let's stand up.

[24:12] And then if the let's stand up isn't enough, then you wait a little bit. It can take 30 to 60 seconds for somebody to respond at certain times in their dementia process. So you've got to give them time to process. So now let's stand up is not working. So then I say let's stand up and I point to the door. Or I'll say come with me and I point to the door. And then if I can get, if that doesn't work, then the third one is let's stand up. I point to the door and then I give a physical cue to try to help them stand up. Okay. So we start with speaking, then pointing and then touching cues. And sometimes we get to the point where we're having to do all of them at the same time. But the less language you use the better so instead of saying let's stand up a walk to the door and go to the bathroom and do all of these things at the same time break it down into chunks what's the next thing what's the next thing what's the next thing the very next thing so stand up now we're on our feet all right come with me now we're walking and just walk to the bathroom and, and then you take care of the thing that needs to happen. Some very, very clear and simple communication. Now, let's talk about how communication works in people living with dementia.

Lizette as a family caregiver

[25:41] As a person, as normal people, normal humans, we can talk to somebody who is on a phone. We don't need to see them. We know they're on the other side of the phone, right? So we have ability to know abstract things. My husband is in the next room. If the door were open, he and I, if we could hear one another, could have a conversation without seeing one another, and we can go back and forth, right?

[26:08] But as a person living with dementia changes, their world is slowly coming in. And so by the time we get to a moderate dementia level, people's awareness of you is not from opposite the side of the room, right? You might be able to wave at them and they'll wave back. But if you try to actually tell them something and communicate with them, it's not going to be going in. So when we start, you know, you've got to consider the person's world is slowly coming in. When we get to the end stages of dementia, inch of we're looking at about six inches in front you know think about the the distance that it would be when you're holding a baby so that you know around arm circle so if you're anywhere outside of that the person may have no awareness that you're actually communicating with them they may hear you but they may not know that you're speaking to them and communicating with them.

[27:13] The next level out is about 18 inches, right? So arms length away.

[27:20] So when you're further than an arm's length away and trying to communicate with this person, that information may not be going in. After that, it's about three feet away, right? So you can be on the other side of the table and talk to them and get a response. So the further into a dementia journey a person is, the closer you need to be to communicate with them. That it is not a realistic expectation if somebody has later stage dementia that you try to talk to them from the opposite side of the room on the opposite side of the house they they either won't hear you or they will not comprehend because they're having trouble with processing of the information, and then you're using perhaps lots of words, and then the information just goes away. These are some simple, clear strategies that you can use to communicate more

Strategy 5: Managing Emotions in Caregiving

[28:22] effectively with a person living with dementia. The fifth strategy today is check your emotions at the door.

[28:31] So I say this a lot, and it's part of the peace framework that we talked about, the person, the environment, the activities, and the care partner. So when you, as a care partner, have stress and emotion or anguish or upset or whatever, frustration, fatigue, and you come into that relationship with that person, because the person living with dementia has lost a lot of the rational part of their brain, what remains is the emotional. They are extremely emotionally in tune to your emotions. So if you do not check your emotions at the door.

[29:26] Inadvertently, we make things worse. And I recognize how very, very hard that is. But the more you practice this, the easier it will get with you helping the person that you're helping. When we put it in the forefront of our mind, like the first tip that I talked about, out, the more we put it in the forefront of our mind and we control our own emotions.

[29:57] The better we are at caregiving because the person will certainly feel it. Like, for example, I went to my parents today and my mom could obviously see I had not been feeling well this week. It's Thursday as I'm recording this. I'm a whole several days behind, but I had a massive raging sinus infection, and I'm still not feeling super great. But when I went to my parents to go help my mom, she could sense that I was frustrated with my dad. And I work very hard on not being frustrated with my dad. It is so much easier with my mom. But with my dad, it really is a challenge. And so I own the fact that I'm I'm not perfect. The Lord is definitely working on my sanctification through this caregiving process and through this caregiving journey. And there are definitely some differences between being a caregiver of somebody who is a believer and being a believing caregiver of somebody who is not a believer. It comes with different dramas, and that'll be actually an episode for a different time, and how to be a Christian caregiver to somebody who's not a believer. I think that would be a great topic.

[31:16] If you can check your emotions at the door, if you see yourself winding up, go back to tip number one, which was stay calm and be patient, right? So all of these tips work together to form a strategy, five strategies for you to cope with these normal human behaviors that are magnified and in the healthcare space called challenging behaviors.

[31:46] So if you haven't joined my Facebook group yet, and you're looking for a edifying place to continue to hang out with me, please join my Facebook group. It's called Christian Dementia Caregiving, and I'd love to have you join. I really am working very hard to serve you as a Christian family caregiver. So please join the Facebook group. and thank you for joining me on this journey. If you like these episodes, please share them with other believers. If you'd like these episodes, please let me know. A wonderful way that you can gift me is by going to Apple Podcasts and leaving me a review on Apple Podcasts. That's where all All the reviews are mostly kept. So that would be a super gracious way for you to show me that you are listening and what you like or do not like from these programs. And like I say in all of my episodes, may the Lord bless you and keep you. And thank you for being here and sharing your journey with me. And I pray for you every single day.

lizette cloete on laptop

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About the author

“Think Different” Dementia’s owner, Lizette Cloete, OTR/L graduated as an Occupational Therapist from the University of Pretoria in South Africa in 1992. Lizette has almost 30 years of experience as an Occupational Therapist in a variety of settings, the latest being in the home health environment. She enjoys teaching on the topic of dementia, most recently presenting at a national conference on the topic “Dementia Made Simple”.

Disclaimer: These blogs, videos and any work done by Lizette Cloete OT, as a Member of Think Different Dementia, LLC, is given only as educational content and consulting work. This does not create an Occupational Therapist-Patient Relationship. The educational content and consulting work performed should not be considered medical treatment as an Occupational Therapist. The consulting work does not take the place of medical work normally performed by a licensed Occupational Therapist. Please consult a licensed Occupational Therapist for medical advice.

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