Sep 9, 2011

Alzheimer's Disease Care Requires Detective Work

Alzheimer’s disease is fraught with mysteries just waiting to be solved. As caregivers, one of the most troublesome mysteries comes in the form of difficult behavior. In order to minimize behavior problems and avoid additional medication that can have detrimental side effects, it helps to take a detective approach.

By P.K. Beville

“Just the facts, ma’am”.

A good detective tries to avoid jumping to conclusions about a case until the facts are gathered. A good detective examines the evidence and continues to adjust their theories until they solve the mystery.

As Alzheimer's caregivers, we could take this method in the pursuit of the truth about difficult behaviors. Our experience from conducting the Virtual Dementia Tour™, a sensitivity program designed to help caregivers experience what it might feel like to have dementia, tells us that most behavior problems are a result of coping strategies. It is an attempt to make sense out of what is happening internally and externally.

Misinterpretation of situations is a common behavior resulting in inappropriate responses. For example, accusations of stealing their money makes sense to Alzheimer's patients because they don’t have money at their disposal and it’s easy for them to make the leap that it has been stolen. Or, if they can’t see food right in front of them, they might say that they haven’t been given any food for days. Of course, they say this when you have company!

In both cases we could argue the point with the person with the disease,
“No one is stealing your money, Mom”, or “you just ate a huge lunch Dad, how can you say that?”
Instead, be the detective, step back, look at the situation and recognize how short term memory problems are a big part of the disease and causing these behaviors.

Trying to reason with a person suffering from Alzheimer's only makes the situation worse. In addition, persons with dementia need concrete anchors to reality because of the loss of abstract thinking. So, give bogus checks in the first situation and hand them some crackers with the promise of dinner in a second. No argument.

The detective approach applies to other behaviors as well, like refusing to bathe, verbal aggression, etc., the detective in us needs to step back as though we are solving a mystery and collect the information.

Take a moment and look at when the behavior most often occurs. What is happening around them? Who is there? What happens right before? Could they be hungry, thirsty or in need of the bathroom? Does the timing of the medication affect the problem? Could they be in pain? Too much noise? Too many people?

As you answer these questions it is likely that you will see adjustments that can be made to lessen the likelihood of the problem. As with a detective, the first conclusion sometimes isn’t the right one. In most situations it takes reexamining the evidence until the mystery is solved.

While you are at it, examine how you respond to the behavior.

Ask yourself,
“is it really a behavior problem or is it a problem for me? Can I adjust how I react and create more calm?”
Objectivity is key to being realistic about expectations but it’s hard to do when you are in the weeds. Sometimes it helps to ask someone who cares about you and your family member to observe and give you caring feedback. Getting this feedback from someone else takes the pressure off of you and gives you another perspective.

Placing expectations beyond ability on a person with Alzheimer's disease will almost assuredly result in behavior problems.

It’s easy to “knee jerk” when problem behaviors occur and simply respond to the moment, but taking the detective approach will make all the difference for everyone involved.

P.K. Beville is a specialist in geriatric care and author of the Virtual Dementia Tour™ (VDT) series. She also created the Family Edition to help sensitize families to the plight of their loved one with cognitive impairment. The goal is to help families develop realistic approaches to care. The VDT is a product of Second Wind Dreams® with proceeds going to help change negative perception of aging.
P.K. is available for behavior help at

More Insight and Advice for Caregivers

Original content P.K. Beville, the Alzheimer's Reading Room