When behaviour is so different from the norm, caregivers are often left scratching their heads. What should they do? How should they react? What is going on in their loved one’s head?
The cause for outbursts may not always be obvious but often it is due to discomfort or pain, anxiety or insecurity, or a dislike or upset with the caregiver. Layer on top of that a reduction in language ability so that communication is difficult and you have created the perfect storm.
Caregivers are often surprised or caught off guard when outbursts occur. We have compiled twelve tips to help you reduce or limit outbursts.
With your loved one:
- Focus on helping them feel secure and cared for. Remember that emotional memory is still very strong and most of their memory cues come from their emotions — so you want to create feelings of love, trust, and security.
- Provide physical comfort. A hand massage or a gentle touch on the arm can convey affection and comfort. Aromatherapy can also play a role here and a light massage with essential oils on the hands or feet can be very calming. Be aware of the fragility of their skin and do not crush or squeeze too hard.
- Encourage them to maintain social relationships and engage in meaningful activities. We are wired to connect to other human beings, and without social relationships we can feel isolated and alone. Supporting your loved one in continuing to engage with people and in meaningful activities helps them maintain purpose and joy in their lives.
- Limit the number of stimuli in the environment. Too many things going on, too much noise, too much movement can cause sensory overload. The individual cannot process what is going on and it creates a great deal of anxiety.
- Reduce the amount of television that they watch. Too much television can lead to sensory overload. Try and introduce music or time spent outdoors enjoying the sunshine or watching a bird feeder to provide more peaceful interactions.
- Reduce clutter in their environment. Being surrounded by a lot of stuff can increase anxiety. There are a lot of tangible objects for them to keep track of and it can lead to feelings of being overwhelmed and increased frustration.
- Create predictability for them in their schedule and surroundings. Routines are comforting. If changes must occur, surround them with as many familiar things as possible during the transition.
- Follow a daily schedule. This creates predictability for your loved one, which is important for confidence. Try and do the same things at the same time and make sure they are aware of their schedule. Have a large calendar that they can look at with appointments written on it. Make sure it is easily accessible for them.
- Avoid activities that are rushed. Having to go somewhere quickly or respond to something quickly can be overwhelming for an individual with dementia. They need time to process and forcing them to think or respond quickly is more likely to cause an outburst of frustration or anger. Slow down and give yourself plenty of time to do what needs to be done.
- Become aware of behaviour before outbursts occur so that you can defuse it as quickly as possible. Your loved one may become red in the face just before they get angry. Use distraction or redirection techniques to defuse difficult situations. Music, pictures, or favourite objects can play a role here.
- Be aware that infections, such as urinary tract infections, can cause uncharacteristic behaviour. It is always a good idea to have a thorough physical, including blood work, to determine if there is a problem that is easily resolved with medication.
- And finally, remember that outbursts are not directed at you. They are usually a combination of the disease and environmental triggers. Try to avoid taking their behaviour personally. If you need to step away from the situation so that your own frustrations do not build up.
These strategies will help you reduce or cope with difficult behaviour. Your loved one is going through a difficult time and reacting with patience and love will help you create a positive environment for them. While this may not always be easy to do, it is worthwhile to strive for. You will feel better about yourself and discover strengths you probably never knew that you had.
Nicole has trained hundreds of professional and family caregivers who have touched the lives of thousands of individuals living with a cognitive impairment. Nicole also holds a law degree from Osgoode Hall Law School, a Master’s in Law from Queen’s University specializing in Negotiations and is a Certified Professional Consultant on Aging.