Using Redirection to Deal with Problematic Behaviors in Seniors with Dementia

Dealing with the frequently difficult and sometimes inappropriate behaviors that can result from a dementing illness or condition can be difficult. There are various techniques that can be useful and can help when dealing with these things. Redirection is a useful and important technique as it  helps steer the older adult’s attention away from the stressful, problematic behavior to something that is more pleasant, less distressing. By using these techniques, it can be possible to delay or possibly even avoid the troublesome behaviors from occurring. 

It is very important, when caring for an older adult with dementia, that if there is a sudden change of behavior to notify their doctor, a nurse or a consult Geriatric Care Manager. This is important because a sudden change can be evidence of an acute medical issue, such as dehydration, a urinary tract infection, etc. The differentiation between an acute issue and a general worsening of their dementing illness has absolute influence of how, or even if, it would be treated and dealt with.

There are several techniques that can be used to redirect the older adult. It is important to remember the safety of all involved when contemplating a technique to utilize.

I will share 4 specific techniques, then discuss various troublesome/problematic/inappropriate behaviors that are frequently exhibited in older adults with dementia and finally some techniques to use and keep in mind (these tips are provided in a chart and can be printed, cut out and taped to a cabinet or the refrigerator for easy access when things get stressful).

*Please keep in mind that while these techniques can be helpful, they may or may not work. They may work one time and not another. Dementia and the related behaviors can be so different and varied depending upon the individual and it is important to keep that in mind when reading or utilizing these tips*

Join in the person’s reality. People with dementia frequently regress to past years, as people often lose their short-term memory first, they are able to recall things from further back in their past. Let’s say for example that our older adult states that they are wanting to find their mother. Do not tell them that due to their own advanced age that their mother wouldn’t be alive at this point. Instead, tell them that you want to help them look. Ask for stories about their mother. Get into their reality by interacting with them, as long as it is still safe for all involved.

Distract. When a behavior is negative, try to find something else to utilize their energy and take the place of the problematic behavior. For example, if the older adult is rummaging through the closet of their neighbor, offer them a task to do. Ask them to help you find an empty box, or find something for them to sort. Giving them a task (something simple as to not incite any frustration that could accompany not being able to successfully complete was is asked of them) to do to distract them but keep them busy at the same time.

Validate the older adult’s emotional state. If you notice the older adult feeling sad or angry, engage in a conversation that shows them that you understand what they are feeling. You might ask, “You look worried, is there anything I can do to help you?” or “You seem sad today? Would you like to talk about anything that may be on your mind or leading you to feel upset?”

Redirection. When the older adult is trying to get out the door, suggest going to get a snack, or participating in an exercise class, something, and say “How about having lunch before you go? The chicken smells so good, let’s go get some lunch!”

There are a variety of inappropriate and problematic behaviors when it comes to older adults with dementia. Here are some:

-inappropriate activities (sexual comments, asking for sexual favors, removing clothing when it is not appropriate to do so, etc)

-hiding, hoarding

-sundowning (agitation that begins or increases late in the afternoon as the sun goes down and the day progresses)

-aggressiveness (verbally, physically abusive, combative)

I wanted to provide a quick reference list to keep handy in case you ever need the information:

Dealing with Problematic Behaviors that Frequently 

Accompany Dementia in Older Adults

-it is important not to overreact

-do not argue or scold the person

-provide activities that have a purpose

-if the older adult seems lonely or scared, hold their hand or ask if they would like a hug

-remind them that they are safe

-provide a rummaging box that they can keep their hands busy with but is only filled with safe objects (nothing too small that could be swallowed, 

nothing sharp and nothing that could be used as a weapon)

-If the weather is appropriate, provide some time outside

-approach the older adult with only one caregiver at a time, it can feel intimidating if more than one person approaches someone 

at the same time

-monitor, possibly eliminate, caffeine intake

-when talking to the upset person, stand to their side, where you are out of their reach

Dealing with these behaviors can be frustrating, scary, overwhelming and no matter how you deal with it, please remember YOU ARE DOING THE BEST YOU CAN. There is no perfect way to deal with it and there isn't a 'right' or 'wrong' way- I only offer these tips to help alleviate any stress and to offer support!

Please feel free to reach out either by commenting on this blog post, on our Thrive GCM Facebook page or by sending me an email, if you need any assistance or would like to share (thrivegcm@gmail.com)

Please check in for our next blog post coming SOON.

Please check out our business website: 

www.thrivegcm.org

Connect with us on social media:

 on Facebook at:

Thrive Geriatric Care Management

on Twitter at:

@thrivegcm

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This blog series is designed to help you 

and your loved ones 

Knowledge is Power!

Let's Talk About Self-Care

 Let’s Explore Self-Care!

During many phases of our lives we are caring, or in the least partially caring, for another. It is of vital importance that while doing that that we care FOR OURSELVES FIRST. This is illustrated easiest by looking at traveling by airplane. They always tell us that in case of emergency when the air masks drop we need to put ours on first before we assist others. In that situation it is literally of life or death importance that we put ourselves first. In our daily experiences it may not seem to be that way; however I would argue that it is of equal importance.

Some people can struggle, in particular caregivers, with putting themselves first, so until that becomes comfortable to do so in its own right, it can be useful to view it in a slightly different perspective: if you take better/best care of yourself, you will be better able to care for your loved ones. Eventually the goal of course is to take care of oneself for that alone, but this is a perfectly healthy placeholder in the meantime. 

Speaking of caregivers, they can be more prone to experiencing some issues regarding their own health, such as:

-sleep deprivation

-poor eating habits

-failure to exercise

-failure to rest when ill

-postponement of failure in scheduling personal medical appointments

There are various reasons for these issues. A few include, the physical demands of the work, the prolonged emotional and mental stressors, ignoring one own’s self in order to keep up with the caregiving work for their loved one.

While you are not able to stop progressive illnesses or the impact of a chronic condition, there are several things that you can do to take responsibility to meet your own personal well-being needs and assuring that they are being met.

We’d like to offer 4 tools that can be effective in developing an increased capacity and utilization of self-care.

TOOL #1: BETTER MANAGEMENT OF PERSONAL STRESS: Our individual levels of dress can be influenced by many factors. Our own perceptions and how we perceive and respond to events in our lives are major factors in how we cope and adjust to what happens. We are not able to remove all stress from our lives; however we are able to use various techniques to better manage the stress we do experience. Some such tools include:

-Identify sources of stress. 

-Differentiate what sources of stress you can and cannot change and control. It is helpful to keep in mind that we can only control ourselves. While we can frequently not control what is going on in our lives, we are able to sometimes make some change, no matter how small, that can at least help us feel more in control

-Take action. Stress reducing activities can be simple activities such as walking, gardening, meditation, having coffee with a friend, etc. These strategies work differently for each individual, so it is important to know what works for you.

TOOL#2: SETTING GOALS: Deciding what you would like to do in the next few months is an important step you can use to take care of yourself. Some examples of goals or action steps can include making an appointment for a medical checkup, walk 3 times a week for 20 minutes or take half an hour break once during the week where you completely “unplug.” 

TOOL #3: SEEK SOLUTIONS: One of the most important tools in life, and in particular in caregiving, is solving problems or resolving issues.

TOOL #4: ASK FOR AND ACCEPT HELP: Asking for help is something that people can really struggle with. Think about in your own life if you’ve ever been offered assistance, no matter how minimal, and you replied, “thank you but I’m fine,” or “no thanks.” Many adults, caregivers in particular, don’t know how to accept, much less ask for help. 

Here are some tips on how to ask for help:

-if you know a particular person enjoys cooking or dislikes driving, try to ask for favors that line up with a person’s abilities and likes

-keep a list prepared of things that need doing, the list might include errands, yard work, or a visit with your loved one. Let the person offering help choose what they’d like to do.

Try to remember that it is absolutely NOT selfish to focus on your own needs and desires, even (maybe even especially) when, you are a caregiver.

We are all responsible for our own self-care— nobody can do that for us.

Here is a list of activities that sums up this article:

-learn (AND USE) stress reduction techniques such as meditation, yoga, etc

-attend to your own medical needs

-rest properly

-take time for yourself without feeling guilty

-seek support when you need it

-set goals and the action steps needed to reach the goals

-participate in pleasant, restful activities such as reading a good book or taking a warm bath.

If you come up with any other useful techniques, please feel free to leave them as a suggestion in the comment section below this posting.

Please check in for our next blog post coming SOON.

Please check out our business website: 

www.thrivegcm.org

Connect with us on social media:

 on Facebook at

Thrive Geriatric Care Management

on Twitter at

@thrivegcm

 Instagram at

thrive_gcm

This blog series is designed to help you 

and your loved ones 

    Knowledge is Power!

What Else is True

This morning’s blog will be focused on introducing one of my favorite life techniques that I’ve been implementing into each and every aspect of my life, and it is so very helpful. It is hard to believe that something that is so helpful and transformative in only the best ways can be captured in just 4 words: WHAT ELSE IS TRUE?

So this is how it works: 

It can be used to help with things such as physical pain, anxiety, sadness, self-doubt- I actually think this can be used in any type of distressing situation.

So it is easiest to use an example. So I will use myself, at present I am having pretty intense abdominal cramps. So if I wanted to use the What Else is New technique it would look like this:

I am having really bad that BUT what else is true? I am cuddling with my kitties, I am listening to some of my favorite music, I am writing a blog for my dream business, I am wearing a new and very special owl necklace a best friend gave to me yesterday. ALL of the above aspects of my ‘right now’ are true. However, what we focus on becomes louder and louder. So while this technique doesn’t technically take the discomfort away per say, it definitely helps to turn the volume down which can be just as beneficial. 

I’ll do another example:

I haven’t written a blog in several days and it could be easy to get in the self-teardown cycle. But what else is true? I have been dealing with some things in my personal life. I’ve been helping friends who are dealing with major things in their lives. I have had several appointments with doctors and business consultants, so while i haven’t had a blog post published in a  while, I have been getting other things done. So using this technique doesn’t change the fact that I haven’t published in a while but it helps me to realize that that fact alone doesn’t mean i haven’t been doing anything.

I am excited about the seemingly countless ramifications this simple question and process can have in our lives. I see it also having equally transformative effects when dealing with guilt in caregiving. I would like to throw a big shoutout to an amazing therapist that I began seeing shortly after my dad passed away nearly 3 years ago and this is just one of the amazing tools she has taught me.

For example:

Let’s say that if I was a caregiver right now, taking care of my aging father and he had a fall that resulted in a hospital stay for him. I could immediately go to the place of “I’m not good enough” shame, intuiting that only should i have been better that he wouldn’t have fallen. Well, what else is true here? I am making sure my dad is eating enough and nutritious food each day. I am making his environment clean and safe. I am working hard on coordinating his medicine and other medical needs and care. I am doing all I can to ensure he is taken care of in every way in which we need care in order to thrive. This does not take away the unfortunate fact that my father has had a fall and has to stay in the hospital to recover but it does acknowledge the great care I do provide. Further, it helps me to realize that I cannot control every aspect of this situation and that it isn't my fault.

The only aspect of blogging that I wish was a little better is I wish they were a little more interactive. I am hoping that the nature of this blogpost in particular will garner some conversation about things people experience this when they incorporate it into their lives.

Please check in for our next blog post coming SOON.

Please check out our business website: 

www.thrivegcm.org

Connect with us on social media:

 on Facebook at

Thrive Geriatric Care Management

on Twitter at

@thrivegcm

 Instagram at

thrive_gcm

This blog series is designed to help you 

and your loved ones 

Knowledge is Power!