November 16, 2016
As noted in our previous blog posts on managing challenging behaviors, the main underlying cause of symptoms like aggression, anxiety and confusion is the progressive damage to brain cells caused by Alzheimer's disease and related dementias. Certain situations — such as a change in living arrangements, switch in routine or certain infections — can cause symptoms to worsen.
In the earlier stages of dementia, confusion may be mild. The person with dementia may even be aware of brain changes taking place, such as increasing difficulty in making decisions or processing what was said by others. As the person’s dementia progresses, they may become confused about the location of home or the passage of time, and forget the purpose of common items, such as a pen or a fork. Sundowning, also known as “late-day confusion,” is a symptom of Alzheimer’s disease and other forms of dementia. With sundowning, confusion and agitation may get worse in the late afternoon and evening and be less pronounced earlier in the day.
When you’re caring for someone with dementia who has become confused, remember to stay calm and try not to take things personally. Although being called by a different name or not being recognized can be painful, try not to make your hurt apparent. Respond with a brief explanation, avoiding lengthy statements or descriptions, and utilize visual cues such as gestures or photos to help orient the person to the current situation. Lastly, offer gentle corrections as suggestions rather than scolding, for example, "I thought that was a fork rather than a toothbrush" or "I think she is your granddaughter Julie.” Since dementia can make it hard to develop and remember new routines, your client or loved one might react to unfamiliar places and things with feelings of stress, confusion, and anger. Adhering to the same schedule every day can do wonders in helping them feel more calm and collected.
One final note: delirium, also called the “acute confusional state,” is a medical condition that results in extreme confusion and other disruptions in thinking and behavior, including changes in perception, attention, mood and activity level. Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized even by healthcare professionals because many symptoms are shared by delirium and dementia. As we’ve mentioned previously, any time there is a sudden change in behavior, it is important to have a medical evaluation to rule out other causes that may be treatable.
This blog post is Part 3 of a 5-part series on managing challenging behaviors.
