Managing Problem Behaviors

Anyone who has an elder with Alzheimer’s Disease knows that the hardest part of caring for the individual comes from the problem behaviors that can occur as a result of the disease. In some people, problems begin in the early stages of the disease and last until they die. Others seem to live in their own little world and are passive and easy to deal with. Sometimes "problem" behaviors are in the eye of the beholder. A behavior that may be problematic for one caregiver may not concern another. The key for dealing with behavior problems is for caregivers to have a positive attitude and be flexible.

This article focuses on reducing or eliminating problem behaviors once they occur.

Alzheimer’s Disease is not just a disease of memory loss. People with Alzheimer’s Disease also show symptoms of:

  • Language problems;
  • Problems with judgement, reasoning, sequencing and planning;
  • Problems with perception;
  • Loss of motor skills;
  • Inability to carry out daily activities;
  • Personality changes

All of these deficits lead to changes in behavior that can range from simple repetitive behaviors and lack of interest in past hobbies to extreme agitation and violence. Some of the problem behaviors seen in people with Alzheimer’s Disease include:

  • Anxiety;
  • Wandering;
  • Stealing other’s property;
  • Pacing;
  • Inability to remain quiet;
  • Disorientation to time, place and/or person;
  • Constant demand for attention;
  • Repetitive speech and/or actions;
  • Restlessness and fidgeting;
  • Inappropriate toileting;
  • Undressing;
  • Feeding problems;
  • Inappropriate sexual behavior;
  • Emotional outbursts;
  • Combativeness;
  • Screaming;
  • Cursing;
  • Lack of interest in surroundings/activities;
  • Disturbance of sleep/wake cycle;
  • Sundowning;
  • Hostility;
  • Being uncooperative;
  • Easy frustration;
  • Hitting, kicking and biting;
  • Paranoid ideas;
  • Resisting care or refusing care;
  • Sadness, hopelessness or despondency;
  • Mood swings;
  • Catastrophic reactions (when a demented person has an extreme reaction, often due to sensory overload);
  • Hallucinations;
  • Delusional ideas;
  • Rummaging

Understanding Problem Behaviors

Difficult behaviors can be more easily understood if caregivers remember that:

  1. All behavior has meaning: It is most important to remember that all behavior has meaning, even if it’s sometimes hard to determine what that meaning is. Caregivers can’t think like a person who has Alzheimer’s Disease because caregivers are capable of logically thinking through their own behaviors. People with Alzheimer’s Disease don’t follow logic and can be very difficult to understand.
  2. There is always a cause for a behavior and a result of the behavior: Behavior always has a cause and a result. For instance, a person may start to pace for multiple reasons. He may have a generalized feeling of anxiety or he may be searching for something. The behavior’s result can be anything from a decrease in the feeling of anxiety to finding a way out of the house in order to search further.
  3. Behavior does not occur in a vacuum: There are always outside influences that modify behavior. They can come from people or from the environment. For instance, a person with Alzheimer’s Disease who is a resident of a nursing facility might become agitated when a message from a staff member is heard over the loudspeaker. Since these influences change from moment to moment, behavior also may change from moment to moment.

Stage One: Early

Behavioral problems often occur early in the disease, before a caregiver is even aware that the person is afflicted. For instance, the person may become easily angered when a mistake is made due to memory loss. One person may lash out verbally at the caregiver when it is pointed out that she forgot to pay a bill. Another may become very angry when he asks why a favorite relative hasn’t visited lately and is told she was just there the day before.

Stage Two: Middle

As the disease progresses, behavioral problems may become more frequent and severe. Some people in Stage Two become very paranoid and suspicious, accusing their caregivers of stealing things or being unfaithful. Some people have sleep disturbances and begin to wander from home.

Stage Three: Late

The person may scream or yell inappropriately and may resist a caregiver’s attempts to help with bathing, dressing or other personal care.

Guidelines for Dealing With Behavior Problems

  • Everything surrounding a person could contribute to the behavior problem;
  • A thorough assessment of the elder, the environment and the caregiver by a trained professional is necessary in order to plan for intervention;
  • Think ahead and plan for situations that could result in problem behaviors;
  • Trying to argue or reason with a person who has Alzheimer’s Disease only results in frustration for both the caregiver and the elder. It is not possible to win an argument with a person who has Alzheimer’s Disease;
  • Distract and divert whenever possible;
  • Keep the routine the same. Changes in routine are upsetting to people with Alzheimer’s Disease and can cause behavior problems;
  • Promote a sense of security and comfort when problem behaviors occur. Problem behaviors often happen because a person is frightened and unable to make sense out of the environment;
  • Use positive reinforcement such as food, smiles, a gentle touch, personal attention and lots of praise. These tools are more effective than negative reactions;
  • Allow a person with Alzheimer’s Disease some sense of control. Being able to save face is important even in a person who is very confused;
  • Maintain a calm manner when confronted with threatening behaviors. This can defuse a very tense situation and help a person become less fearful;
  • Keep things simple. Complex situations only cause frustration and can escalate behavior problems;
  • If a caregiver becomes frustrated and angry, it is best to find someone else to handle the problem and have the caregiver leave the immediate area or take a break (respite). An angry caregiver will only intensify problem behaviors;
  • Caregivers should practice ways to reduce stress when they become frustrated and angry. Deep breathing or talking to someone can be helpful. Remember that stress comes from many sources, including personal life;
  • Behavioral problems result from the disease. Don’t take things that the person says and does personally. It is the disease speaking;
  • Be creative when seeking solutions to difficult behaviors;
  • Use good common sense when attempting to solve problem behaviors;
  • Keep a sense of humor even in the most difficult situations. Humor will help you cope with the frustrations of caring for a loved one with Alzheimer’s Disease.


Available from ElderCare Online™                2000 Prism Innovations, Inc.