How to Handle Difficult Situations with Dementia Patients

For those of us who have cared for or loved someone with dementia, we know how frustrating and painful it can be for everyone. Oftentimes, the responses that feel so natural to us can only make things more difficult when interacting with people who suffer from dementia. How do we navigate situations with dementia patients when we cannot understand their reactions or the things they truly need? Below are some common problems that may arise and how to handle them correctly.

Problem: Your loved one has moments where they become verbally or physically aggressive.

What’s really happening – When someone with dementia is acting aggressively, it could be the result of a number of things. Perhaps they are in physical pain you are not aware off, perhaps they are hungry, or tired, or emotional because they are confused and don’t feel normal or comfortable. Whatever the reason, it is an inappropriate response to something deeper and we have all dealt with it before.

Solution: Try to identify the cause. Ask them if they are in any pain or if they would like to rest. Never engage with them in their aggressive behavior – it will only escalate the situation. Speak calmly and thoughtfully and pay close attention to what would calm them down. If they are safe to be alone, leave the room for 5-10 minutes to give them a little space and calm down.

Problem: You start to notice them making poor decisions that are out of character.

What’s really happening – Dementia can have an impact on the parts of the brain that we use to make good decisions. One of the worst ways this impact can manifest is in financial decisions. People who suffer from dementia often have trouble keeping track of bills or keeping their money organized which causes enormous problems, but is difficult to recognize for families that aren’t involved in their loved one’s finances.

Solution: Digging deeper into these kinds of concerns can be met with resistance. They can be embarrassed or defensive about the struggles they are facing. If there are problems with their accounts, approach the matter gently by asking if the bank made a mistake. Keep judgment out of the conversation and make sure that you do not express your own stress and fear as it can strongly influence them.

Problem: They have started hoarding

What’s really happening – Just like the deterioration that leads to problems with finances, dementia can also cause someone to begin hoarding which can lead to an unsafe environment. It may seem simple at first, but it can build quickly and make it hard to keep a clean house or even move about.

Solution: Keep a close eye on their home to make sure it isn’t becoming an unsafe place. Ask them if they need the things they are choosing to hold onto and discuss a way to limit the excess in a calm, supportive, and encouraging conversation.

Problem: They keep asking to go home.

What’s really happening – People who suffer from dementia are often extremely frustrated by their own confusion. Many times, they desire to return to something that feels normal because it comforts them and makes them feel like they have control. The idea of “home” becomes a secure base for them to fall back on for comfort.

Solution: Sometimes, when people become confused the best thing to do is redirect the situation before it escalates. Instead of repeatedly telling them they are home, which may confuse them more, ask questions about their home – how long have they lived there, what they like about their home, etc. Show them pictures or ask them to take a walk with you. Anything that diverts their attention may diffuse the situation.

If they are in a facility and they keep asking to return home, a therapeutic lie can be a kind way to deescalate the situation. Instead of reminding them that this is their new home, which may upset them, tell them that there is bad construction on the way home or a blizzard is coming.

Problem: Your loved one is repeatedly doing unsafe or inappropriate things you’ve talked to them about.

What’s really happening – When someone with dementia does something unsafe or inappropriate, such as accidentally leaving food on the stove, it is normal to remind them not to, to be more careful, or to explain why it is dangerous. We approach the situation as if they were children and we are teaching them. However, the obvious difference is that they are not children and the reason these behaviors are taking place in the first place is because they have difficulty processing the thoughts they had been taught to prevent these things from happening.

Solution: Asking someone with dementia to remember to stop doing a certain behavior can be fruitless. Instead, consider outside solutions. Hire a caregiver to prep meals for them and keep them safe, make the home safer by removing dangerous and unnecessary components, or ask family to stop in for a couple of hours each day to visit and keep an eye on them.

Problem: Their doctor doesn’t seem to have the right idea.

What’s really happening – One of the things that makes dementia so difficult to manage is that it can look different from moment to moment.  When someone with dementia visits their doctor, their doctor may not be aware that just yesterday their patient was confused and crying because they didn’t know where they were. It can be difficult to treat them properly when their mental state can be so varied

Solution: Make an effort to go to doctor’s appointments with them. Speak plainly to the doctor and be as clear as possible. Never hide information you think will embarrass or upset the person you love. You may ask to speak to doctors privately if you don’t want to say certain things in front of them, but you never know what bit of information will help doctors do their job more efficiently.

Problem: They are always contradicting themselves

What’s really happening – It has been really hard to make them happy or give them what they want because they are constantly forgetting or changing their minds. They can forget minute by minute – which means that they can become confused and angry when you don’t expect it.

Solution: Instead of giving them so many options, it can be easier on you and them to tell instead of ask. Telling them that it is time to go or time to use the toilet or time to take a bath and being firm can implement more structure and lessen the possibility for arguments and bargaining.

It can be extremely difficult to handle these kinds of situations calmly and coolly day after day. For the sake of your own mental health and general wellness, never hesitate to ask for help when you need it. Take time for yourself, when you can, to relax and do something you enjoy. Self-care is just as important as the care we give others. It will be hard to be a good caregiver if we, ourselves are not taken care of.

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