Family Support System for Alzheimer's Behavior Problems

David Roeltgen, MD Health Guide
  • What can a family support system do for behavioral disturbances in someone with Alzheimer's disease?

    Approximately 50 to 80 percent of persons diagnosed with Alzheimer's disease have some type of behavioral or psychiatric condition, such as agitation, psychosis, disinhibition or a combination of these. Agitation is restlessness, irritability, resistiveness or a combination of the three, and may include problems such as wandering. Psychosis is a disturbance in the perception of reality and may be represented by abnormal thoughts or hallucinations. Disinhibition is a loss of social restraint, and may include aggression or sexual suggestiveness.
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    Although loss of memory and loss of abilities is a devastating part of this disease, the behavioral disturbances may have a greater impact on caregivers. These disturbances are difficult to manage and not always easily treatable with medication, and therefore they can put great stress on caregivers. Consequences may include caregiver burnout or illness, patient abuse, and institutionalization sooner than might otherwise be necessary. (Lesser and Hughes, Geriatrics, 2006)

    Discuss Behavioral or Psychiatric Conditions with Your Loved One's Physicians

    First, it is very important that families know to discuss these issues with physicians. Often, physicians ask about memory and abilities but tend to not ask about which impairments were abnormalities of behavior. Many medications have been tried in attempts to help treat these problems. However, success is not common and research has shown that complications from some of the medications may be more serious than the problems for which the medications are being used. Therefore, if medications are prescribed, it is very important that families ask about potential side effects so that they can be aware if such problems occur.

    It is important for the physician and the family to balance the potential benefits from medication with the potential side effects and decide that the risks are worth the potential benefit.

    Recognize Side Effects of Alzheimer's Medications

    Second, families must be aware that side effects from medications, perhaps unrelated to the Alzheimer's disease, may make behaviors on the part of the Alzheimer's patient more abnormal or more severe. For this reason a family should make certain that physicians are aware of all the medications and the doses of the medications that the patient is taking.

    Mention "Unrelated" Medical Problems, In Case They Are Related

    Third, it is important that the physician is aware of any, apparently unrelated, medical problems that the patient may be having. What might normally be considered relatively minor problems, such as colds or the flu, fluctuating blood pressures or fluctuating blood sugars may make behavioral abnormalities more prominent.

    Discuss How Families Can Support Behavior Improvement

    Fourth, families should discuss with their physician any role that they, the families, might play in helping to improve the behavioral difficulties. For example, if the patient is hallucinating, it is not of benefit to argue with the patient that the hallucinations are not real. Such an argument may actually confound the behavioral disturbances by increasing agitation and leading to further difficulties. Another example, is that families should attempt to give the patient a stable environment.

  • Although a trip to visit a relative may seem to be a potential benefit for the patient, the change in environment may cause an increase in behavioral disturbances. Similarly, the environmental change caused by frequent changes in caregivers may also contribute to increased behavioral disturbances.
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    However, this statement should not be taken to imply that a single caregiver should devote all his or her time to the patient. It is important that caregivers "get a break" from their chronic care giving in order to avoid burnout or personal illness. Without such breaks, it sometimes becomes difficult to avoid arguing with the patient about hallucinations or abnormal behaviors.

    In summary, attempting to minimize the behavioral and psychiatric symptoms in a person with Alzheimer's disease is difficult and necessitates a systematic and complete overview of the patient as well as good cooperation between the physician and the caregivers. This is an area in which a team effort is especially important.
Published On: February 16, 2007