Apportioning Blame for Difficult Behaviors in People with Alzheimer’s

Christine Kennard Health Pro
  • In the middle and late stages of Alzheimer's disease behaviors occur that often seem unrelated to what is happening around the person. In this context, is it helpful for caregivers to decide the exact level of intent if the behavior is challenging or difficult?  Incidents like aggression or resistance to care procedures cause a lot of caregiver stress and it is important we try to work out what contributed to causing them.


    So often I've heard caregivers in nursing homes say ”he knows exactly what he is doing.” The comment often followed some incident of verbal or physical aggression, inappropriate touching or a sexual advance, or more commonly, refusal by the patient to cooperate in a care procedure. Thinking a person may be doing something negative on purpose is understandable but usually unhelpful.

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    We also know how it happens. Professional caregivers are often under pressure at work to complete tasks on time in order to meet the demands of all the other clients needs. Looking after a relative in their own home is hard work. We established routines. We want to get things done within our set timeframe so we can do all the other tasks we have to do. It is difficult not to let our frustration lead to low moods and anger. But apportioning blame hinders rather than helps and of course people with Alzheimer’s get frustrated, moody and angry too.


    I have put together a few tips to may help you manage these situations better. They are things I always found helpful to remember.


    Alzheimer’s causes significant brain damage

    First I really think it helps to remember just how much physical brain damage results from Alzheimer’s disease. Brain damage that occurs in Alzheimer’s disease is significant and progressive. As brain cells and their connections are destroyed cognitive changes occur. The brain shrinks . Confusion makes previous activities difficult and later impossible. See this video link for more information on Alzheimer’s disease


    Changes in Health

    Ill health can all cause behavior changes and problems. Diseases such as infection of the urinary tract and respiratory tract, an upset stomach, constipation, incontinence, and very commonly discomfort and pain may cause difficult behavior.


    Understanging Psychological Needs

    Try to understand the person as an individual rather than just a disease process. Memory, language, perception about how our brains interpret messages from our senses and motivations all contribute to our knowledge and understanding of people with Alzheimer’s. Here are two links on how psychological needs influence their behaviour.

    Behavior as an expression of unmet need in Alzheimer’s

    The impact of Alzheimer’s on roles and relationships


    The past will influence behavior in Alzheimer’s

    People with Alzheimer’s, like all of us, are influenced by life experiences. Memories of long ago are often more easily retrieved than the more recent experiences. As Alzheimer’s disease’s progression causes more damage and memory deteriorates and become jumbled it can be acted out in inappropriate ways. A good example is discussed in this sharepost on dementia and post traumatic stress disorder in veterans and victims of war.It is just one example of how important knowing a person’s life history may be to help people with Alzheimer’s.


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    Environmental Influences on Behavior in Alzheimer’s

    Environment can play a huge part in how we behave, especially when people are no longer able to express themselves clearly. Caregivers have to look after and predict how someone’s surroundings may make them uncomfortable and unhappy. This can include the layout of their rooms, heating, light levels, mobility issues, ability to get fresh air, go on outing, have contact with people inside their home and outside.

    Problem Behaviors in Mid to Late Stage Alzheimer’s



    I hope this has given you some ideas and tips on how you can stop attributing blame when people are suffering the ravages of Alzheimer’s but does not stop you searching for ways you can help a loved one or a patient have as positive a life as is possible.


Published On: October 30, 2013