People afflicted with Alzheimer's disease find it increasingly difficult to deal with constant changes brought about by every stage of the disease. One of the most alarming changes that occurs in many Alzheimer's patients are mood and behavior swings that cause a great deal of alarm and concern in family members involved in the care giving process.
Understanding the different behaviors and mood changes that can often be expected during various stages of Alzheimer's progress enables caregivers and their loved ones to deal with such incidents with calm compassion and understanding.
Understanding Difficult Behaviors
For many caregivers, sudden changes in mood and behavior are startling and disturbing. For example, a daughter who heretofore has dealt with the parent who has a history of gentle behavior, excellent etiquette and intellectual speaking patterns may be horrified to find her mother issuing expletives or making rude and hurtful comments on a daily basis when agitated.
Other caregivers may deal with increasing situations in which arguments over everything cause [tension and stress] in family members as well as increasing agitation in a loved one. By improving our understanding of what may cause such mood swings and behavior problems, family members and caregivers can learn how to not only tolerate some of these behaviors, but also head them off before they occur.
What Causes Mood Changes
Complicating medical problems as well as drug reactions may often cause changes in behavior and moods. In such situations, it is important for the caregiver to remain calm and not to provoke situations that may lead to outbursts or incidents. Issues such as fatigue, dehydration, and even constipation may initiate such mood changes in many patients, so watching for physical signs is as important as recognizing emotional ones.
Sudden mood swings and changes in demeanor from cheerful to agitated behaviors may also point to a urinary tract infection or fever. However, one of the most common factors in such incidents of agitation and difficult behaviors expressed by Alzheimer's patients is when instructions are not clear. For many elders suffering from dementia or varying stages of Alzheimer's, following multiple directions or requests at one time may prove overwhelming. Seemingly difficult tasks compounded with any other type of health problems often leads to communication breakdown between caregiver and patient.
Changes in environment may lead to problems. [Taking a loved one from one home to another] may prove confusing. Sudden changes in location, as well as the people around them provoke not only agitation, but may lead to fear, tears and obstinate temper tantrums. Initiate such changes slowly. When more than one family member cares for an aging parent with Alzheimer's, don't disappear suddenly, but initiate the change as well as the number of people within their environment slowly and calmly.
Managing Difficult Behaviors
What may not seem difficult for a caregiver may seem an insurmountable obstacle to someone suffering from Alzheimer's disease. Something as simple as getting dressed may cause agitation, confusion, and emotional outbursts. To limit such incidents, it is often necessary for a caregiver to limit choices and to reduce stimulating factors such as a full closet or overflowing drawers to a minimum of necessities and choices.
Instructions need to be broken down into manageable steps. Saying, "Why don't you get dressed?" to someone with Alzheimer's can lead to frustration, belligerence, and downright refusal to do so. Placing one item at a time within reach of a loved one will help to alleviate the pressure of such a complicated process and relieve the stress of making such decisions.
Because someone suffering from Alzheimer's often has a difficult time speaking and understanding what is spoken to them, communicating needs is often a slow process. Speaking slowly and simply, and using physical cues such as pointing or gesturing may help to clarify, conversation, directions, and requests.
It is up to the caregiver to avoid arguments. In many cases, rephrasing a request or giving your loved one a moment or two to process the request or direction is extremely helpful. The Alzheimer's Association suggests a three-step process to manage difficult behaviors:
- Identify the behavior
- Understand the cause
Using one command or direction at a time often makes such tasks easier for someone suffering from Alzheimer's to understand. Writes David Carroll, in his book, When Your Loved One has Alzheimer's, "Their judgment may become impaired. They may become combative and cause physical harm. They may exhibit rapid mood swings from calm to tears to anger for no apparent reason. Their personalities may change, but not the subtle changes associated with age. They become extremely confused, suspicious, fearful."
When dealing with a difficult situation, a caregiver may try to defuse the situation by turning on the television or the radio. Because many Alzheimer's patients who are agitated do not like to be touched, it is suggested that a caregiver try talking to them in a calm and soothing tone of voice. Never raise your voice, as this will only increase tension and agitation.
Focusing On the Patient
In order to avoid battles, it is important for a caregiver to remember to focus on the person, and not on the specific request or task on hand. For example, if [getting a parent to bathe] is your goal, and you see that they are not in the mood and are going to refuse, it is best not to waste your time arguing, but to wait for another point in time to suggest that bath. As long as the person is not in any danger, make it a point to avoid arguments whenever possible.
While it is certainly never easy for children to watch a steady decline in the cognitive abilities of the parent, it is essential to remember that most mood swings and behavioral changes are not the fault of the person suffering from Alzheimer's disease, but the fault of the disease process. Patience, compassion, and understanding go a long way toward providing the care and love that your parent deserves.
Keep the Peace
The bottom line toward dealing with behaviors such as confusion, repetition of actions or speech, as well as the wary suspicion that is often expressed by Alzheimer's patients is to:
- Stay calm
- Try not to take it personally
- Be patient
- Don't take offense
- Don't argue
- Attempt to switch focus to a new activity
Avoiding reactions such as frustration, tension, and hurt feelings helps a caregiver to focus and maintain on what they are trying to provide for someone with Alzheimer's disease, which is a safe and secure environment and making every day as easy on a loved one as possible.