Problem Behaviors in Mid-to-Late Stage Alzheimer's

Health Professional

Is he/she being difficult on purpose?

Responding to and dealing with hallucinations and delusions, refusing food, refusal to bathe or change clothes, hygiene issues, aggression, sexually inappropriate behavior and repetitive behaviors are all features of these stages. We try to make sense of the causes and purposes of any behavior. It is important because our interpretations help dictate our responses. Greater understanding should provide the platform for caregiver insight, patience, and ideas for changes to care regimes to help minimize problem behaviors.

So, why do people with Alzheimer's behave the way they do?

Alzheimer's disease causes huge amounts of damage to the brain.  With this can occur dramatic and unexpected behavior changes. However, behavior does not occur in isolation; all of us interact with the people and events in our environment. For people with Alzheimer's disease it is no different. Professionals who study normal behavior know that we cannot always predict or undertstand the people's motives. When there is brain damage and impairment the picture becomes even less clear. Brain damage is interwoven with the individual's personality prior to the disease, their old styles of coping, old habits then expressed in more immediate, simple and sometimes unsophisticated behaviors.

Intent and Problem Behaviors: From the time we are children we attribute intent to behavior. For example,  a car runs a red light, why? Was driver was drunk, or inattentive? Or maybe his brakes failed? We have an innate need to make sense of the things we observe and if this isn't obvious, we tend to fill in the gaps by supposition. This can sometimes be harmless, but it can also cause problems.

When I was a nurse looking after people with dementia, I often heard the phrase; 'she (he) knows what she is doing,' often following an aggressive or disruptive incident. The belief that the incident of aggression, inappropriate sexual advance, refusal to cooperate with a care procedure, whatever, was intentional caused a lot of caregiver stress. Apportioning blame when someone has brain damage can hinder rather than help you. It never helps anyone deal with incidents better.

I thought it would be helpful to provided some links to information and, most importantly, caregivers experiences of some of examples of problem behaviors. Seeing how other caregivers cope not only give ideas about how you can provide better informed care for your loved one, it also reminds you that there are others out there going through the same struggles Knowing you are not alone is so important.

Coping with aggression

Information about causes, some treatments and strategies to help caregivers cope.  Aggression in Alzheimer's Disease

Dorian Martin's insightful sharepost on aggressive outbursts - Another Side to the Discussion of Anti-Psychotic Drugs - My Mother's Experience

Coping with hallucinations and delusions in alzheimer's disease

Hallucinations and Delusions-How to help a loved one

Hallucinations in Alzheimer's Disease

Coping with paranoid behavior

Coping with Paranoid Behavior

Coping with food refusal

Dehydration and Malnutrition in Alzheimer's Disease

Dorian Martin's sharepost-Trouble Swallowing Solid Food