5 Challenging Dementia Behaviours Explained
By Teepa Snow, via A Positive Approach to Care
Have you ever struggled with these challenging situations, commonly seen in those living with dementia?
Vision changes in dementia can be dramatic, and can account for numerous unusual actions, including:
1. Picking at or grabbing at things that are not there
Your first thought may be that the individual is hallucinating. While this could certainly be true, it is equally likely to be caused by vision loss. At a more advanced state of dementia, when depth perception is lost, the individual could actually be trying to turn off the ceiling light or fan, not realizing that it is more than six feet away. Or, they could be trying to pick up objects from the floor, not understanding that they are actually far from reaching them.
2. Startling very easily
Have you noticed that people living with dementia often seem to be startled easily when you approach them? Sometimes they may even react by striking out, verbal anger, or losing their balance. Since people living with dementia lose peripheral vision early, and lose even more visual field as the disease progresses, it is very difficult for them to tell when someone is approaching from the side or behind. This often results in a reaction of surprise or fear or anger. Approaching from the front, in the middle of their visual field, is the best practice.
3. Trouble with eating or drinking
Although difficulties with eating or drinking can be caused by a variety of issues in dementia, vision loss definitely contributes to these difficulties. When their visual field and depth perception is reduced, people living with dementia may not easily be able to see their utensils, plate, or beverage. Also, since visual discrimination is diminished, it may be difficult for them to clearly see the food if it is not a contrasting color with their plate. This can result in not eating or drinking, eating without utensils, or spills.
4. Losing objects in plain sight
People with dementia often spend a lot of time looking for objects that, to you, appear to be right in front of them. The main reason for this is due to vision changes in dementia. Without properly functioning peripheral vision and depth perception, it can be challenging to see the pair of glasses that are sitting on the table right in front of them or the remote control that is on their lap.
5. Wearing clothes that are visibly soiled
There are several reasons that people living with dementia may do this, but changes in vision definitely contributes. If they have lost significant peripheral vision and have a very narrow visual field, it is extremely challenging for individuals to see whether or not they have spilled down the front of their shirt. So, it is quite possible that they are unaware that the clothing is stained, simply because they are unable to see it.
Visual abilities change drastically throughout the GEMS States progression of dementia. For instance, in a Diamond state of early dementia, an individual loses peripheral vision. By the Ruby state of late dementia, an individual experiences monocular (single eye) vision without depth perception.
Understanding and responding appropriately to vision changes can significantly improve your daily interactions and reduce stress, both for yourself and the person for whom you are caring.
5 ADDITIONAL Dementia Behaviours Explained
People living with dementia often experience changes in their ability to process language, which means they it may become increasingly difficult for them to understand words. This can result in many challenges, including the ones listed below:
1. Constantly saying “What?” or asking you to repeat yourself
This usually leads to an assumption that the person is experiencing hearing loss. While this may be true, it is also quite likely that their hearing is actually not the issue. Instead, they may be experiencing changes in their ability to understand language.
Did you know that people with mid-stage dementia commonly miss one out of every four words that are spoken to them? When that many words are being lost, it becomes increasingly difficult to understand what someone is trying to say to them, so they may often ask you to repeat yourself.
Try this: Instead of increasing your volume, try using less words and speaking more slowly.
2. Having trouble following instructions
While some might assume that the individual is being stubborn or defiant, it is very likely that they may in fact be having trouble following a set of directions due to changes in language processing.
Try this: When providing instructions, give only one step at a time and keep the number of words to a minimum.
3. Resisting Care
There are a wide variety of reasons that this may occur, but one of the most significant is that the person living with dementia is simply not understanding what the care partner is attempting to do. Even though the care partner believes that they are explaining things adequately, they are often providing too many words and speaking too quickly to allow for the individual living with dementia to process and understand.
If the individual is missing some or most of the words, then it is likely they will become confused, startled, or alarmed when someone tries to remove their pants or touch their face, and they may strike out in self-defense.
Try this: When providing care, use just a few words, speak more slowly, and provide visual cues to allow for optimal processing.
4. Being agitated or distracted in noisy environments
It is extremely common for individuals to have a much more difficult time processing language in noisy or busy environments. The more stimuli present, the more challenging it can be to follow and process the words in a conversation.
Try this: Choosing a calmer environment, such as a quiet restaurant rather than a bustling one, or an empty day room rather than the busy common area, can help optimize the ability to process language.
5. Turning up the TV or radio volume
It is very easy to assume that this action is due to a hearing loss, or maybe even a desire to irritate a spouse or roommate! However, it is quite likely that the individual may be experiencing a change in the ability to understand language. They likely do not understand this change is occurring, so they may feel that they may be able to understand the words better if they increase the volume.
Try this: Sometimes suggesting a gradual shift to a different type of programming, such as a music station rather than all-talk radio, may help to ease some frustration for someone struggling with language processing.