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“I Can’t Believe what Mary Said to me Today!”

“I Can’t Believe what Mary Said to me Today!”

nurse visiting senior patient

It’s way more common than people realize.

Front-line care providers interact with patients more closely than nurses and often even more closely than family. So, home health care aides and personal care aides may see dementia-related behaviors far more often than other care providers typically do.

Overwhelmed by memory loss, confusion and disorientation, many seniors with dementia fall back on attitudes and societal values that were common many decades ago—and may say things that are startlingly inappropriate today.

In addition, the brain disorder has disrupted their normal inhibitory and organizational capabilities and they may do puzzling and sometimes seriously inappropriate things.

Don’t take it to heart.

As we’ve discussed before, professional detachment is a powerful tool for managing difficult interactions and behavioral situations. Remember—it’s not personal. Use your sense of humor and compassion to deflect hurtful speech. Creative approaches to managing their care, flexibility and patience are keys to getting the necessary tasks of daily living accomplished when the patient is behaving erratically.

Here are some suggested approaches:

  1. First, check in with the doctor. There may be medical reasons for bizarre behavior, especially if there has been a change. Pain, medication side effects or interactions, or systemic issues like kidney failure can all have behavioral effects. See if appropriate medical treatment options are available. Once those are ruled out, it’s time for behavioral psychology and management.

  2. When possible, agree and adapt to unusual choices. If it’s a harmless choice, go along with it. Escalating or over-controlling will cause frustration and resistance which is counterproductive. If it’s something you can’t accommodate, try to help them realize what’s necessary. For example, if the patient refuses to wear their coat or proper footwear when it’s cold outside, go along for the moment—but bring the clothing with you. Should they become uncomfortable, you’ll be prepared when they change their mind. You might let them feel the winter air just outside the lobby—before setting out on a longer walk—so when they change their mind, you can bring them right inside for a quick change of outerwear.

  3. Frustration and resistance are the other side of that problem. If they feel out of control, rushed, confused or afraid, they can stubbornly refuse to perform necessary tasks. Give the resistant person time and room to calm down, then break down the task into simple steps and get their cooperation for each one. Starting with a pleasant activity or a treat can get the process started.

  4. Wandering off can be a serious safety hazard for the disoriented senior who is ambulatory. They can become lost or get into dangerous situations. You can help prevent this by creating real or perceived barriers. Some suggestions are “Stop” or “Do Not Enter” signs, beaded or cloth curtains over doorways, or even a black mat, which can be mistaken for a hole and inhibit their impulse. If they take their glasses or keys before trying to leave, put them out of reach. Always make sure they have identification on their person, be it a label in their clothing, an ID bracelet, or even the new GPS trackers now available for this situation. If it’s a recurring problem, let local law enforcement, EMS and fire departments know about them to assist in responding quickly and appropriately.

  5. Obsessive behaviors such as “shadowing” (following the caregiver constantly and continuously talking to or questioning them) can be managed. Sometimes a poster with the answer to their repeated question can help calm them. Others have had success distracting them by giving them a task or chore to occupy their mind.

  6. Physically or sexually inappropriate behavior, including acts of physical or verbal abuse and sexually harassing or lewd behavior can be all too common as the disorder affects the patient’s normal inhibitions. Remember that this is a product of the disease, and don’t take it personally. This is a complicated problem, and healthcare and long-term care supervisory professionals can offer practical advice. At the very least, protect your safety by removing yourself from the threat zone, and negatively reinforce this behavior by temporarily isolating them (safely!) or removing a treat or favorite object. Let them know that this is connected to their behavior, and immediately reward positive developments. If your safety is at risk, treat patients who have this issue only with assistance.

Nighttime is not the right time.

Behaviors like these often increase at nighttime (so-called “sundowner syndrome”). Try to organize their most challenging tasks as early in the day as possible and wind down activities as the day goes on.

Above all, keep your cool.

Remember that underneath it all is a living, feeling human being that is struggling with the greatest challenge of their lives. Help them remember their good times, celebrate their lives with them, and enjoy their amazing memories and stories, if they are willing to share. This work can be very challenging—but for a “people person,” the rewards can be equally great.

Have care questions, or just need a break?

Contact us today for more information.