Behavior

What It Is

Strategies

Aggression

Behaving in a forceful way that doesn’t fit the situation:

• Verbal—screaming, cursing, threatening, or loud, repetitive sounds.
• Physical—hitting, kicking, biting, scratching, throwing objects at others or oneself.
• Verbal aggression can escalate into physical aggression. De-escalating at the verbal stage can be preventive.

• Ensure safety and remove potential triggers.
• Focus on feelings, not facts.
• Try to be positive and reassuring.
• Shift the person’s focus to another activity.
• Take a break after ensuring safety.
• Observe patterns for triggers.
• Try to incorporate music.
• Call 911 if the person or your safety is at risk.
• Speak with the person’s medical team.

Agitation

Behaving in a way that is uncharacteristically stubborn, uncooperative, hard to handle, or resistant to care:

• Repetitive questioning, fidgeting, nervous pacing, and hiding or hoarding objects
• Arguing, complaining, being overly critical, or becoming easily upset
• Inappropriate screaming or disruptive noises
• Resistance to bathing, dressing, or taking medications
• Leaving home on purpose

• Look for a reason or trigger.
• Turn action or behavior into an activity (for example, turn noises or yelling into music or turn on music; if person is rubbing their hand on the table, provide a cloth for dusting).
• Offer reassurance and approach the person in a calm manner.
• Take a short break from the task/activity if faced with resistance.
• Try to understand where the person’s frustration is coming from.
• Provide an answer and/or write down the answer and put in prominent location.

Anxiety

Signs of feeling nervous, worried, or frightened, such as:

• Shortness of breath or panting, sighing, being unable to relax, jumpy. or tense
• Easily startled by light touch or noise
• Asking repeated questions about what they should be doing or where they are going
• Shadowing or following you around wherever you go; nervous pacing

• Create a calm and soothing environment.
• Talk about worries or fears.
• Learn triggers or causes for their anxiety.
• Consider ways the person found comfort before cognitive changes.
• Stay active—physical activity can reduce anxiety and help with sleep.
• Maintain a healthy diet.
• Talk with the person’s doctor if anxiety is new.

Apathy or Indifference

Exhibiting decreased motivation and symptoms that may include:

• Less interest in or trouble with initiating usual activities or activities and plans of others
• Difficulty engaging in conversation or doing chores
• Lack of emotion

• Introduce a range of different activities, including art, cooking, Montessori methods, exercise, multisensory stimulation, pet therapy, music, reminiscence.
• Break tasks into simple steps.
• Gently prompt the start of activities.
• Avoid blaming the person for being lazy.
• Try to remain calm; take a break.
• Consider hiring help or enrolling in a day program.

Delusions

Having strong beliefs that are not true, such as:

• Believing others are trying to steal from or harm them
• Believing their house is not actually their home
• Believing their significant other is having an affair

• Remain calm.
• Don’t argue or try to convince.
• Try to understand their reality and provide reassurance, care, and concern.
• Investigate for any environmental triggers.
• Replace any lost items.
• Try not to take offense.
• Use distraction with an enjoyable activity or topic of conversation.
• Talk with a doctor to evaluate for medical causes.

Depression

Persistent (lasting more than two weeks) signs of sadness and hopelessness, such as:

• Feeling like a failure, stupid, or useless
• Feeling like a burden to family and loved ones
• Periods of tearfulness or sobbing
• Sleep and appetite changes
• Loss of pleasure in usually fun activities

• Acknowledge the frustration and sadness, while continuing to express hope.
• Establish a predictable daily routine.
• Find ways they can contribute to family life.
• Make a list of activities, people, or places the person enjoys.
• Exercise regularly, particularly in the morning.
• Provide reassurance of love and respect.

Disinhibition

Acting impulsively or inappropriately, such as:

• Talking to strangers as if they know them
• Saying things that may hurt people’s feelings
• Talking openly about very personal matters not usually discussed in public
• Behaving in a way that is socially inappropriate for the situation (e.g., talking in church or singing at mealtime)

• Try to react with patience and gentleness, even though behaviors may be embarrassing.
• Give plenty of physical contact such as stroking, hugging, and rubbing.
• If behavior is sexually inappropriate, gently remind them their behavior is inappropriate and guide them to a private place or try to distract.
• Carry companion cards you can give to others to help them understand that your person has dementia.

Hallucinations

A sensory experience of seeing, hearing, smelling, feeling, or tasting things that don’t exist outside of the mind, such as:

• Auditory—hearing voices, sounds, or music from inside or outside the person’s mind; the voices may be talking to each other or to the person
• Visual—seeing something no one else can see, such as people, animals, bugs
• Olfactory—smelling an odor that is not present
• Tactile—feeling insects, touch, or pinpricks on or under the skin that are not there
• Gustatory—sensing an odd taste in food or liquids that is not there

• Determine if the hallucination is bothering the person.
• Stay calm and avoid contradicting them.
• Respond in a calm, supportive manner (e.g., “I’m here, I will protect you. I will take care of you.”).
• Listen intentionally to what they are saying so you can better understand what they are experiencing.
• Check the environment and remove any triggers.
• Focus on feelings (e.g., “You seem really scared.”).
• Talk to a doctor to rule out medical causes.
• Distract and redirect.

Irritability

Acting cranky, overly critical, or impatient, such as:

• Being argumentative or having sudden angry outbursts
• Frequently complaining
• Crying unpredictably or having sudden mood changes

• Allow the person to keep as much control in their life as possible.
• Build in routine and quiet time.
• Reduce noise and clutter.

Motor Disturbance

Doing things over and over, such as:

• Opening and closing drawers or doors
• Putting on and removing clothing
• Fidgeting, pacing, tapping fingers or bouncing feet a lot
• Repeatedly handling buttons or picking at things
• Wandering (repeatedly walking away without any purpose)

• Turn action or behavior into an activity (turn noises or yelling into music or turn on music; if person is rubbing their hand on the table, provide a cloth for dusting).
• Identify the time of day the person is most likely to wander and plan things to do during that time.
• Involve the person in daily activities.

Nighttime/Sleep Behaviors

Changes in sleep habits, such as:

• Waking up during the night
• Walking around the house at night
• Getting up earlier than usual in the morning
• Taking excessive naps during the day

• Maintain regular times for meals and bed.
• Seek morning sunlight exposure.
• Schedule regular daily exercise.
• Avoid alcohol, caffeine, and nicotine.
• Provide nightlights and security objects.
• Discourage watching television during periods of wakefulness.

Sundowning

Behaviors that worsen in late afternoon into the evening, including increased confusion, anxiety, agitation, pacing, and disorientation.  Factors that may aggravate late-day confusion:

• Fatigue (mental or physical)
• Low lighting/increased shadows
• Disruption of the body’s “internal clock”
• Difficulty separating reality from dreams
• Presence of an infection such as UTI

• Try to keep a predictable daily routine.
• Encourage activities during daylight.
• Make early evening a quiet time of day.  Play soothing music, read, or go for a walk.
• Limit daytime napping and caffeine.
• Have a family member or friend call during this time.
• Close curtains or blinds at dusk to minimize shadows, which can cause confusion. Turn on lights.
• Distract with a favorite snack, object, or activity.