I was watching television one evening when I came upon a movie called “The Accountant.” It starred  Ben Affleck as a high functioning autistic man who has a number of special gifts, including a bit of a dark side, to say the least.

You first meet his character as a young boy and learn very quickly that his father is not going to give in to his son’s alleged weaknesses but teach him to adapt and overcome those weaknesses to make him a stronger person. The father has an exchange with one of his sons and makes it very clear to him that he is not weird like the other kids say, he’s just different. Dad goes on to say, “eventually different scares people.”

When you look at some of the different behaviors that people afflicted with Alzheimer’s and other dementias display, I guess you could understand why many folks, especially those who don’t understand dementia, are indeed scared.

About 80% of people with Alzheimer’s will develop some form of challenging behavior, with verbal aggression being No. 1 on the list. Many other behaviors, of course, present the most experienced caregivers with some real challenges. Maybe they refuse to shower, won’t get in the car, want to wear the same clothes, won’t eat or won’t stop eating, display inappropriate sexual behavior etc. Always remember my “three rules of the caregiver road.” 1. They are looking to us to feel safe. 2. You can’t reason with someone who has lost the ability to reason, and 3. It’s the illness that is responsible for their behavior. Let’s drill down a little on these.

We need to be detectives and try to get to the bottom of why they are behaving the way they are. Remember, too, that their behaviors are, more often than not, reactions. For example, is the reason he doesn’t like to shower because he doesn't feel safe? Or is it modesty, or the feeling of being cold? Ensuring that the bathroom is warm, that she is covered with a towel and isn't walking on a wet slippery floor can go a long way. Telling the person that he or she's got nothing to worry about won’t work because, as we all know, perception is their reality.

The illness has taken away their brain's boss and therefore whatever behaviors they are displaying make perfect sense to them. I’ve told you of the lady who almost killed herself and a few others in a car crash. Her response when they took her license away? “You’re taking away my independence.” Not, “Good idea, I’m a danger to myself and others on the road.”

When determining what may be behind a certain behavior, you should always be asking, is she in pain? hungry? thirsty? constipated? Do they need the toilet or are they scared? Evaluate the environment. Is it too loud? Is it a new environment they're not familiar with? 

Some other causes of behavior challenges can be drug interactions, an environment that is not dementia friendly, perceived threats, fatigue, vision or hearing loss, a hospitalization, or being asked to do something they are not able to do. Like I said , we have to be detectives.

Please be aware, too, of communication challenges. Do they have trouble finding words (expressive aphasia) and can’t tell you what may be bothering them? Or do they have receptive aphasia, in which they don’t always understand what you’re saying? It’s been said that having Alzheimer’s is like living in a foreign country and not speaking the language. Personally, I’ve been that guy more than once and it’s not fun. 

Finally, do you know how to get them to their happy place or even what their happy place is? A TV show, a piece of music, photos of the family, the cat or dog? Knowing how to redirect them is a great tool when they go their dark place.

Questions? Email me at repe@careforcaregivers.org. Join the Journey.

Robert E.P. Elmer III, of Stonington, is a senior care adviser and Alzheimer’s care specialist. His website is at www.careforcaregivers.org.

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