What Has Triggered Your Loved Ones' Behavior – Encore

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Lisa Skinner: Hello to all of
you who have tuned in to listen

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to this episode of the truth
lies and Alzheimer's show. I am

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Lisa Skinner, your host, and I'd
like to shout out a very warm

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welcome to all of you who have
joined us today. Thank you so

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much for being here. There are
so many aspects of living with

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dementia that are unexpected and
can surface out of nowhere at

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any time. These are what I call
the hidden or secret faces of

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Alzheimer's disease, and as many
of you know, they show up

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unannounced are completely
unpredictable, and that is the

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reason why it's so important to
be prepared for anything that

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emerges on this journey. And to
be honest with you, I don't

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think there's much doubt that
what makes our relationships and

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caring for those who live with
Alzheimer's and related dementia

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so challenging is the disconnect
that occurs in our ability to

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communicate effectively with one
Another as the progression of

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disease worsens over time, it
clearly becomes more and more

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difficult to know what your
loved one is trying to tell you

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when they are no longer to able
to articulate their wants and

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needs to you. This is the very
reason why I cannot stress the

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importance of arming yourself
with an arsenal of tools and

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strategies so you can be as
prepared as possible when these

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situations arise. And just like
we can count on the sun rising

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each morning, you better be sure
we can count on these situations

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arising unexpectedly every day,
and I want to remind you,

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because I've said this before,
not every strategy works for

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each situation every time. So
the more tools you have

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collected in your toolbox, the
more options you will have to

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use to try to diffuse a
situation from escalating into a

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catastrophic reaction where it
can just really get out of

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control. So what I'm going to
share with you today are some

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triggers and responses to some
of the behaviors that occur as a

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result of this disconnect and
communication, they typically

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manifest as behaviors, and this
is really the way that the

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person you're caring for or your
loved one is trying to tell you

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that there is something
genuinely wrong. They are not

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trying to be difficult. They are
not trying to make your life

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hard. They are not trying to be
spiteful. They honestly can no

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longer tell you what is
bothering them so they will

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behave in a way to get your
attention, trying to relay a

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message to you. And these are
the things that you must learn

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to recognize. That is their way
of communicating with you. You

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learn to recognize the
behaviors, and then you're going

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to have to learn how to identify
what the trigger was for that

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particular behavior. So the tips
and the tools that I share with

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you, you want to just kind of
file them away or collect them

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in your toolbox, as I said. And
if one thing doesn't work, you

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can try another, and the more
tools you have to pull out and

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try, the better equipped you're
going to be for any circumstance

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that will arise. So
environmental issues can create

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behavioral problems in people
with dementia. Examples of

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environmental related issues are
sensory overload. So in other

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words, too much going on around
them, being around unfamiliar

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people, noise, lighting,
something that startles them,

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agitating behaviors of others in
the environment. People with

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dementia pick up other people's
moods and emotions, and they can

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mimic those emotions, and
that's. Other thing I wanted to

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mention, because people lose so
much of their cognitive skills,

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what it really comes down to, at
the end of the day, is

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everything that they are
reacting to is basically comes

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down to raw emotion, because
they no longer have the ability

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to reason things out or to think
things through. So these

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behaviors are raw emotion,
trying to tell you that they

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need or want something. Tasks
presented to a resident with or

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a person with dementia can
create these behavioral

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problems. Here are some of the
task related issues and

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solutions. So in terms of
issues, if a task is

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overwhelming to a person, that
can be a trigger, if they feel

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rushed, if it causes them to
become overstimulated if a task

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is too complicated, if they are
not able to focus on a given

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task, and if they have a poor
attention span. So here are some

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of the solutions to those
issues. Keep things simple, slow

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it down, stay calm and be
gentle. Take one step at a time,

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always make eye contact and
repeat instructions as needed.

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Communication can also
contribute to a person's

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behavioral challenges. Without
effective communication, the

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psychosocial quality of life of
the resident quickly

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deteriorates. Now communication
can be verbal, nonverbal, or

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both. Now verbal communication
is the words we use. Nonverbal

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communication are your actions,
your body language and your

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facial expressions, your tone of
voice, expression of emotion and

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your inflections are also
considered part of nonverbal

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communication. Effective
communication is the key to

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working with people with
dementia. So when communicating

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with people who have dementia,
it helps to face them directly,

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speak slowly, use their name

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and then wait for a response
from them. Don't rush. Repeat it

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if necessary. Use cueing or
modeling behaviors. Smile at

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them at all times, then they
will not absorb feeling a

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sternness coming from you or
that you're mad or upset with

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them, and then praise them
always and reassure them that

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everything is fine and they're
doing great now, according to

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the Alzheimer's Association,
there are three basic steps to

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assist in identifying common
behaviors and causes. Step one,

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identify and examine the
behavior. You should ask

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yourself the following
questions, what was the

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behavior? Was it harmful to the
individual or to others? What

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happened just before the
behavior occurred? Did something

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or someone trigger that
behavior? Other questions you

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may consider in order to examine
the behavior include what

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happened immediately after the
behavior occurred. How did you

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react? The Alzheimer's
Association suggests that you

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should consult your loved one's
physician to identify any causes

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related to medications or an
illness that may be developing.

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So step two is explore potential
solutions. The Alzheimer's

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Association also recommends
identifying the needs of the

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person with dementia and
evaluate if these needs are

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being met. So some of the
questions you may consider in

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your exploration is, Can
adapting the surroundings

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comfort the person? How can you
change your reaction or your

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approach to the behavior? Are
you responding in. Calm and

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supportive way. It is very
important to keep in mind that

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the person with dementia may be
using these behaviors to

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communicate his or her needs in
the only way he or she knows

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how. This is why you as a care
provider or a family member,

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need to be cautious of your
response. It can make all the

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difference in the world. Step
three, try different responses.

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Again, once you attempt new
responses, you should evaluate,

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did your new response help in
this situation, the Alzheimer's

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Association asks, Do you need to
explore other potential causes

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and solutions? If so, what can
you do differently? There are

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many, many resources you can use
to discover positive solutions

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to challenging behaviors. And I
want to also remind you again

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that if your response works at
that time for that given

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situation, and then the same
thing happens again and you try

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that same response, it may not
work this next time. So the more

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responses you have to pull out
of your toolbox, the more

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chances you will have of
diffusing the situation. So

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below, I mean, what I'm going to
share with you now is a list of

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what we call 13 R's, what is
called a solution focused model.

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And the solution focused model
focuses on what you can do right

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now to change the person's
behavior, rather than focusing

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on the problem that made the
person display a difficult

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behavior. Now this approach does
not focus on the past, but

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instead focuses on the present
and the future. The 13 R's are

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number one, remain calm your
voice and your body language.

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Number two, remove the trigger.
You want to eliminate the source

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of agitation, but you have to
figure out what that source of

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agitation is. First, not an easy
task. Number three, redirect the

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person, so guide them to another
task. Number four, reassure them

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by making positive statements.
Number five, Repeat if

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necessary. Number six, revise
present, one step at a time.

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Number seven, respond, which is
listening and paraphrasing their

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words. Number eight, reference,
validate their point of view.

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Number nine, remind, always
encourage reminiscing and

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praising past accomplishments
number 10 reflection, which is

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physically acknowledging
communication. In other words,

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one example would be by nodding
your head to them. Number 11 is

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reinforced. You can do this by
praising positive behaviors

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number 12 reporting incidents,
and what they mean by that is,

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write down, keep a journal of
things that trigger behaviors so

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you will have a reference to
look for in the future, and then

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13 reevaluate, establish the
root cause and assess it for

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controlling the situation. So
next, I'm going to share with

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you some very specific
behavioral responses that you

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may see in people with dementia,
each type of behavior you may

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observe, followed by some
suggestions that you can do to

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help minimize the undesired
behavior when a loved one

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displays anger or agitation.
Here's some tips, do not express

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impatience. Maintain calmness,
smile and reassure. Speak slowly

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and offer comfort. Redirect.
Attached to a quiet area, engage

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with them in a favorite past
time, offer a favorite food or

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beverage and whisper. When the
person becomes aggressive, it

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can help to again remain calm
while you approach them, get

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help, if necessary, use what's
called change of faith

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technique, and what that means
is you get a different person to

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come in and see if that will
make a difference, to diffuse

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the behavior, again, called
change of face. Attempt to

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redirect the person, and when
you do, redirect them to a safe

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area, for example, their room or
a quiet area. Provide a

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distraction. You can use a known
interest to distract them when a

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person with dementia is anxious.
It also helps to identify the

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trigger and time of the
occurrence. It's helpful to keep

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a journal of these things and
reinforce positive behaviors,

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help the resident, help the
person with dementia, reduce

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anxiety, encourage viewing
family photos for discussion,

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that's a great distraction, Keep
them busy and use relaxation

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methods. One of the really
effective ones is give them a

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hand massage. They love that,
and it's very calming. Now, here

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are some things you can do when
the person has increased

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behaviors in the late afternoon
and evening, often referred to

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as sundowning. Prepare for
raised anxiety, turn lights on

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ahead of time. Minimize their
distractions, remove any

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clutter, provide a safe place
for them to rummage. Offer

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favorite items of interest.
Offer snacks and drinks and play

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soft music in the background.
That is very effective.

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When a person is disruptive, you
may seek their attention,

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approach them in a friendly
manner, redirect them to a

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private area, if possible,
inform them of a change in

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routine, encourage an
independent activity, involve

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them in any plans, If possible,
and help them gain their coping

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skills. Here are some things you
can do to help with sleep

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problems. Monitor their sleep
patterns, determine cause such

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as hunger or discomfort, provide
daily exercise, establish

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routine napping, if necessary,
remind them that it's their

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bedtime. Provide security items
such as a favorite picture or

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stuffed animal. Create rituals
such as hand massages, drink,

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prayer, beds, etc, and wind down
activity participation after

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dinner. Unless requiring
exercise, it's always best to do

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more stimulating activities
earlier in the day and wind down

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as the day progresses, on supply
night lights, if they're

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preferred, and reassure them
that you will check on them

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throughout the night. Now, tips
for handling agitation include

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address any chaos in the
environment by reducing noise

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levels and the number of other
people, avoid moving household

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objects around whenever
possible. Familiar object

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located in the same places
provides them with a sense of

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security. Change the immediate
environment. When the person

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with dementia becomes agitated
again, play soothing music. It's

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magical. It's powerful. Safety
proof the environment to allow

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for as much autonomy as possible
with the least number of hazards

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handling communication problems
include giving reassurance. Is

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trying to use a touch if verbal
support isn't working. Again,

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limiting outside distractions.
Turn off radios and television.

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Listen for the meaning of the
feelings behind their words.

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Speak clearly and loud enough to
be heard, and then, of course,

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use nonverbal means of
communication, such as body

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language, facial expressions and
touch. Many people with dementia

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have ongoing communication
problems. This is going to

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include forgetting words using
repetitive phrases and other

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things that you will notice now
how to handle delusions,

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hallucinations and paranoia,
along with Anxiety, delusions,

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hallucinations and paranoia are
extremely common behavioral

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issues in people with dementia,
and they may occur as a result

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of changes in physical health of
the brain. So some tips for

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handling delusions,
hallucination and paranoia

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include probably the most
important thing is avoid arguing

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or trying to impose a sense of
truth or reality into the person

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with dementia. Why it absolutely
does not work. Don't feel the

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need to play into the lie. You
can be honest while still

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providing dignity and respect,
and then reassure that person by

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saying things like, I am so
sorry. You are getting upset by

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this. Let me see if I can help
and then redirect the person

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with dementia to divert their
attention to something more

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appropriate tips for handling
sleeplessness and sundowning. So

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insomnia and sleeplessness also
known as sundowning, are again

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common behaviors in people with
dementia. They occur due to a

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combination of factors and can
be worsened by exhaust, by being

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exhausted after a day's events.
So some tips on handling

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sleeplessness and sundowning
include avoid giving your loved

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one alcohol, caffeine or sugar,
considering hiring help at night

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so you as a caregiver can get
enough sleep without having to

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leave your loved one with
dementia unattended. Discourage

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napping during the daytime, talk
to a healthcare provider about

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natural sleep induced medication
such as melatonin, and turn the

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lights on and close the curtains
well before sunset to eliminate

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confusion about the time,
particularly in the winter

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months. And then the last tip I
have for you today is how to

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handle wandering. It's not
always easy to find out why a

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person with dementia is
wandering, but caregivers can

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use these insights to help them
more effectively deal with that

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problem. You can add child safe
plastic covers to doorknobs. You

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can consider having them carry a
GPS tracking device, always have

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a current photo on file, just in
case the person with dementia

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goes missing, register them with
the safe and sound program in

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your local area. Install door
alarms and set them to go off if

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the door is opened, and finally,
install locks that require a

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key, keeping safety issues in
mind for all people in the home.

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So those are hopefully some very
helpful and valuable tips for

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you to consider while
encountering some of these

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challenging behaviors that will
occur. So in my segment, what's

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news, I want to share with you
an article that I stumbled upon.

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It was in Fortune, well
presented by CVS Health, and the

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title of the article is called
cognitive decline after

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retirement is a universal trend.
Here are four ways to reverse

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it. The article was written by
Aaron Prater, and it was

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published on May 19, 2023 so.

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And this is what the article
tells us now. It was authored by

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researchers at the University of
Cologne in Germany and the

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University of California San
Francisco. The researchers

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interviewed nearly 9000 European
retirees, ages 50 and older,

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from 17 countries each completed
six memory assessments over the

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course of 13 years. Their
findings retirement was

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generally associated with a
moderate decrease in Word recall

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and memory decline accelerated
after retirement. This was true

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in all countries involved, even
in those with more generous

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welfare systems and higher
pension benefits, like Germany,

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Austria, France and Belgium,
versus those with low public

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pensions, like Portugal, Greece,
Israel, Estonia, Poland and

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Slovenia. The study showed that
postponing retirement can

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protect against cognitive
decline, especially among the

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more highly educated. But let's
face it, the article says life

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is short for those who can and
wish to retire on time, here are

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four tips for staying mentally
sharp during what should be the

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most joyous season of your life.
So keep or get connected. A

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quarter of Americans age 65 and
older, are socially isolated.

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According to a 2020 report from
the National Academies of

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00:26:45,760 --> 00:26:50,440
Sciences, Engineering and
medicine, while loneliness is

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00:26:50,620 --> 00:26:58,480
miserable, it's also more, it's
also more, it poses a health

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00:26:58,480 --> 00:27:04,080
risk as deadly as smoking a
dozen cigarettes a day the US

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00:27:04,200 --> 00:27:09,300
Surgeon General, Dr Vivek Murthy
recently told attendees of

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Fortune's brainstorm health
conference, retirement often

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00:27:13,620 --> 00:27:18,360
means loss of the community you
worked in perhaps for decades.

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So keep connected to others by
taking classes, volunteering,

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hanging out with friends, or
picking up a sport. The second

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00:27:29,360 --> 00:27:35,480
recommended advice is to keep
active. It's never too late to

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begin an exercise routine, even
if you didn't do it in pre

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retirement, or if you fell off
the wagon at same point, get up

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and get going again. The third
one, keep your stress to a

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minimum. There are many, many
ways to keep stress at bay. A

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few of them are get a good
quality sleep and do your best

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not to introduce any new
stressors in your life. And then

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finally, keep working. Ideally,
you're in a situation where you

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you might not have the financial
need for a typical nine to five

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00:28:19,920 --> 00:28:24,740
day like you did when you were
working, free retirement, but

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00:28:24,980 --> 00:28:29,000
you have just as much to
contribute to society as the day

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00:28:29,000 --> 00:28:34,880
before you retired. If it brings
you joy, consider volunteering

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00:28:35,180 --> 00:28:39,680
contract work or a part time job
in the field you love.

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00:28:39,680 --> 00:28:44,920
Regardless of pay, you'll reap
the benefits of connectedness

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00:28:44,980 --> 00:28:49,120
and cognitive acuity and
typically accompanying work,

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hopefully without all the
stress. So I think that's some

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pretty good advice. I have known
a lot of people who have retired

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00:28:58,480 --> 00:29:02,640
and then just seem to
cognitively decline within years

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00:29:02,640 --> 00:29:06,660
of retiring. So I think this is
some really sound advice to

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00:29:06,660 --> 00:29:12,060
follow for those of you who want
to stay sharp even in your

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00:29:12,060 --> 00:29:19,560
retirement years. So that's what
I have for you today. I want to

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00:29:19,560 --> 00:29:24,320
thank you again for listening.
We always have so much to cover

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in our current episode and
upcoming episodes. And as you

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00:29:29,240 --> 00:29:33,980
know, I really it's so important
for me to provide you with

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00:29:33,980 --> 00:29:38,360
information that you will find
helpful and valuable throughout

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00:29:38,720 --> 00:29:44,140
this journey. Remember, and I
can't emphasize this enough,

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dementia awareness occurs every
day. The kindness is the ability

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00:29:51,280 --> 00:29:55,960
to speak with love, listen with
compassion and act with

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00:29:55,960 --> 00:30:01,260
patience. These are all very
necessary. Attributes to have in

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00:30:01,260 --> 00:30:07,380
order to outlast Alzheimer's
disease. This show is all about

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00:30:07,440 --> 00:30:13,740
you and how my experiences,
expertise and strategies can

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00:30:13,740 --> 00:30:17,940
help you and your loved one have
an easier time while struggling

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00:30:17,940 --> 00:30:23,240
through this disease. I know how
difficult it is, therefore I

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00:30:23,240 --> 00:30:26,780
would love it if you would send
me your comments and suggestions

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00:30:26,780 --> 00:30:31,460
on what topics you'd like me to
cover on this weekly show. I

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00:30:31,460 --> 00:30:34,220
genuinely look forward to
receiving your thoughts and

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00:30:34,220 --> 00:30:39,320
ideas, and in the meantime, take
care of you, talk to y'all next

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00:30:39,320 --> 00:30:39,800
week.