It’s an understatement to say that caring for someone with Alzheimer’s or other memory impairments is challenging. You wear many hats throughout the day, but one you probably didn’t anticipate is that of detective. However, when our loved ones exhibit troubling behaviors, playing detective can be the key to interpreting what these behaviors mean. We’ve all heard of the 5 Ws – here are 6 to keep in mind for understanding behaviors.
What is happening?
The first question to ask is the what. What behavior is occurring? Sometimes this is an obvious answer, especially if there is a physical behavior involved. If your loved one is continually pacing, or perhaps striking out, these are clear behaviors. However, sometimes the behavior might be emotional. Perhaps they are afraid, withdrawn, or frustrated. These emotional behaviors may not be as obvious to spot, and could manifest themselves through physical behaviors. Perhaps your loved one is pacing because they are frustrated. Take note of everything you can when determining what is actually happening.
Why is the behavior happening?
This leads into the next question: why? Is there an emotional or psychological reason for the behavior? Feeling afraid, frustrated, or lost can lead anyone to act out. Don’t forget about physical and environmental triggers too. Is the person hungry or thirsty? Are they uncomfortable? Is it too hot or too cold? Are they in an unfamiliar setting? The behavior in question can easily be triggered by these needs for comfort. Finally, see if the behavior may be related to their cognitive decline. Is the task too difficult? Maybe the current activity is too complex, or their attention span isn’t long enough to hold interest. Try to take a look at what might be going on behind the behavior.
Who is involved?
This may seem like an easy question. The person demonstrating the behavior is the obvious answer. But see if the behavior involves just the person you are caring for or if others are involved. If others are involved, is it a particular person? Or perhaps it’s a certain type of person; does the behavior only occur with male or female caregivers? Perhaps the presence of young children affects the behavior, versus someone in their peer group? If a particular person is triggering the behavior, do they look like, or remind your loved one of someone else? As much as we may not want to admit that we hold onto grudges, if your loved one’s care provider reminds them of their former high school bully, they will probably be resistant to care from that particular person. Remember to examine who might be affecting the behavior.
Where does the behavior happen?
Keep your detective skills out for this question too. The environment can be key to assessing – and triggering – behavior. Does the behavior only happen in a certain location? Is it one particular place, or a certain type of place or room? For example, if your loved one is resistant to getting in the car, is it just a certain car? (Maybe it’s hard for them to get into?) Or is it all cars in general? (Perhaps they’re unsure where they might be going). Does the behavior happen in both familiar and unfamiliar environments? (Does the person recognize the car they’re getting into?) Again, gather as much information as you can about the environment where the behavior is taking place.
When does the behavior usually happen?
Is the behavior predictable? Does it happen at the same time every day? If so, time may be what’s to blame. Sundowning is a very common example of this. As the sun sets and natural light begins to fade, many with memory impairment experience increased confusion, as well as mental and physical fatigue, which cause them to act out. If the behavior isn’t always on schedule, could it be due to a change in their schedule? If someone normally eats lunch at 11, but doesn’t eat until 2 on a particular day, they may simply be acting out because they’re hungry. Make a behavior log with times if necessary to get to the root of the behavior.
If you’ve put your detective skills to good use, hopefully you’ve determined – or at least narrowed down! – the cause of the behavior. So then what? First ask yourself if this is a behavior you need to change. Is it dangerous, or hurting or affecting other people? Or is it just annoying? If it’s not harming your loved one or others, it may be fine to let the behavior continue. At least now you may be able to anticipate when, where, or who might trigger it. If the behavior is a problem, do you need to reinforce, or redirect it? Reinforcing or supporting the behavior namely requires that you validate the person’s emotions. If the person is afraid to get in the car, confirm where they’re going, or what they’re going to do. Redirecting, or changing a dangerous or inappropriate behavior will most likely be the hardest. But keep the person in mind; remember their personality, their likes and dislikes. Information gathered from your 5 Ws will help address the situation appropriately.
Carrie Idol-Richards is the Communications Director of Insight Memory Care Center.