dementia and Alzheimer’s disease

Agitation

  • Definition: Excitement, restlessness, or trouble in residents; can be triggered by new people, places, or changes in routine.

  • Triggers can include movies that cause confusion between fiction and reality.

  • Response strategies:

    • Remove triggers.

    • Maintain routine and avoid frustration.

    • Redirect attention and reduce noise and distractions.

    • Engage in familiar activities like sorting or looking at pictures.

Sundowning

  • Definition: Increased restlessness and agitation in the late afternoon through evening in individuals with Alzheimer's Disease (AD).

  • Possible triggers: Hunger, fatigue, changes in caregiver, new situations.

  • Response strategies:

    • Maintain a daily exercise routine.

    • Encourage dressing in regular clothes during the day.

    • Provide adequate lighting and avoid stressful situations.

    • Limit activities and provide calming activities before sundown.

Catastrophic Reactions

  • Definition: An exaggerated response to situations or stimuli due to fatigue, changes in environment, or physical discomfort.

  • Response: Remain calm, assess for triggers, and support the resident without agitation.

Violence

  • Definition: Physical aggression or threats towards others due to frustration or triggers.

  • Response strategies:

    • Call for help if necessary.

    • Block blows but do not hit back.

    • Avoid restraining the resident; keep them calm and remove triggers.

Pacing and Wandering

  • Causes: Restlessness, hunger, disorientation, pain.

  • Response strategies:

    • Provide nutritious snacks and encourage exercise.

    • Allow pacing in safe areas and monitor without restraint.

    • Use clear signs to help identify rooms and areas.

Hallucinations and Delusions

  • Definitions: Hallucinations involve sensing things that are not present; delusions involve false beliefs.

  • Response strategies:

    • Ignore harmless hallucinations but reassure agitated residents.

    • Avoid arguing about delusions.

Depression

  • Signs: Withdrawal, lack of energy, loss of interest.

  • Causes: Loss of independence, inability to cope, fear of disease.

  • Response strategies:

    • Report signs to nursing staff.

    • Encourage social interaction and self-care.

Preservation/Repetitive Phrasing

  • Definition: Repeating words or questions often due to confusion.

  • Response: Be patient, answer calmly, and use the same words.

Disruptive Behavior

  • Definition: Actions that disturb others, often due to pain or frustration.

  • Response strategies:

    • Stay calm and friendly.

    • Identify underlying causes of behavior.

Inappropriate Social Behavior

  • Definition: Includes cursing, name-calling, or yelling.

  • Response: Stay calm, redirect to private areas, report any abuse.

Inappropriate Sexual Behavior

  • Definition: May include unwanted touching or exposing oneself.

  • Response: Stay calm, assess the need for stimulation, and redirect gently.

Hoarding and Rummaging

  • Definitions: Hoarding is collecting items, rummaging is searching through belongings.

  • Guidance:

    • Label personal items.

    • Prepare families to understand residents' behaviors.

    • Provide rummage drawers with safe items.

Sleep Disturbances

  • Strategy: Ensure moderate exercise, time in sunlight, and reduce noise at night.

Suspicion

  • Observation: Increased suspicion and paranoia as AD progresses.

  • Response: Reassure without arguing; provide support.

Creative Therapies

  • Validation Therapy: Accept residents’ feelings in their perspective without reorienting them.

  • Reminiscence Therapy: Encourage discussion of past experiences to enhance memory.

  • Activity Therapy: Use enjoyable activities to prevent boredom and promote self-esteem.