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When the person enters the later stages of dementia, his behaviors become more difficult to handle. He can act in an agitated and aggressive manner. You usually encounter these problems during bath or shower time, or in reaction to an overstimulation in the environment.

Other triggers to problematic behaviors include physical discomfort, frustration over not being able to communicate or do something he pleases, and alterations in his routine. Sometimes, too, the patient exhibits certain behaviors, like refusing help and hoarding. He would just refuse any help or he may only accept help from a specific person. It is also not uncommon for him to hoard food or other items, keeping them underneath mattresses, inside jars, or in dresser drawers.

As his caregiver, remember that his sense of reality may now be different from yours, but it is still real to him. Usually, the environment you create around him can make a huge difference. While you cannot change him, you can employ some strategies to ease any behavioral problems.

Examine the behavior and validate his feelings. Remember that the person has a deteriorating brain function that shapes who he has become. Instead of attempting to control him, try accommodating his behavior. If for example, he insists on getting the car keys, you may say something like, “Yes, you will surely have it as soon as the mechanic is done with the car.” Don’t answer him with a flat “No.”

Also, look at the behavior from a different perspective. You may want to try putting yourself in his shoes so you may better understand his feelings. Remember, you cannot change the person’s behavior. But you can change your own behavior or the physical environment around him.

Introduce pleasant stimuli. You may suggest looking through an old photo album and relive the good memories he had. You may let him listen to his favorite songs, or give him some food to snack on. The important thing here is to divert his attention from what upsets him.

Consult the person’s physician. In many cases, behavioral issues have something to do with the person’s feelings or discomfort. He may be in pain or having an adverse reaction to the medication he has been taking.

Determine the proper approach. Sometimes, his refusal to accept help from other persons is just a matter of how he is being approached. If you are the reliever of his caregiver, you must carefully explain your presence. Tell him when his caregiver is coming back. You may say something like, “Your regular caregiver is coming back in a little while. In the meantime, I’ll help you out until she returns.”

If the person is worried about upcoming activities, like a visit to his doctor, and does not want to cooperate, you must refrain from giving him advance notice about it.

Sometimes, too, the dementia patient refuses to cooperate because he feels like losing control over things. In this situation, it may be helpful to give him a task to do.

Adapt to his behavior. When a patient keeps on hoarding food and things, do not confront and correct him. Instead, try adapting to it. Limit the number of hiding places by locking drawers, cabinets, and closets that are not frequently used. Check the places where he usually hides food and other items, including the trash and laundry bins.

There is no doubt that caring for a person with dementia is a challenging job. Dealing with the different extreme behaviors can be stressful. But even then, care providers must understand that these actions are coping tactics of a person with deteriorating brain function. You must be equipped with patience, understanding, and enormous love for the person if you are to be an effective care provider. After all, the life of a dementia patient is a journey in which you are his trusted companion.

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About the author 

Dr Michael Chua PT, DPT

Dr Michael Chua is a physical therapist practising in Home Health, Skilled Nursing Facilities and Acute Care Hospital. His clinical interest involves pain management, geriatrics and dementia management. He enjoys treating patients and bringing out the best in them using positive treatment approaches, his dynamic work setting in a rural area provides an opportunity to treat a wide range from geriatrics to orthopaedics.

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