Top 10 Triggers for Sudden Behavioral Changes in Dementia

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Hi everyone. Welcome to another new episode

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of the truth lies and Alzheimer's show. I'm Lisa

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Skinner, your host. I have a question for you. How many of

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you have encountered a situation, whether it would be

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spending time with a loved one living with dementia or caring

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for someone who's living with dementia, and then, out of

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nowhere, the entire climate changes, and you have no idea

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what just happened. Does this sound familiar? And maybe for no

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apparent reason. For example, the person you're caring for

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just flat out digs their heels into the floor and refuses to

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take a shower. Or you could be right in the middle of that

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shower, shampoo is still on their head, and they all of a

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sudden, out of the blue, decide they're done, but obviously the

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shower isn't. Or couple other scenarios that happen pretty

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regularly and are very common, is that all of a sudden they

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become angry or anxious or combative for no apparent

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reason. Well, these sudden changes in moods do happen

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regularly with dementia, as a lot of you probably already

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experienced, but there is almost always a reason, I would say

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99.9% of the time. And we call these incidences triggers,

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something trigger the sudden change in mood, and

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unfortunately, the hard parts on us as family members and

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caregivers, because we are tasked with having to figure out

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what that something is, and it's not always obvious. And the

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other thing is, there are so many things that can trigger

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sudden mood changes or behavioral changes. So that's

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what we're talking about today. On this episode, I'm going to go

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over the top 10 triggers for sudden behavioral changes with

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dementia, and I'm going to give you some tips for de escalating

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the situation, effective responses and strategies, as

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well as other helpful information that will help you

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turn these situations around into positive outcomes. Now

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there are more than 10 triggers, but I'm just going to go over

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probably the top 10 that we know that would you know cause a

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sudden behavioral change in the person you're caring for, or

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family member. So you want to look to see if they are somehow

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in pain or they're experiencing discomfort. But dementia can

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make it hard for them to express pain. So what you want to do is

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look for nonverbal cues. There are they grimacing? Are they

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resisting movement? Do they seem withdrawn? Then there could be

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one another. Trigger, commonly is hunger, thirst, or they have

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a physical need. Do they need to go the bathroom? Is the

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temperature of the room too hot, too cold? Are they sleepy? So

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one example is a full bladder, being hungry or being too hot or

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cold. Does cause agitation, or can cause agitation and or

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aggression. A change in their routine or their environment can

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trigger a behavioral change, such as a sudden schedule

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change, bringing in a new caregiver, relocating them to an

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unfamiliar place or unfamiliar surroundings can trigger

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confusion and also distress. Number four is it's a medical

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issue, or has to do with a medication there on infections

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such as urinary tract infections, pneumonia,

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dehydration, constipation and side effects of medications can

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and do alter moods and behavior. Number five is over stimulation

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or sensory overload can trigger behavior. Neural changes. So

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what does that look like? Noise being in a crowded space, the

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lights are too bright or busy environments, these things can

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all overwhelm people living with dementia. Also number six is

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under stimulation or being bored, so too little engagement

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can lead to restlessness, pacing and repeating type behaviors.

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Fidgeting can also show up when they're bored or over

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stimulated. Number seven is communication gaps or

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frustration with expression, and that would look like difficulty

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finding words on their part or understanding their symptoms

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that would inevitably cause frustration and outbursts a

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recent loss or or emotional trigger. So anniversary

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reactions, grief or reminders of their cognitive decline can

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definitely provoke mood changes, fatigue and or sleep disruption,

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if you remember me telling you in one of the previous episodes,

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when people live with dementia, their circadian rhythm is

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completely thrown off. So a lot of people with dementia think

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they're supposed to sleep during the day and they're wide awake

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and wandering around and restless at night because their

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bodies can't tell the difference anymore. So poor sleep

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definitely can worsen memory, cause confusion and

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irritability, and then number 10 is they feel unsafe or that

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something is a perceived threat to them, perceived danger or

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lack of control can trigger fear based reactions. So keep that in

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mind. They could become aggressive. They can become, you

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know, guarded, and lash out. So these are all things that you

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want to kind of go through a process of elimination and see

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if it's any of these. Now, as I mentioned, there are so many

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triggers that are out there, but these are the top 10 Things to

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probably start with. So now I'm going to offer you some de

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escalation and response strategies for caregivers and

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family members who might be visiting or or, you know,

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spending time with their loved one, and then these mood changes

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occur, and you're not really sure what just happened. So

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identify and address their underlying need. Look for signs

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of pain. Do they need to go to the bathroom? Are they hungry?

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Are they thirsty? Are they tired? Check for medical issues

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or medication effects with their care team always create a calm,

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safe environment. So some of the things you can do is reduce

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noise, reduce clutter, use soft, soothing, calming lighting,

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minimize competing stimuli, turn down the TV or the radio if it's

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way too loud, or you're noticing that, you know based on their

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body language and the way they're acting, that they're

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over stimulated, and then always ensure that the person has a

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comfortable temperature in the room that they are in. Use clear

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communication and be patient. Speak slowly. They don't process

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information the way they used to one idea at a time and use

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simple words, ask yes or no questions and give options.

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Would you like to sit here or would you like to sit here?

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Validate their feelings? I can see you're upset, and I'm here

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to help

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redirect rather than confront. So what does that look like?

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Offer a simple, engaging activity for them to do to, you

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know, help them get their mind off of whatever it is that's

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bothering them. You can ask them to help you full towels, sort

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things. Let's go for a short walk. But the key is avoid

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arguing about who is right, acknowledge their emotion first.

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There is no right. Establish predictable routines, maintain

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consistent daily schedules for meals, activities and rest. This

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makes a huge difference in the day of a person living with

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dementia. Trust me, prepare in advance for changes, and use

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visual schedules or calendars if those are helpful. So learn to

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manage these triggers proactively. If a known trigger

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is present like you walk into a room and the music is obviously

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loud. Modify it, remove it, turn it off. Prepare for predictable

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events. So in other words, you got to go the doc, take your

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loved one to the doctor or the person you're caring for. So

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preparation for that is to show them or give them a familiar

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object, provide them with reassurance, and make sure you

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allow plenty of time and then using soothing techniques like

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gentle reassuring touch, if appropriate, and welcome on

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their end, you saw a soft voice, slow breathing exercises,

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playing familiar music for them is very common and triggers most

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of the time, very fond memories, familiar routines or reminiscing

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with them, looking at photos, telling Simple Stories. Now

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there's safety considerations. Also monitor for aggression,

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safely give space if someone needs it, move to a safe, quiet

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area if the aggression escalates, remove the trigger

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that you believe is causing this aggression and allow time for

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them to calm down, avoid physical restraint, unless

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necessary for safety, and then, of course, always allow for time

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and patience. Allow pauses, give the person time to process, be

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consistent and calm. Your emotional state communicates a

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lot. They pick up on your emotions and they emulate your

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emotions. This is a known fact plan for difficult episodes. So

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what one of the things that we recommend is that you have what

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we call a comm kit ready. What's in your comm kit? Well, you can

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be creative with that. But some of the suggestions are to have a

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favorite snack, readily available, or a comforting item,

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a familiar blanket and a water bottle. And then the other thing

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that you can do whenever these behavioral changes happen.

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Document the patterns. So include what happened, the

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triggers you identified, what calmed the person in that given

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situation, and of course, you always want to share this

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information with the care team. So if the exact similar

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situation arises, you will have the have documented what de

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escalated that particular situation. But I just want to

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tell you that the strategy that worked for this particular

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situation may not work for the next time it happens, even

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though the circumstances are pretty much the same. So this is

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why we really emphasize having a toolbox that you've assembled

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with different strategies, skills and techniques. So if one

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strategy doesn't work for a situation you have something

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else to pull from, or others to pull from. So I'm going to give

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you this quick checklist to keep handy of all the things that I

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just went over, so you can write these down and have a checklist.

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Number one, check the basic needs. Are they hungry, thirsty?

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Do they need to go the bathroom? Could they be in pain? Is the

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temperature surrounding temperature in the room

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comfortable for them? Have they had enough sleep? Number two,

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eliminate or reduce triggers? In the environment number three,

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Speak calmly, using simple sentences and validate their

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feelings. Always recognize and acknowledge the emotion first

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and then the problem. Number four offer a distraction or

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gentle redirection. Let's go for a walk. It's a beautiful day

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outside. The next one use a familiar, comforting routine or

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object. Next ensure safety for yourself and the person you are

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caring for or your loved one. In other words, make sure that

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they're in a safe space, that they can't exit the building or

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the environment, and they're properly supervised. Record what

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happened and what helped for future reference. And then the

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last one is communicate with healthcare providers about

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recurring or severe changes. One of the questions that comes up

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quite often is, well, when should I seek medical advice?

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When these things arise? Our advice is if sudden, new or

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escalating aggression or confusion occurs, signs of

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infection, dehydration or new medications that are causing

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these occurrences to happen, severe withdrawal, you thinking

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they may be at risk of self harm or harming others. And then here

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are some additional tips for you use meaningful activities tied

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to their past interests. Do they like to garden? Or did they like

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to garden? Were they a baker in their earlier years, the younger

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years? Were they a craft person? So you can offer these types of

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activities and limit the sessions to 10 to 15 minutes to

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avoid fatigue, because that can create a mood change, build a

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simple choice board with three easy options for activities to

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reduce their decision making fatigue, they just can't process

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information very easily anymore, so too many choices is

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overwhelmed for people living with dementia, use nonverbal

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cues such as nodding, gentle facial expressions and hand

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gestures to support your spoken words validate briefly then

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offer concrete options. So here's an example. I know you're

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upset. So would you like to sit here next to me? Or would you

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like to sit in the chair right there? Create a stimulation map

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of your home zones that are quiet, predictable and safe,

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label rooms with photos or words, use familiar smells,

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vanilla, lemon, chocolate chip cookies coming out of the oven,

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bread, anything that you know they really resonate with. The

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other thing you can do is play soft music to create calm,

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establish a predictable rhythm for mornings and evenings, but

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allow wiggle room for days when it's obvious that they're just

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feeling Off. Build build in, built in buffer times between

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activities to reduce rushing and frustration,

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maintain an up to date medication list, including the

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vitamins and over the counter items that they're currently

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taking, and review them on a regular basis with their doctor.

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Schedule regular check ins, even if they're short and brief, with

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their primary care provider or geriatrician to catch evolving

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needs, early, track symptoms in a simple diary, moods, sleep

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patterns. Is appetite patterns, pain indicators and any new

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medications that they have been prescribed. You can use a simple

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pain scale adapted for dementia. For example, you might have a

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category facial expressions. And are you noticing from on a scale

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from zero to three, what is their current facial expression,

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and what is it trying to tell you? And you want to note this

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during uncomfortable moments, and then check always this is

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part of your process of elimination, check for subtle

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signs of constipation, dehydration or urinary issues,

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which are extremely common triggers. Now it is very common

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for people living with dementia to become dehydrated, and part

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of the reason is they can't tell they get to a point in their

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decline, they can't evaluate or tell when they're thirsty. So

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they're probably not going to indicate to you that they need

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something to drink. That's going to be the responsibility of the

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caregiver and or the family member to, on a regular basis,

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offer hydration. It doesn't always have to be water. It can

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be other forms of liquids, or popsicles, things like that, but

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they do become dehydrated very easily and quickly remove any

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trip hazards and ensure good lighting at night, consider grab

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bars and non slip mats where needed. Keep a list of emergency

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contacts and a copy of key medical information available at

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all times. Schedule regular breaks for yourselves as

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caregivers, use respite care when possible, I recommend

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joining a caregiver support group, either in person or

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online. It is always so nice to feel that you are not alone in

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this journey, and that other people are experiencing a lot of

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the same situations that you face on a day to day basis, and

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you can share your strategies and be supportive emotionally

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for one another, set boundaries for yourself and realistic

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expectations. Acknowledge when a situation is beyond your

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capacity and seek help a lot of times, family members and

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caregivers believe that they're super human beings and they can

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do it all, and that is a recipe for Quick caregiver burnout.

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Consider reminders on a simple timer or watch for medications

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and routines, use big button phones or tablets with easy

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navigation for reminders or for communication. And then there

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are door monitoring devices that can provide alert cues for

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safety while preserving independence. You can visit on

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my website, mining dementia.com, and there is a products list

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there that you can find these door and monitoring devices.

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Maintain a care plan document with typical triggers, effective

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de escalation approaches as you continue to collect them and

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learn them, the medical history of the person that you're caring

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for and preferred objects, things that they really seem to

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take to create an advanced care directive and discuss future

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wishes early when possible. So when do we involve professionals

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if the behavioral changes are abrupt, severe, or are

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increasing in frequency. If there are new safety concerns,

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you've seen an increase in significant memory decline or

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confusion. And as a caregiver, if you're feeling overwhelmed or

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you're feeling that you're at risk in some way, and then some

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of the resources that are out there that you can tap into, our

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local dementia and Alzheimer's Association chapters, geriatric

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care managers and social workers, home health aides or

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respite. Care Services, palliative or comfort care

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specialists, if you feel that's applicable. And then there are

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cognitive rehabilitation and also occupational therapy

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providers for engagement strategies, if you'd like, share

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the details about the person's living situation, their typical

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routines and the current challenges that you're noticing,

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like the time of day that they seem to become more agitated, or

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when some of these behaviors spike, and what specific

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triggers you've noticed, bring these on. So that is what I have

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for everybody today. I hope this has been extremely helpful. I

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will share other triggers in the future on future episodes,

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because there are a lot to consider, but these, let's start

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with these 10 so we don't get you too overwhelmed and put you

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in information overload mode. Okay, so again, I want to thank

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everybody for spending part of your day with me here on the

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truth, lies and Alzheimer's show. I'm Lisa Skinner, your

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host, I'll be back next week with another brand new episode

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for you. I hope you'll be joining us, and hope you enjoy

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the rest of your day and always try to stay happy and healthy.

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Okay, talk to you soon. Bye, bye.