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There is no hard and fast answer to addressing a problem behaviour.
The following information is provided as a tool to help the Caregiver find the solution that works for situation they are faced with.
People with Alzheimer's often act as if their minds are caught in an endless tape loop. They may ask the same question 20 times in an afternoon, pace a stretch of floor for hours, or hum a tune that never seems to run out of verses.
At times, caregivers can feel frustrated and even angry at this sort of thing. By understanding the reasons behind repetitive behaviour, you can help provide comfort while preserving your own sanity. It's important to know that your loved one isn't trying to annoy you or push you to breaking point.
A continually repeated question, for instance, doesn't mean that he or she isn't listening to the answer. In the later stages of the disease, damage to the memory may be so severe that the sufferer will not even remember asking the question. With Alzheimer's, the person may also be expressing a specific concern, asking for help, or coping with frustration in the only way he or she knows.
Physiological or Medical Causes
- Side effects of medication (particularly repetitive movements)
- Physical changes in brain from dementing illness
- Memory loss from dementing illness - sometimes people with dementia no longer have the ability to remember that they are repeating themselves
- Misinterpretation of sounds or sights causing anxiety
- Perceived separation from family or loved ones - husband, children or past boyfriends/girlfriends
- Misunderstanding of what is happening, expressed in questions such as, "what are you doing?"
- Inability to express need - such as hunger or need to go to bathroom (expressed by asking food questions or increased agitation and fiddling with clothing)
- Trying to express an emotion, such as fear, anger or insecurity
Have a medical examination done to check medications and for illness or pain
Distract person with a favorite activity, such as walking, or food such as fruit.
Try these communication techniques:
- Respond to the emotion instead of the specific question... The person may simply need reassurance... Remind with brief, simple statements.
- Do not remind the person that he/she has asked before as this may be upsetting.
- Try a gentle touch when a verbal response does not help.
- Sometimes a hug or a gentle shoulder massage may be more reassuring than words.
- Use a calm voice when responding to repeated questions.
- Use simple written reminders with people who can still read. For example, a large sign might say, "We will eat at 5:30 p.m." .
- Use pictures to replace written reminders when ability to read is lost. For example, a picture of a toilet might replace a sign that says "toilet" on the bathroom door.
- Do not discuss plans with the person until just prior to an event ...if this causes agitation and repeated questions ... Ignore the behavior or question ... If there is no response or reinforcement ... the behavior may stop. By remaining silent, anger and frustration cannot be conveyed in your voice ... However, some people are very upset by this and become more agitated ... For others, ignoring eventually works.
- Try audio recordings ...Sometimes a recording of the caregiver talking in a reassuring voice may be helpful. (However, for some people a disembodied voice is confusing).
- Try a videotape of the caregiver speaking ... Again, this can be helpful for some, confusing for others.
- For some dementia victims, videos/dvd have been very reassuring when caregivers are away.
- Use memory aids. Signs, large numeral clocks, calendars, and schedules can help orient some people.
- Remove things in the environment that may trigger repetitive question ... For example, a visible coat rack may trigger the question, "Is it time to go now?
Try these suggestions for repetitive movements,
(Such as moving tongue in and out, rubbing hands together or on legs, tapping, repeated actions of various kinds):
- Have medications checked by physician.
- Occupy the person's hands with an activity, a doll, a stuffed animal, a nerf-ball, when repetitive tapping or hand movements occur.
- Try distraction with music, food, exercise, etc.
- Keep in mind these points when a person is stuck on one step of a task, repeating it again and again:
- Use touch and pointing to gently move on to the next step, e.g., touch arm that goes in the sleeve, point to the sleeve ... Be aware that interrupting the repetitive movement may be very annoying to the person ...
- Be sure to allow enough time, so the person isn't rushed through the task.
- Repetitive motions may be necessary before the person can move on to the next part of the task.
It is sometimes helpful to keep a log or diary to help determine possible causes of repetitive actions.
- Does the behavior occur at a certain time of day or night?
- Are there particular people or events that often precede the behavior?
- Could the person be hungry?
- Could the person be cold or hot?
- Could the person be in pain?
- Could the person be tired?
- Could the person be in need of bathroom?
Remind yourself that people with dementia do not have the ability to remember because of changes in the brain.
To you a question, story or comment is repetition ... To the other person ... it is new information
- Caregivers often have trouble believing that the person is not purposely repeating questions in order to annoy them ... This is rarely, if ever, the case. More likely, dementia victims are trying unsuccessfully to feel a sense of control over their lives.
- Sometimes people with dementia have lost the ability to know how to get attention and may be using questions as an attention getting device ... If this is so, giving them full attention and responding to their emotional needs may sometimes break the cycle of repetition for a while.
- Some repetitive motions, particularly sticking one's tongue in and out, are indications that a person may be receiving too much of a sedating medication.
- If this type of behaviour appears, it is important to consult with a physician about medication doses.
- Occasionally when people ask the same question over and over, they are trying to express I feeling, such as a fear that they will be abandoned or not fed.
- Sometimes responding to the emotion (if you can guess what it is correctly), rather than to the specific question, will help calm some of their anxieties ... For example, "I will always make sure you get fed. Don't worry, I will take care of you," may be a more reassuring answer to questions about mealtimes, than the time of the meal.
- Repetitive motions and questions can be one of the most upsetting behaviors for caregivers ... Sometimes you need to be able to walk away and take time for yourself ... Take a bath, take a walk, do relaxation exercises, etc.
- Sometimes when a word is repeated over and over, it may have a special meaning to the person ... Family members or close friends may be able to interpret the words or identify a person, place, or event which the dementia victim is trying to talk about
Alzheimer's Association (ADRDA) chapter newsletters
Aronson, Miriam (ed) Understanding Alzheimer's Disease. New York: Charles Scribner's Sons, 1988.
Gwyther, Lisa. Care of Alzheimer's Patients: A Manual for Nursing Home Staff.
American Health Care Association and the Alzheimer's Association (ADRDA), 1985.
Mace, Nancy and Peter Rabins. The 36-Hour Day. Baltimore: The John Hopkins University Press, 1981
Powell, Leonore and Courtice, Katie. Alzheimer's Disease: A Guide for Families. Massachusetts: Addison-Wesley Publishing Company, 1983.
Safford, Florence. Caring for the Mentally Impaired Elderly: A Family Guide. New York: Henry Holt and Company, 1986.
Robinson, Anne, Beth Spencer, Shelly Weaverdyck and Susan Gardner. Helping People with Dementia in Activities of Daily Living. Video and slide tape production. Ann Arbor: PhotoMotion Productions, 1987.
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