How to handle big changes in how they act or what they believe

When someone with dementia experiences big changes in behavior or beliefs, such as paranoia, hallucinations, or repetitive actions, it can be challenging for family members to respond. Here are tips, actions, and recommendations to help navigate these changes:

1. Stay Calm and Reassure Them

• Remain composed: When they exhibit sudden changes like paranoia or hallucinations, stay calm. Your own calm demeanor can help soothe their anxiety or fear.

• Offer reassurance: Gently tell them, “I’m here with you. You’re safe,” or “I understand this is upsetting, but everything is okay.” Avoid dismissing their feelings, even if what they’re experiencing isn’t real.

2. Avoid Arguing or Correcting

• Don’t contradict them: If they believe something that isn’t true (e.g., thinking someone is stealing from them), avoid correcting them directly. Arguing can increase agitation. Instead, acknowledge their feelings and redirect them.

• Validate emotions: Say things like, “That sounds upsetting. Let’s see what we can do about it,” rather than focusing on whether their belief is factually correct.

3. Use Distraction or Redirection

• Redirect their attention: If they’re fixated on a false belief or repetitive action, gently shift their attention to another activity or topic. For example, suggest going for a walk, listening to music, or doing a calming activity they enjoy.

• Create a diversion: For repetitive behaviors, introduce a new task, such as folding laundry or arranging items, to distract from the behavior without making them feel dismissed.

4. Address Suspicion and Paranoia

• Reassure with gentle explanation: If they suspect others of wrongdoing, like theft or lying, reassure them by checking the situation together. For instance, if they think someone stole their belongings, help them find the item and calmly explain its location.

• Limit stimuli: Reduce overwhelming stimuli like noise, too many people, or a cluttered environment, which can heighten feelings of suspicion or paranoia.

5. Monitor Environmental Triggers

• Identify patterns: Keep track of when these changes happen. Is there a specific time of day, location, or activity that seems to trigger certain behaviors or beliefs? By identifying triggers, you may be able to prevent or minimize the behavior.

• Adapt their surroundings: Modify their environment to reduce potential stressors. Keep spaces well-lit to reduce shadows that could be misinterpreted, and eliminate confusing objects.

6. Create a Structured Routine

• Consistent routines reduce confusion: A predictable daily routine can help reduce anxiety and agitation. When they know what to expect, it may minimize suspicion or fear of the unknown.

• Provide simple choices: Offer simple, structured choices to avoid overwhelming them. For example, give them two options for clothing or meals rather than an open-ended question.

7. Engage in Meaningful Activities

• Encourage repetitive but positive activities: If they repeat certain actions, guide them toward safe and meaningful repetitive tasks, such as sorting items, folding clothes, or doing puzzles.

• Stimulate with sensory activities: Sensory experiences like looking at family photos, listening to calming music, or playing with familiar objects can help shift focus away from negative behavior or beliefs.

8. Use Validation Therapy

• Acknowledge their reality: When they talk about things that aren’t real, respond to the emotion rather than the content. For example, if they’re scared of someone imaginary, say, “I can see that you’re worried. Let’s make sure you’re safe.” This validates their feelings without reinforcing or dismissing the hallucination.

9. Ensure Physical Safety

• Prevent unsafe behavior: If they start wandering, pacing, or performing repetitive actions that could harm them (e.g., handling sharp objects), gently guide them away from danger or modify the environment to make it safer (e.g., remove sharp objects, lock doors).

• Install safety measures: Consider installing nightlights, securing exits, and using safety locks on cabinets with dangerous items if their confusion leads them to unsafe actions.

10. Consult Professionals

• Involve healthcare providers: Significant changes in behavior or beliefs may signal progression of dementia or an underlying issue such as an infection, medication side effects, or dehydration. Consult with a doctor to rule out or address these issues.

• Consider medication adjustments: If paranoia or hallucinations are severe, a healthcare provider might recommend changes in medication or introduce new treatments that can help manage these symptoms.

11. Educate and Prepare Family Members

• Prepare family and friends: Let other caregivers and visitors know about these changes so they can respond with understanding and patience. Teach them to avoid arguments and respond calmly.

• Join support groups: Connect with other caregivers facing similar challenges. Support groups can provide valuable advice on how to manage behavioral changes and offer emotional support.

12. Recognize the Importance of Self-Care

• Take breaks when needed: Behavioral changes can be exhausting for caregivers. Make time for self-care and seek respite care or support from family, friends, or professional caregivers to avoid burnout.

• Stay patient and empathetic: Dealing with paranoia, suspicion, and hallucinations can be emotionally taxing, but it’s important to maintain a compassionate and understanding approach.

By staying patient, using gentle redirection, and focusing on the emotional needs behind the behaviors, family members can help alleviate distress and support their loved one through difficult behavioral changes.

Source: UCSF

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