Support for Caregivers of Older Adults
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Behavioural Changes

 
 Overview    ↓ next top ↑
  • It is important to recognize changes in behaviour as they are often the only sign of a change in health status.
  • Negative behaviours can be a great burden for family caregivers.
  • There are numerous strategies to avoid or reduce negative behaviours.
  • Negative behaviours require a team approach with health care providers and caregivers.
 
 Introduction    ↓ next top ↑
  • Sudden changes in behaviour are important to recognize as these are often the only clue that an older person is sick, getting worse in their dementia, becoming depressed, or having a side effect from a new medication.
  • Attention to your family member's behavioural and psychological symptoms are key to improving and maintaining their quality of life.
 
 What You Need to Know    ↓ next top ↑
 
 Types of Negative Behaviours 

Behaviours that cause the greatest burden on caregivers include the following:
  • screaming
  • physical aggression
  • arguing
  • wandering
  • showing signs of depression
  • resistance to help with activities like dressing, washing, toileting, eating
  • suspiciousness
  • accusations (e.g., theft, infidelity)
  • paranoia about having clothing, jewelry or money stolen
Over time, these kinds of behaviours place a growing burden on caregivers. Therefore, by eliminating or controlling these behaviours, care giving arrangements can be maintained for a longer time.
 
 Ways to Avoid or Reduce Negative Behaviours    ↓ next top ↑

Ways to avoid or reduce negative behaviours include:
  • set up daily routines
  • avoid big changes in the environment
  • make the environment safe and less irritating
  • encourage physical activity during the day, such as exercises or walks, to help work off anxiety and excessive energy
  • respond to your family member's emotions, provide reassurance, touch, and hugs
  • avoid arguing
  • be empathetic to your family member's problems
  • maintain a consistent approach among all caregivers in managing the behaviour
  • consider whether a day program may be helpful, as program staff are usually familiar in dealing with behavioural issues and it will provide a break for you, the caregiver
 
 What to Do    ↓ next top ↑

If you notice a negative change in your family member's behaviour, here are some suggestions about what to do.
  • Write down what the changes are, how long they have been going on, and what makes them better or worse. This information will help the health care provider decide what the problem might be, how it started, and how to treat it.
  • Never change medications or add new ones – this is the responsibility of the health care provider.
  • Ask others who have contact with your family member to see if they have noticed any changes in behaviour.
 
  When Medical Help is Required    ↓ next top ↑
  • If you notice a negative change in your family member's behaviour, talk to the health care provider directly about the problem. Make an appointment as soon as possible, and watch for any signs that the behaviours are getting worse or changing in some way.
  • The health care provider may prescribe medications to treat the behaviours.
  • Some newer anti-psychotic and antidepressant medications, as well as the use of cognitive-enhancing drugs, have been shown to be helpful.
  • Often it is a case of trial-and-error to figure out which drugs (or combination of drugs) have the best effect in improving behaviours.
  • A team approach is the best way of providing care to an older person with behavioural problems and supporting the caregiver(s) as well.
 
 See Also    ↓ next top ↑

While the content of each Caregiver College Topic may be linked to a variety of other Topic areas, the following have been identified as a Key Linkage which you may be interested in also reviewing:
 
 Resources  top ↑

Managing Cognitive Dysfunction
  • This article by Dr. John Morely, University of Illinois discusses dementia and behavioural disturbances in older people. It provides an excellent flow chart for handling problems associated with these problems.

Active Seniors' Options
  • This website provides the user with information on older people and identifies other important sites with direct links to them.
Depression in Seniors
  • This website explores the various components of depression and behavioural changes. It includes a wide array of further readings and online resources on depression and depression in dementia.
HereToHelp - Confusing Behaviours
  • This website, developed by BC Partners for Mental Health and Addictions Information, provides easy-to-read information including fact sheets, toolkits and workbooks.
American Geriatrics Society – Foundation for Health In Aging
  • Understanding Behavior Disorders Related to Dementia examines changes in behaviour and resulting strategies.
Alzheimer Society of Canada
  • This Society has developed a list of 10 warning signs to help you know what to look for. It is important to see a doctor when you first notice any of the warning signs as they may be due to depression, drug interactions, infections or Alzheimer's disease.
Alzheimer Wandering Registry – Safely Home
  • This is a nationwide identification program developed by the Alzheimer Society and the RCMP to help people return home safely.
International Psychogeriatics Association
  • Introduction to Behavioral and Psychological Symptoms of Dementia: This resource provides a very detailed educational package on the behavioural issues seen in dementia. Module 4 is excellent and helps caregivers understand the potential roles they play in caring for individuals with behavioural problems. Medication and non-medication therapies are also covered.


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