Behaviors are things that we do. Those who work in the rehabilitation field — physical, occupational, and speech therapists, recreational therapists, and others — work with behaviors all the time. I might teach a person who has had a stroke what to do when he can’t think of the word he wants to say. An occupational therapist might help that same person learn how to button his shirt with one hand. And a physical therapist might show him how to do exercises to make his leg muscles stronger. These are all aspects of our professions that most people are familiar with.
Therapists occasionally encounter people who wonder what therapists can do for someone with dementia. Well, we can address behaviors with this population just as we might with any of our patients. Sometimes that might mean teaching a person a new behavior — for example, I might help a man learn to use strategies for remembering his daily routine. Or an occupational therapist might help him organize his medications, so that he can take them properly. This kind of therapy usually takes place in the early stages of the disease process, and is designed to help an individual live independently for as long as possible.
But there comes a time, in the progression of the disease, when the individual with dementia is no longer capable of learning new behaviors. That doesn’t mean the person is stuck, doomed to stay where he is or descend into a bottomless pit of despair and lack of function. It does mean, however, that often the goals of our therapy will need to focus on helping the person retain what skills he still has, for as long as possible, and adapt to the demands of his environment. Many times this is accomplished by modifying this environment, or by teaching caregivers how they can best support the person with dementia. This might be by helping them to break down a task into discrete steps, or it might be learning the best way to cook for someone who has no teeth.
There is another kind of behavior that we are often called upon to deal with, however. Sometimes the person with dementia will exhibit behaviors that we would like them to stop, or at least be controlled to some extent. These can include wandering, rummaging through other persons’ belongings, striking out at a caretaker who is trying to give a bath, asking repetitive questions, and other similar actions. It’s not uncommon, in a long-term care facility, for the therapy department to get a request from the nursing staff, for example, to see if we can get Mrs. Jones to stop yelling for help and use her call light.
Usually, one of the first steps in handling one of these undesirable behaviors is determining why it is occurring. This involves gathering historical information, looking at reports from his physician as well as any lab-work, completing a cognitive evaluation, talking to caregivers to determine what has been done in the past, and any other evaluations that might be pertinent to a particular case. Then we might try various strategies, to see which ones have a positive effect. We might also make referrals to other professionals, such as a physician or an audiologist.
I once heard a statistic that 95% of behaviors were a form of communication. Some of the messages that a person might be trying to convey could include (1) expressing a need or a want, such as going to the bathroom, (2) telling caregivers that he is in pain, (3) indicating a desire to leave a situation, (4) stating that he is confused about something, or afraid, and (4) making an attempt to socialize. For example, the woman who is sitting in her room calling out may have forgotten how to use her call light, and needs someone to help her to the bathroom. Or perhaps she has a toothache.
Sometimes behaviors can manifest as remnants of old habits or personality traits. I once knew a woman who, when she was younger, worked two jobs and was always busy doing something. I met her when I was asked to help find a way to stop her incessant wandering from place to place, as if she was looking for something. Another woman was asked to leave one facility, because she would wander into other residents’ rooms at night. But what we discovered was that she had been a nurse for many years, working the night shift. Something compelled her to continue making her rounds, making sure that everyone was in bed and safe. Since she never bothered anyone and trying to make her stop only upset her, the staff decided to allow her to continue her routine, watching her from afar, and helping her back to bed when she was finished. They even made up a mock chart for her to look at, and write in, and this would keep her busy for hours.
Now, I’m not trying to say that therapists are the only people who can figure out how to deal with these problems. Yes, we do have training in how to deal with physical and cognitive issues that our patients demonstrate. But quite often I’ve encountered caregivers, whether they be family members or nurse’s aides, who have spent a lot of time with the individuals who have dementia. And many times they instinctively know how to address the problem. Often I’ve learned as much from them as they have from me. However, in a long-term care facility, that aide who is so perceptive has a dozen other residents she has to deal with, and sometimes she just doesn’t have the time to spend trying one thing and then another, to find something that works. And, too, it often ends up being a group effort. More than once the speech therapist, the occupational therapist, the aide, the daughter, and sometimes even the housekeeper, all put their heads together to come up with a workable solution.
So, the next time you see a person with dementia who is doing something that you feel is not appropriate, or that causes a problem, remember that there are a number of people who are willing and able to act as a resource. Maybe you’ve tried everything you can think of to remedy the situation. Or maybe you’re just so busy with your job and your family, and other matters, that you can’t take the time to figure out why Grandma won’t let you give her a bath. Too many times, the easiest answer to such problems is to give Grandma a pill, when it could be that the water is too cold, or she thinks that the mirror over the sink is a window and she worries that someone will be watching her.