Stages and Behaviours Archives - DementiaHub.SG

Managing Anxiety

shekinah — Wed, 11 Jun 2025 00:57:24 +0000

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Anxiety is common in persons living with dementia and can make daily life challenging. This article explores the causes and symptoms of anxiety in persons living with dementia and provides practical tips for caregivers to support their loved ones.

For persons living with dementia, anxiety often intensifies, making daily tasks and interactions harder. Anxiety is more commonly experienced by persons with Vascular Dementia or Frontotemporal Dementia (FTD) Understanding how anxiety affects them and learning how to manage it can greatly improve quality of life for both the caregiver and the person living with dementia.

Causes of Anxiety

Sometimes, persons living with dementia may display anxiety due to neurological and psychological factors. Some common causes of anxiety are listed below:

Neurological Factors

Damage to parts of the brain that involve emotion regulation:

As dementia progresses, it can affect areas of the brain that are responsible for processing emotions.

Cognitive decline:

Difficulty with memory, and spatial orientation may create fear and anxiety.

Psychological Factors

Fear of the future:

In the early stages of dementia, individuals may become anxious about their future.

Confusion and disorientation:

In later stages of dementia, anxiety may stem from feeling lost or an inability to recognise familiar faces.

Other Contributing Factors

Pain or Discomfort such as physical ailments or hunger:

Physical ailments or even hunger can trigger anxiety in persons living with dementia.

Medications:

Certain medications used for persons with dementia can have side effects that increase anxiety.

Trauma or Past Mental Health Issues:

A history of trauma, abuse, or pre-existing anxiety disorders can make individuals more vulnerable to anxiety.³

Anxiety in persons living with dementia can look different depending on the stage of the condition. In the early stages, anxiety can be due to concerns about the future and the fear of how the condition may worsen. However, in later stages of dementia, anxiety is typically rooted in confusion about the present, such as an inability to recognize one’s surroundings.

Symptoms of Anxiety

It is important to recognise signs of anxiety in persons living with dementia. These symptoms vary based on the individual’s stage of dementia and overall health.

Common symptoms may include:

Restlessness or fidgeting
Irritability or frustration
Rapid heart rate or trembling
Insomnia
Increased confusion
Feeling constantly ‘on edge’

Supporting Your Loved Ones with Anxiety

Establish a Calm and Predictable Environment

A consistent routine can reduce uncertainty and anxiety. Try to keep daily activities, such as mealtimes, dressing and bathing times predictable and minimise any major changes in the environment. If changes are needed, introduce them gradually. This can help your loved one feel safe, which can reduce anxiety.

Reassurance and Validation

When your loved ones with dementia expresses anxiety, do acknowledge their feelings without judgment.

Gently acknowledge their anxiety: “We understand you’re worried, and we’re here to help.”
Keep your tone calm.
Redirect their attention by using activities they enjoy, like arts or games, to reduce anxious emotions.

Physical Exercises

Accompany your loved ones for regular physical activities, such as walking or gardening to reduce feelings of anxiousness. Encourage them to take part in group sessions, such as dancing or singing.

Relaxation Exercises

Consider guiding your loved ones to participate in relaxation activities, such as arts and crafts or music. Include mindfulness activities in their routines to reduce anxious emotions.

Watch this short mindfulness video to learn simple breathing techniques that can help ease anxiety.

Mindfulness Exercise for Stroke Survivors and Caregivers [English Version]

Source: Agency for Integrated Care

This video demonstrates a 10-step mindfulness exercise customised for stroke survivors, but is also suitable for anyone with affected mobility to manage stress. It takes only 15 minutes to complete all the practices in the video.

Seek Professional Help

If anxiety becomes unmanageable, consult a healthcare provider to adjust care plans or explore medication options.

It is important to note that these strategies may generally be more effective for persons living with early to middle stages of dementia. Your loved one may also want to try complementary and alternative therapies. This can include aromatherapy, acupuncture, or massage therapy.

Do consult a doctor first before participating in any of these therapies.

Adapted from Alzheimer’s Society and DementiaUK.

Conclusion

Managing anxiety in loved ones can be challenging but with patience and the right strategies, you can help reduce anxiety and improve the quality of life for you and your loved ones.

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Alzheimer’s Society (2025). Anxiety and Dementia. https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/anxiety-dementia.
Barrell, A. (2020). Stress vs. anxiety: How to tell the difference. Medical News Today. https://www.medicalnewstoday.com/articles/stress-vs-anxiety
Dementia UK. (October, 2022). Managing anxiety and depression in a person living with dementia. https://www.dementiauk.org/information-and-support/health-advice/managing-anxiety-and-depression-in-a-person-living-with-dementia/

Why Do Behavioural Changes Happen?

Admin — Tue, 25 Oct 2022 10:04:41 +0000

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Dementia is accompanied by behavioural changes, which affect your loved one living with dementia and all of you around him/her. Behavioural changes can be one of the aspects of dementia that are most difficult to address. Persons living with dementia who experience behavioural changes are often described as having a “completely different personality” from their “old self”. Different behaviour changes occur at different points in mild and moderate stages of dementia, and vary between people and across different types of dementia.

These are some common behaviours exhibited by persons in the mild, moderate, and advanced stages of dementia that vary from person to person:

Mild Dementia

⇒ Forgetting things

⇒ Occasionally repeating themselves

⇒ Isolating themselves from others

⇒ Feeling tired all the time

⇒ Being easily irritated

Moderate Dementia

⇒ Getting lost in familiar places

⇒ Repeating things said

⇒ Problems with communication

⇒ Neglecting personal hygiene and self-care

⇒ Losing track of time & events

⇒ Misplacing items more frequently

⇒ Behavioural disturbances

⇒ Forgetting the names of common objects and familiar people

⇒ Forgetting important events, e.g. birthdays of their children

⇒ Being confused about timings and places

⇒ Poor or decreased judgement

⇒ Problems with abstract thinking

⇒ Swallowing problems

Advanced Dementia

⇒ Losing mobility and ability to perform daily tasks

⇒ Losing ability to communicate

⇒ Food refusal

⇒ Swallowing problems

Sometimes, behavioural changes during mild and moderate stages of dementia can cause concern. Some examples of behaviours of concern that are commonly seen include:

Aggression

Agitation

Being easily upset

Being easily irritable

Being prone to argue

Inappropriate screaming or crying

Refusal to shower or be groomed

Running away from home

Disinhibition

Sexually inappropriate behaviour

Socially inappropriate behaviour

Hoarding

Irregular Night-time Activity (Sundowning)

Getting up at night

Repetitive Behaviours

Sundowning

Anxiety or excessive worry

Apathy or indifference

Delusions and/or hallucinations

Depression

Misidentifying familiar people

Personal Stories

What My Grandmother Was Trying To Say

In this video, Dr. Chen Shiling, who cared for her late grandmother living with dementia, tells us how she has learnt to understand what her grandmother was trying to communicate through many trying episodes and her grandmother’s behavioural changes, which included her making wrongful accusations, wandering behaviour, and depression.

Dr. Chen Shiling is a Resident Physician at Khoo Teck Puat hospital. She was raised by her grandmother who had dementia.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Where Is My Money?

Episodes involving accusations, arguments, and tension are trying and stressful for family members. Unfortunately, these situations are common in households with persons living with dementia. In this video, Lily tells us her secret to always being able to ‘find’ missing money that has been misplaced by her mother-in-law.

Lily Phang is a caregiver and co-founder of Homage, a caregiving service. She helps her family to cope with the symptoms and behavioural changes that her mother-in-law, Tan Mui Hua faces.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Causes of Behaviour Changes

Every individual has needs that need to be met. However, as dementia affects the brain which controls all mental functions and voluntary behaviours including thoughts, emotions, and speech, the progression of dementia may cause your loved one to be increasingly less able to recognise their needs, know how to meet them, or communicate them. In addition to this, behaviour changes also occur due to changes in the brain. The type of behaviour change exhibited depends on the areas of the brain affected by the condition causing the person’s dementia as well.

It is also crucial to understand these behaviours from the perspective of your loved one living with dementia. They may present with these behaviours as a result of their needs not being met, their attempt to meet a need, or an attempt to communicate to individuals around them.

Unmet needs underlying behaviour changes can be generally categorised into the following four factors:

1. Physical Needs: Your loved one living with dementia may be experiencing pain or discomfort, and may be suffering from other illnesses at the same time.

2. Psychological/Cognitive Needs: Your loved one may be depressed or may have other mental health issues. They could also be feeling confused or threatened in an environment that does not seem right or familiar.

3. Social Needs: Your loved one may be feeling lonely, isolated, or bored.

4. Environmental/External Needs: Your loved one may be in an overstimulating environment (e.g., with loud noises or busy environment), or experiencing a different and unfamiliar routine.

Management of Behaviour Changes

When managing your loved one’s behaviours, it is important for you, as a caregiver, to ascertain some factors that may cause certain behaviours to happen. For example:

• What triggers the behaviour: Consider commonly unmet needs, such as constipation, pain, and toileting needs, or environmental triggers such as sounds, smells, and temperature.

• Whether the behaviour is causing distress to the person: If so, prompt treatment may be necessary.

• Whether the safety of the person is compromised: If so, some modifications to the home setting may need to be made to ensure that the environment is safe.

For every behaviour change, it is always good to share the above information you have collected and consult the doctor (geriatrician or psycho-geriatrician) who is seeing your loved one with dementia to rule out any physical health problems (for example, infections, medication side effects) that may be causing it. After ruling these problems out, non-pharmacological approaches should be first attempted to meet your loved one’s unmet needs and minimise or prevent their behaviour changes, before considering pharmacological management.

It is often the daily, non-pharmacological methods and techniques that turn out to be effective in the long-term. Non-pharmacological measures such as psychosocial interventions (e.g., music therapy, art therapy) are usually the first-line approach before medication treatment is considered. Below are some examples of simple, non-pharmacological techniques to consider as well:

1. Revise your approach. The task on hand may be too difficult that it needs to be simplified, or your loved one living with dementia may need some help with it. Help them to focus on their abilities, rather than on their inabilities.

2. Validate your loved one feels. Acknowledge your loved one’s feelings and experience, and patiently communicate this acknowledgement to them by your words and actions. Do not confront or argue – it is not necessary to always correct the person when they are in the wrong.

3. Direct their attention elsewhere. Identify the cause behind the behaviour and address it through engaging your loved one in meaningful activities.

Sometimes, a combination of both non-pharmacological and pharmacological managements may offer better outcomes too. Read further about the Pharmacological Management of dementia and behaviour changes.

Some Tips to Manage Behaviour Changes

In the fifth episode of a 6-part series “All About Dementia – Ask the Experts”, Dr Ng Wai Chong explains why persons living with dementia have changes in their behaviours. He also answers questions related to strategies in managing these behaviour changes, such as wandering behaviour, repetitive behaviour, refusal to take medications, and refusal to eat.

Source: Agency for Integrated Care

The Alzheimer’s Society from the United Kingdom provides general tips to family caregivers on ways to support persons living with dementia to meet their needs and reduce their behaviour changes using a non-pharmacological approach. It also lists a five-step strategy to manage behaviour changes. Read further about Alzheimer’s Society’s tips and strategies.

Finally, it is not easy managing the behaviour change(s) your loved one living with dementia is exhibiting. It is thus equally important that you take good care of yourself by seeking support from family, friends, counsellors or support groups, in order to better cope with your caregiving journey. Learn more about tips and resources on how to look after yourself.

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Additional Resources for Other Behaviour Changes

Admin — Thu, 08 Sep 2022 07:02:47 +0000

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1. Talking Point | CNA Insider

Looking after a loved one living with dementia can be frustrating. In this episode of Talking Point, it provides you with some tips on what to do when you face the following 3 scenarios – when your loved one living with dementia:

Refuses to bathe
Forgets that he/ she has eaten and keeps demanding for food
Accuses you or others of stealing

Source: CNA Insider

2. UCLA Alzheimer’s and Dementia Care Video series

The Multicampus Programs in Geriatric Medicine and Gerontology (MPGMG) at the David Geffen School of Medicine at UCLA created a series of videos on understanding and managing behaviours associated with dementia.

Every video scenario shows:

The common response that family caregivers give in order to manage the behaviour change exhibited by their loved ones living with dementia;
An expert’s explanation about the behaviour change, with tips to identify and minimise the triggers and suggestions for redirection; and
The recommended response (incorporating the tips) that family caregivers can show instead to better manage the behaviour change.

This site also provides a Take Action worksheet that allows caregivers and care professionals to record what they can do to minimise the triggers of the behaviour changes.

Watch the UCLA Alzheimer’s and Dementia Care Video series now.

3. Fact Sheets Developed by Overseas Dementia Associations

There are other behaviour changes that a person living with dementia may exhibit. For each of the following list of behaviour changes, there are overseas resources which:

Define each behaviour change;
Detail their possible causes and underlying unmet needs; and
Suggest some plausible strategies to manage them at the time and when the behaviours have passed (to prevent the behaviours in future).

Please note that this is not an exhaustive list of resources. Click on the logos to access the fact sheets and websites for further reading.

Anxious Behaviours

Restlessness

Refer to Pg. 8

Refer to Pg. 94-105

Apathy

Refer to Pg. 6

Refer to Pg. 106-117

Depression

Refer to Pg. 7

Disinhibited Behaviours

Hallucinations & Delusions

Ooi, Yoon, How & Poon, 2018

Hallucinations

Delusions

Hallucinations

Accusing

Paranoid Thoughts

Hoarding

Repetitive Behaviours

Repetitive Behaviour

Trailing, Following & Checking

Repetitive Behaviour

Repetitive Phone Calls

Repetitive Questions

Ooi, Yoon, How & Poon, 2018

Resistance to Activities of Daily Living (ADLs)

Refusal to Bathe

Refusal to Take Medications

Sleep Disturbances

Ooi, Yoon, How & Poon, 2018

Vocally Disruptive Behaviours

Refer to Pg. 8

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Managing Wandering Behaviour

Admin — Thu, 08 Sep 2022 07:02:37 +0000

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Many persons living with dementia feel the urge to walk about and in some cases leave their homes. Though it is sometimes termed as “wandering”, it is rarely ever aimless. Persons living with dementia may simply not remember where they had set out to go, or what they had intended to do.

It is all right for persons living with dementia to walk around in a secure environment (for e.g., in their own homes or at day care centres), with supervision from others. However, wandering becomes a cause of concern when persons living with dementia meet with dangerous situations while wandering outside, about the neighbourhood alone. For example, they often experience problems with orientation, which causes difficulties in finding their way back home (getting lost). When the person living with dementia is away from home for an unusually long time, or when the caregiver is unable to locate him/her, then wandering becomes a problem.

Moreover, there is a significant number of older persons living with dementia, whose primary caregivers are seniors (for e.g., their spouse) as well. These seniors are more prone to falling and more susceptible to sustain fall-related injuries.

Your loved one may set off to a place and forget where he/she is going or why. Sometimes your loved one may tend to wander and forget how he/she got into that room in the first place. This can happen a lot more often in persons living with dementia. Your loved one may be trying to ‘retrace’ their steps. Likewise, if they do not remember an area, they may wander off until they find something familiar.

Confusing night with day

Your loved one may suffer from sleep problems, or wake in the early hours and become disoriented. He/she may think it is daytime and decide to go for a walk.

Looking for familiar persons / items / places

Your loved one may wander off in search of someone, something, or a place relating to their past when he/she becomes confused. Wandering may occur because they suddenly decide they need to find an old friend they have not seen for a long time. They could also be wondering where they parked their car, even if they have not driven for quite some time. Confusion about time and place is one of the symptoms of dementia.

Continuing with a habit or routine.

If your loved one had a very specific routine or habit that they used to follow, they may want to carry on with it. Your loved one who is used to walking long distances may simply wish to continue doing so. They may also head out to attempt to go shopping or back to their old workplaces if this was something they used to do in the past.

An attempt to get away from something

If the situation or place they are currently in is stressful or unpleasant in any way, they may simply walk off to get away. Likewise, if the environment is noisy, they may walk off to find somewhere more quiet and peaceful.

Change of environment

Your loved one may feel uncertain and/or disoriented in a new environment such as a new home environment or daycare centre.

Physical discomfort or pain

Your loved one may walk to ease discomfort that is caused by uncomfortable clothes, excessive heat or the need to go to the toilet.

Night Wandering

Always be aware that wandering can happen at any time, including the middle of the night. If a person who lives with dementia gets easily confused with what time of the day it is, you may find them wandering at 2 a.m. because they think they have to be somewhere and do not understand that they are supposed to be asleep.

Some Ways to Manage Wandering Behaviours

The tendency to wander is common amongst persons living with dementia. Depending on your loved one’s personality, how well they can cope, their reason(s) for wandering and the safety of the surrounding environment, you may use the following strategies to manage your loved one’s wandering behaviour:

Carry out daily activities

Having a routine can provide structure. Try to create a daily routine for your loved one with dementia.

Install locks out of the line of sight

Install either high or low exterior doors and consider placing slide bolts at the top or bottom.

Identify the most likely times of day or situations that wandering may occur

Identify your loved one’s wandering behaviour patterns by keeping records or a diary. Plan activities at that time. Activities and exercise can reduce anxiety, agitation and restlessness.

Use devices that signal when a door or window is opened

Use devices that signal when doors or windows are opened. For example, doors can be placed over bells, and electronic home alarms can be used.

Reassure the person if they feel lost, abandoned or disoriented

If your loved one wants to leave to “go home” or “go to work”, use communication focused on exploration and validation, and refrain from correcting them.

Provide supervision

Do not leave someone living with dementia unsupervised in new or changed surroundings. Never lock them at home or leave them in a car alone.

Keep car keys out of sight

If the person is no longer driving, remove access to car keys — a person living with dementia may try to drive. If the person is still able to drive, consider using a GPS device to guide them if they get lost.

Redirect attention elsewhere with activities

Engage your loved one through a simple and quiet activity that is familiar to them from their earlier days.

Ensure all basic needs are met, and that your loved one is not experiencing any illness, pain or discomfort

Has your loved one gone to the bathroom? Is he or she thirsty or hungry? Go for his/her regular physical check-ups, which help to identify the presence of any illness, pain or discomfort.

Avoid busy places that are confusing and can cause disorientation

Shopping malls, grocery stores or other busy venues.

Remove objects that may encourage wandering

Objects that may prompt wandering, such as handbags or keys, can be removed from sight.

Remove any obstacles to allow your loved one to wander about safely – ensure supervision is available and he/she has steady gait at all times.

Carry identification

Have your loved one carry identification such as the CARA Membership Card (which replaces the Safe Return Card). This can be helpful when he/she is found by others or the police. Find out more about the CARA Membership Programme.

ForgetUsNot Initiative: Don’t Go Missing

Source: LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

Hear what care specialist Lily Teh from Homage has to say about helping the community and persons living with dementia find their way home.

When Your Loved One Goes Missing, You Should:

Remain calm.
Make a thorough search of the house and familiar places.
Try to remember what he/she was wearing.
Walk or drive around the vicinity and/or to any places he/she may visit regularly. Have someone stay at home in case he/she returns home, or to answer any phone calls.
Contact the police if immediate searches yield no result. Tell them the person has dementia and any concerns you have for their safety.

For CARA members, use the CARA app to notify members of the public to keep an eye out for your loved one living with dementia who is lost.
If your loved one lives in the Sembawang-Woodlands community, you may reach out to the Dementia Search Activation Network (DSAN). DSAN is a Telegram channel run by AWWA Community Outreach Team (CREST) for persons living with dementia and caregivers within the area. The Telegram channel will be activated upon receiving information about lost seniors within Woodlands and Sembawang from national apps such as CARA. Upon activation, the channel’s chat function will be activated for 48 hours to allow participants to share critical information to help locate the lost individual. Those interested to join the channel can click here.

When your loved one returns home:

Notify the police immediately.
Do not scold them or show anxiety as this may confuse or frighten them.
Provide reassurance and get back into their regular routines as quickly as possible.

William’s Story

CNA Insider: My Grandpa Has Dementia

Source: Channel News Asia

At first, William’s dementia symptoms included forgetfulness and confusion, but then the wandering and getting lost began. William’s dementia makes him sneak out in the middle of the night. He even found a way out after the family padlocked the gate.

Watch how Bethany and her mother, Geraldine (William’s daughter and main caregiver), coped until they finally realised they needed help.

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Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. HealthHub. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia

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Managing Sundowning

Admin — Thu, 08 Sep 2022 07:02:22 +0000

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Changes in the physical brain may affect the sleep cycle and cause wakefulness in the evening and at night.
Your loved one may have previously been occupied and busy at a particular time of the day.
Little or disturbed sleep that may cause restlessness or napping during the day time.
Side effects of medication that can cause confusion, agitation or wear off during the evening time.
Environments that cause discomfort may precipitate sundowning, for e.g., shadows that occur around evening time.

Some Ways to Manage Sundowning

Sundowning may cause some distress to caregivers. Here are some tips which may be helpful in reducing sundowning symptoms in your loved one.

Implement a daily schedule.
Occupy your loved one with a familiar activity that will bring them comfort, such as listening to their favourite music and looking at old photographs.
Reduce sources of discomfort from the environment such as loud noises and bright lights.

Content adapted from Alzheimer’s Society.

How Exercise Helped My Wife with Sleep

John Chin explains to us how evening walks have helped to prevent sundowning in his wife by keeping her engaged.

John Chin used to live in Miami with his wife Kwan. With the help of Kwan’s family, he now shuttles between the US and Singapore to take care of his wife who now lives here.

Source: ForgetUsNot Initiative by LIEN Foundation, Khoo Teck Puat Hospital, & Dementia Singapore

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Mealtime Behaviours

Admin — Thu, 08 Sep 2022 07:02:08 +0000

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Persons living with dementia may sometimes refuse to eat. They may become angry, agitated, or challenging to feed during mealtimes. This can happen for a variety of reasons:

Disliking the food
Feeling rushed
Feeling uncomfortable with people or the environment
Feeling frustrated with the difficulties they are having

It can be challenging to identify what the actual problem is, particularly if they have difficulties communicating. It is important to remember that these reactions are not deliberate.

Try not to rush your loved one or pressure them to eat and drink quickly. Instead, look for non-verbal cues such as body language and eye contact as a means of communication. Wait until they are calm and less anxious before proceeding with the meal.

What You May Observe & Suggested Strategies to Prevent This

Refusing feeding attempts, spitting out food

• Check their mouths for ulcers or poor dental health as these can be painful
• Encourage independence when eating or drinking; gently place your hand over theirs to guide the cutlery to their mouth if they are unable to self-feed
• Offer familiar or favourite food and drinks
• Make the food look and smell appealing — prepare food with different tastes, colours and aromas
• Use familiar utensils
• Ensure that the temperature of the food served is appropriate

Eating very quickly

• Supervise the meal and use verbal and non-verbal prompts, e.g. prompt them to chew before swallowing
• Gently place your hand over theirs to control their feeding rate
• Cut up their food into smaller pieces to reduce the risk of choking

Distracted during mealtimes/ not attentive to eating

• Have a minimalistic table set-up
• Ensure that there are minimal distractions, e.g. quiet and calm environment, or fewer people
• Play calm and soothing music in the background during mealtimes
• Ensure appropriate and adequate lighting

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Managing Agitation & Aggression

Admin — Thu, 08 Sep 2022 07:01:59 +0000

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At some point, your loved one living with dementia may behave aggressively, display an outburst of emotions, or act angrily towards individuals around them.

Sometimes, your loved one may display agitation or behave aggressively as a result of an unmet need, which is causing them discomfort. Managing their agitation and aggressive behaviour is not easy. However, it is always useful to identify the cause/unmet need that triggers the agitation and/or aggressive behaviour, and find effective ways to manage them.¹

The table below lists down some possible unmet needs that your loved one may be experiencing:

Biological

Progression of dementia causing loss of control over behaviours

Physical discomfort, such as pain, fever, illness, or constipation

Adverse reaction to medications

Fatigue/ sleep deprivation

Misunderstandings due to poor eyesight/ hearing

Hallucinations and delusions

Social

Lack of social contact and loneliness

Boredom, inactivity and sensory absence

Changing of established routine

Psychological

Frustrations at not being able to complete tasks

Possibility of depression

Perception that personal space is invaded

Perception that independence and freedom are threatened

Feeling ignored

Fear of surroundings or people as he/she can no longer recognise them

Some Ways to Manage Agitation & Aggression

Communication and Interaction Style

Try to stay calm and take a deep breath. Avoid potential confrontations. Any expression of fear, alarm, anxiety or anger may make the situation worse.
Be patient and listen to what they are saying.
Approach your loved one slowly, maintain eye contact and try to encourage communication.
Validate your loved one’s feelings – reassure them and acknowledge how they are feeling.

• If your loved one gets agitated/aggressive when you are caring for him/her, explain your actions in short, simple sentences such as “I am going to help you remove your shirt” or “We are here to help you”.

• Ask yourself if what you are doing for your loved one really needs to be done at that moment.

• Give them some time and space, and return in a while to try again gently.

If your loved one living with dementia gets physically abusive

• Make some space between you and the person (at least one arm-length) to prevent yourself from getting physically injured.

• Do not try to restrain or restrict the outburst of anger unless they are causing harm to themselves or others.

• Call for help if needed.

• Ensure the environment is safe by keeping away dangerous items, such as scissors, knives, or any sharp objects.

• Identify and be aware of signs or behaviour indicating agitation or aggression. Redirect your loved one’s attention to focus elsewhere early with appropriate activities, before their outburst.

• Ensure your loved one’s basic needs are met, such as hunger, thirst, and sufficient sleep.

• Try to maintain consistency in your loved one’s daily routines, environment and carers.

• Ensure your loved one’s medical conditions and medications are reviewed regularly by the doctor.

Adapted from: Changi General Hospital

Galen's Mother: A Journey Into Dementia Documented Over The Years

Galen Yeo documents the drastic changes in his mother over the years, since she was diagnosed with dementia.

She was the sociable hostess whom friends loved to be around. And then one day, she started losing her memories. Frustrated at losing who she was, she’d have moments of violent temper. Being around her became a draining ordeal. These are the challenges of #facingdementia.

Source: CNA Insider

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Changi General Hospital. (2020, October 5). Managing agitation and aggression in dementia. https://www.healthhub.sg/live-healthy/843/managing-agitaton-and-aggression-in-dementia

The post Managing Agitation & Aggression appeared first on DementiaHub.SG.

Dementia Progression & Behaviour Changes

Admin — Thu, 08 Sep 2022 07:00:38 +0000

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The progression of dementia comes along with changes in persons living with dementia:

Abilities in Activities of Daily Living (ADLs)
Behaviours
Cognitive Function
Orientation to People, Places and Time

Dementia progression and its corresponding behaviour changes require the appropriate response from caregivers.

With the necessary information and resources at hand, you will be better equipped to respond to these changes while providing care for persons living with dementia.

Dementia Progression

Enable Persons Living With Dementia to Perform Their Daily Activities

In the fourth episode of the 6-part series “All About Dementia – Ask the Experts”, Ms Low Mui Lang answers questions related to managing the daily activities for persons living with dementia.

By watching this video, you can learn some helpful tips on how you can enable your loved one living with dementia to perform his/her daily activities, such as supporting him/her to continue what he/she loves to do, or assisting him/her in showering and respecting his/her privacy at the same time.

The following articles offer general tips which may help you to manage the progression of a person’s dementia.

Sharing Caregiving Responsibilities: Gathering the Family

Designing A Daily Routine

Supporting Activities of Daily Living

Helping A Person With Dementia Who Lives Alone

Taking Public Transportation

Behaviour Changes

It is important to understand how dementia may cause a person to behave differently, and how to address these changes constructively.

In addition, it is important to note that persons living with dementia present symptoms and behaviour differently. These symptoms and behaviours also differ across different types of dementia, and change as a person progresses through different stages of dementia.

However, there are many common behaviour changes observed in persons living with dementia. The information provided below and in the linked pages include tips on how to address such changes.

Behaviour Changes at Mild and Moderate Stages of Dementia

The articles below include information on some behaviours commonly exhibited in the mild and moderate stages of dementia.

Why Do Behavioural Changes Happen?

Managing Agitation & Aggression

Managing Mealtime Behaviours

Managing Sundowning

Managing Wandering Behaviour

Additional Resources for Other Behaviour Changes

Behavioural Changes in Advanced Stage Dementia

Some common behaviours in the advanced stage of dementia include:

Losing mobility and ability to perform daily tasks
Losing ability to communicate
Food refusal
Swallowing problems

Read the following articles about managing some of these behaviours in the advanced stage of dementia:

Swallowing Difficulties & Soft Diets

Managing Constipation

Managing Urinary Incontinence

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ABCDs of Dementia Progression

Admin — Wed, 10 Aug 2022 08:44:12 +0000

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All types of dementia are progressive. This means that while symptoms may at first be mild, they deteriorate with time. As dementia progresses, a person with this condition will need increasingly more help and support with daily living. Dementia affects every individual differently. This includes their experience of the symptoms, the rate at which the condition progresses (which itself varies across the different types of dementia), and the type and level of support required.

There are several stages of dementia. In all types of dementia, memory problems are the early signs. The deterioration in cognitive skills is gradual and in later stages, daily activities will become increasingly challenging without assistance.

Dementia progression can generally be classified into three stages – the mild, moderate, and advanced stages. These stages are a simplified explanation on how dementia symptoms change over time, and can be used as a guide to help persons living with dementia and their loved ones prepare for the future. It may be difficult to place a person’s condition in a specific stage as symptoms may appear in a different order and stages may overlap¹. However, understanding the stages as such helps us see how dementia progresses in general.

The following provides an overall idea of how the symptoms affect a person living with dementia and change across the three stages:

Activities of Daily Living

Mild Dementia

• Still able to care for self in basic activities of daily living, i.e. personal hygiene, dressing

• May have some difficulty with:

⇒ Taking public transportation
⇒ Money management

• May have difficulty planning and managing household tasks such as cleaning and cooking

• May have difficulty initiating activities

Moderate Dementia

• Needs regular reminders and prompts in daily tasks

• Requires assistance with dressing, personal hygiene, going to the toilet, eating, and some other daily activities.

• High risk of falling

Advanced Dementia

• Unable to care for self. Total dependence in taking care of own hygiene, eating, going to the toilet, and taking a shower

• Problems with balance, coordination, resulting in instability and falls

• Likely to have mobility issues, could be bed-bound

• Eating and swallowing problems

• Loss of bladder and bowel control

Behaviours

Mild Dementia

• Apathy; lack of interest in activities they used to engage in

• May become socially withdrawn

• Rapid mood changes or have low mood

Moderate Dementia

• Wandering

• Repetitive actions/ questions

• Sleep reversal

• Frustration at not being able to communicate well

• May appear depressed, and more easily upset, frustrated, agitated, and suspicious

Advanced Dementia

• Crying, shouting or repetitive vocalisation as a means to communicate needs

• Refusing care due to confusion

• Passive/ withdrawn

Cognitive Decline

Memory

Mild Dementia

• Forgetfulness (Difficulty with short-term memory)

• Impaired judgement

• Impaired abstract thinking

• Misplacement of items

Moderate Dementia

• Difficulty with short- and long-term memory

• May begin to forget or be unable to recognise certain family members

• May begin to be unable to remember own address or phone number

Advanced Dementia

• No apparent awareness of past or present

• Inability to recognise current self

• Inability to recognise common objects

Language & Communication

Mild Dementia

• Difficulty in following storylines and conversations

• Difficulty finding the right words or remembering names

Moderate Dementia

• Difficulty in communication due to repetitive speech or inability to understand contexts

• Difficulty in expressing emotions and making needs known

Advanced Dementia

• Unable to communicate through language

• Unable to engage in meaningful conversations

• May not be able to communicate or may be unresponsive at times

• Incoherent speech

• May express needs by yelling

Calculation

Mild Dementia

• Problems with handling finances

Moderate Dementia

• May have problems performing simple calculations

Advanced Dementia

• Unable to perform any calculation

Disorientation

Mild Dementia

• May occasionally feel disoriented, but may be able to navigate frequently visited places

• May get lost in less familiar places

Moderate Dementia

• May experience confusion in general; may have poor orientation to day, date and/or time

• May get lost outdoors, even in familiar places

Advanced Dementia

• Unable to differentiate day and night

• May get lost at home

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Alzheimer’s Society. (2021, February 24). The progression and stages of dementia. https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/progression-stages-dementia#content-start

The post ABCDs of Dementia Progression appeared first on DementiaHub.SG.

Stages and Behaviours Archives - DementiaHub.SG

Managing Anxiety

In this Article

What is Anxiety

Causes of Anxiety

Neurological Factors

Damage to parts of the brain that involve emotion regulation:

Cognitive decline:

Psychological Factors

Fear of the future:

Confusion and disorientation:

Other Contributing Factors

Pain or Discomfort such as physical ailments or hunger:

Medications:

Trauma or Past Mental Health Issues:

Symptoms of Anxiety

Supporting Your Loved Ones with Anxiety

Establish a Calm and Predictable Environment

Reassurance and Validation

Physical Exercises

Relaxation Exercises

Seek Professional Help

Conclusion

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Read Next

Why Do Behavioural Changes Happen?

In this Article

Mild Dementia

Moderate Dementia

Advanced Dementia

Personal Stories

Where Is My Money?

Causes of Behaviour Changes

Management of Behaviour Changes

Some Tips to Manage Behaviour Changes

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Additional Resources for Other Behaviour Changes

1. Talking Point | CNA Insider

2. UCLA Alzheimer’s and Dementia Care Video series

3. Fact Sheets Developed by Overseas Dementia Associations

Anxious Behaviours

Apathy

Refer to Pg. 6

Refer to Pg. 106-117

Depression

Refer to Pg. 7

Disinhibited Behaviours

Hallucinations & Delusions

Hoarding

Repetitive Behaviours

Resistance to Activities of Daily Living (ADLs)

Sleep Disturbances

Vocally Disruptive Behaviours

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Managing Wandering Behaviour

In this Article

Possible Causes of Wandering Behaviours

Boredom

Restlessness or a need to burn up energy

Memory problems and confusion

Confusing night with day

Looking for familiar persons / items / places

Continuing with a habit or routine.

An attempt to get away from something

Change of environment​

Physical discomfort or pain​

Night Wandering

Some Ways to Manage Wandering Behaviours

Change of environment

Physical discomfort or pain