Alzheimer's Foundation of America

Foundation of America

Navigating Difficult Behaviors

When our loved ones begin their journey with dementia, they transition into visual learners. They watch us, as their caregivers, for visual cues on how to feel, react, or respond to their environment. When we talk about behaviors, we really need to start with ourselves. We reflect our state of mind, be it angry or nervous, or patient and relaxed. Our loved one is using these emotions as a guide and will respond accordingly and often mirror our demeanor.

Difficult behaviors may also be a response to our lack of visual signals when our loved one is communicating a need. We can ask ourselves, “Is my loved one hungry, thirsty, in need of the bathroom, in pain?” If we meet that need, then the behavior may cease. We may also need to ask ourselves what happened before the behavior. Can we identify any triggers? Understanding triggers and needs will help better manage these difficult behaviors.

Common behaviors of a person living with Alzheimer’s or dementia are rummaging, wandering, hallucinations, shadowing, repetitive questioning, and paranoia. Not everyone living with dementia will have these exact behaviors. Some families may experience other negative behaviors or even no difficult behaviors at all. Sometimes the best way to deal with a behavior is to not deal with it. Ask yourself whether the behavior really matters or is hurting anyone. Try to find a way to use the behavior to your advantage.

Here are some ideas to address difficult behaviors:

Rummaging through things may be due to boredom, fear or anxiety. Use the behavior of rummaging as an activity. Create a special place where the person can rummage freely or sort things. This is a great activity for hand/eye coordination.

Wandering may be the person’s attempt to “go home” or communicate they are uncomfortable; possibly the environment is too warm or cold. It is possible that there are too many stimuli and the person needs to flee. If your loved one wants to “go home,” ask them why. Do they have something to “do” there, or do they just want to “be” there? Gaining as much information as possible will help you identify the appropriate response or activity to redirect their mind.

Hallucinations are sensory experiences and occur in at least half of all cases. When a person is experiencing a hallucination, do not try to explain reality. Instead, state that you understand their distress and be present through it. Keeping their environment simple and increasing lighting may help eliminate distractions.

Shadowing, or following the caregiver physically, may represent insecurity. The person living with this behavior may be saying, “If I am out of your sight, will you forget that I need you?” I like to think that a person may follow me around for a feeling of safety. Of course, having someone follow you around can be nerve-wracking. Try asking your person to hold something for you or open a jar or container. Getting their mind on a specific task may give you a moment of solitude.

Repetitive questioning is due to short-term memory loss. Asking questions multiple times is common and expected. Give the person the answer that they are looking for, even if you have given it several times. Try distracting the person with a favorite activity or redirect them to another room.

Paranoia is linked to memory loss and can worsen as a person’s memory dissipates. Try not to react if you are being blamed for something. Do not argue; they have lost their ability to reason. nstead, validate the feeling that something is missing and ask if you could join the search for the missing item. If possible, have extras of frequently lost items. Keep original and important pieces in a safe place. If possible, make color copies if they want to carry these on their person.

Caregiving is challenging, even under the best circumstances. Dealing with difficult behaviors can be time consuming and frustrating. Before trying to stop a behavior always ask yourself, “Does it matter?” If the behavior is not harmful, it may be better to adapt and redirect.


Lynn Wood is a Positive Approach to Care (PAC) certified Caregiver Support Coordinator at Mental Health America of the MidSouth, in Nashville, Tennessee, and a member of the National Council of Certified Dementia Practitioners.

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