Professional guidance for family caregivers
Dementia-related behaviors—repeating questions, pacing, refusing care, accusations, agitation—are usually signals of distress or unmet needs, not “bad behavior.” This guide shows you how to decode what’s underneath and respond safely and calmly at home.
Why behaviors happen (the “3 buckets”)
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Brain changes: slower processing, short-term memory loss, language/visual changes, disorientation.
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Unmet needs & medical causes: pain, infection/fever, constipation, dehydration, hypoxia, medication effects, hunger, fatigue.
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Environment & task mismatch: noise/clutter, glare/shadows (sundowning), too many steps at once, rushing or loss of privacy.
✨Principle: Treat behavior as a message. First relieve distress, then finish the task.
The 90-Second De-escalation Plan (in the moment)
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Breathe & soften your voice. Stand at eye level, hands open.
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Validate the feeling: “I can see this is upsetting.”
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Offer two simple choices (both acceptable): “Tea or water?”
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Change the setting: lower TV, turn on warm lamp, reduce crowding.
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Redirect with purpose: “Could you help me fold these towels?”
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If stuck, pause 5–10 minutes and try again.
✨Avoid: arguing facts, more than two choices, sudden touch, blocking the exit.
Decoding common behaviors (what it might mean + what to try)
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“I want to go home.” → Seeking safety/familiarity
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Repeating questions → Anxiety; can’t retain the answer
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Refusal of bathing → Cold, embarrassment, fear of slipping
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Pacing/exit-seeking → Restlessness, purpose seeking
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Accusations (“You stole my wallet!”) → Misplaced items feel threatening
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Sundowning (late-day agitation) → Light/shadow changes, fatigue
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Communicating so it “lands”
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Use names/roles: “Mary, it’s John—your son.”
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One step at a time: “Stand up.” (pause) “Walk to the chair.”
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Two choices only: “Blue or green sweater?”
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Praise effort, not accuracy: “Great job; we did it.”
Set up the home for fewer flare-ups (fast wins)
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Clear floors; remove throw rugs; coil cords; add motion nightlights to bathroom route.
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High-arm chair for safer standing; table for glasses/ID bracelet.
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Big labels (words + icons) for rooms/drawers; whiteboard with today’s plan.
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Auto-shutoff kettle/cooktop; secure knives/cleaners.
Make a simple Behavior Plan (so everyone responds the same way)
Use ABC notes for a few incidents:
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A – Antecedent (before): time, place, trigger (hungry, bath time, noise, constipation).
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B – Behavior: what happened (shouting, hitting, pacing) and how long.
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C – Consequence (after): what calmed/helped (space, music, snack, two choices).
Then write a standard response for your home:
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Prevention: snack + hydration at 3 pm; lights on before dusk; bathroom before bath.
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De-escalation script: validation → two choices → redirect → music.
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Roles: who leads, who steps back, who calls the nurse if it continues.
Medications: when and how (clinician-directed)
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Non-drug strategies first. Many behaviors improve with routine, environment, pain relief, and communication.
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If danger or severe distress persists, your clinician may consider medication.
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Depression/anxiety: typically SSRIs; aim to avoid benzodiazepines when possible.
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Psychosis: antipsychotics carry a black-box warning in dementia; use lowest dose/shortest time, and avoid haloperidol in Lewy body/Parkinson’s dementia.
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Always report side effects like increased sleepiness, falls, or confusion.
Red flags—call the care team
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Sudden confusion (possible delirium: infection, dehydration, meds)
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Head strike, chest pain, stroke signs, or serious injury → 911
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New or worsening aggression, unsafe wandering, refusal to eat/drink
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Signs of depression with thoughts of self-harm
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Caregiver exhaustion or feeling unsafe at home
How MedProUSA helps (Memorial & Greater Houston)
Caregivers (private pay): calm companionship, bathing/dressing, meals & hydration, evening/sundowning routines, overnight safety, brief visit notes.
Nurses/Therapists: check medical causes (pain, infection, constipation, meds), create safety and communication plans, teach de-escalation, train on safe transfers, and coordinate with your physician to prevent avoidable ER trips.
Typical schedules: morning start-ups, evening/sundowning coverage, or overnights; 4–12-hour visits; short-term or ongoing.
Ready to create a calmer plan at home?
Memorial & Greater Houston • 📞713-932-0017 ✉️Info@MPUHealthServices.com
🏠Address: 9219 Katy Freeway, Suite 207, Houston, TX 77024 🌐Web: mpuhealthservices.com
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