Changes in Behaviour in People with Dementia

If you suspect or notice hallucinatory behaviour, consult with the person’s doctor. When these symptoms are diagnosed and treated with medication, the attitude will be to maintain a calm, safe environment. Emotional support is basic, and should be reinforced, and it should be repeated that the person is not alone, is loved and will be helped. Positive reinforcement.

As the dementia progresses, hallucinations (seeing or hearing things that do not actually exist) and delusional ideas (false beliefs) can occur.

It is extremely disconcerting to see our loved one suddenly become suspicious, jealous or start making accusations. Remember that, from his or her point of view, those feelings are very real.

The best thing to do is not to argue or hit back at what is said. These behaviours form part of the dementia. It is important not to take it personally.

Recommendations for managing delusions or hallucinations

• If the person is in a state of confusion and insists that he or she “is missing money”, keep a small amount in his or her pocket or bag, so it can be taken out easily
• Help the person to look for the “lost” item, then try to distract him or her with a different activity. Try to discover where the person hides the things he or she thinks are “lost”. Avoid having an argument
• Explain to other relatives and home helps that the accusations and suspicions form part of the illness
• Use non-verbal means to strengthen the feeling of being safe, such as gentle caresses or a hug. You can try saying “I see you’re frightened. Stay by my side. I’m not going to let anything bad happen”
• Let the person know, simply and calmly, that other people cannot see or hear these things, but avoid arguing and trying to convince the person that his or her perception is wrong
• Keep the room well lit to reduce shadows
• If these symptoms worsen, consult a professional

Wandering is a behaviour that often appears in the intermediate stage of the illness.

Causes of wandering

• Confusion. While feeling disoriented, the person does not realise that he or she is at home, and sets off “to find it”, ending up somewhere else as a result
• Delusions. This relates to thinking things that are not really there, and the person may be trying to fulfil a past responsibility, such as going to work or going to look for a child
• Attempts to escape from a real or perceived threat. People with dementia can feel frightened by a noisy house, a stranger visiting or even by the belief that their carer is trying to harm them
• Due to this nervousness, people with dementia can become more anxious. Sometimes this anxiety and nervousness can be side effects of some medication, so check with a professional if the behaviour persists
• Restlessness, due to a lack of exercise and other forms of stimulation
• Searching from something or someone, a place or personal item that they have lost

If the person persists with this behaviour, he or she should never be left alone. Care providers should take certain measures to reduce the danger of the person with dementia leaving the home unaccompanied.

Recommendations for managing wandering

• Ensure the person takes regular exercise to reduce feelings of anxiety
• Obtain a medical ID bracelet and ensure it is worn at all times. They are often sold in pharmacies. Other options are also available, such as watch-type or key fob GPS locators
• Establish a clear and safe place in which to walk
• Give the person something repetitive to do
• Keep a few essential articles, such as the person’s overcoat, wallet or spectacles, in a safe place
• Keep the doors leading outside closed, and keep the keys in a safe place that cannot be accessed by the person with dementia
• Install safety devices on the windows
• Install bells or alarms that sound when a door leading outside is opened
• Inform the neighbours that your relative has dementia and ask them to tell you if they see him or her out in the street alone
• Try to use barriers to hide the doors. A sign saying “Stop” or “No access” might also work