Dealing with advanced stage dementia

As your loved one enters advanced stage dementia, challenging behaviours and patterns emerge, putting more strain on the person looking after them. Communication becomes difficult and their actions might confuse you. It’s important to remember that these are side-effects of dementia and everyone might exhibit them in a different way. In this article, we provide helpful tips on managing common behaviours in dementia. 

Dementia care and challenges communicating

Social engagement becomes difficult for people in dementia care, consequently, making it harder for the caregiver to understand their needs and provide optimal support. Your loved one may not be able to tell you if they are hungry, cold, need to use the toilet, experience boredom or restlessness. Instead, this manifests in unusual behaviour, requiring special care and understanding. Dementia patients often become confused, have poor judgement and even get aggressive or manipulative. It’s important to acknowledge, this is routed in decreased cognitive ability and memory loss, as well as fear and anxiety. To ease communication, set a positive mood and eliminate distractions. Be clear in your message, use names instead of pronouns and ask simple questions, of no more than two choices. Be assuring in your approach and watch out for nonverbal cues. Finally, break down activities into simple tasks and avoid conflict, if the person refuses to follow through. 

The underlying cause of challenging behaviour

Although people in advanced stage dementia struggle with social engagement, their behaviour can give you all the clues you need to provide appropriate support. Pacing or wandering may indicate they are looking for something or someone, or they may be fulfilling the physical need for exercise. Physical or emotional aggression is often a sign of fear, so make them feel secure by identifying the cause of anxiety, and eliminating it. Knowing your loved one can go a long way in preventing situations like this, as you might be aware of what’s causing the issue. Confusion is another common problem associated with advanced stage dementia, especially, if they have moved to another location or care home. Repetitive actions and speech, and paranoia are linked with fear and confusion, so provide as much assurance as possible. Random actions, such as rearranging their room, may be indicative of boredom and desiring a sense of purpose. Dementia care and challenges communicating can result in manipulation or bargaining, as well as poor judgment, as the person is trying to navigate their condition. 

Dealing with challenging behaviour and dementia

There are ways you can work around common behavioural challenges of late stage dementia. Here’s how: 

• Confusion about place or time – provide familiar objects in their environment to make them feel at home. Distract them, if necessary, with a ‘therapeutic lie’, for example, ‘we can’t leave because the weather is bad, there’s traffic’ etc. It may be more effective than reasoning with a dementia patient

• Poor judgment – avoid questioning their ability to do certain things. Instead, assist them in different tasks, like keeping on top of their finances, and create an environment where they are unafraid to ask for help 

• Aggressive behaviour – identify the cause, whether physical or emotional, and provide necessary adjustments. Avoid restraining the person, unless absolutely necessary, and try not to become agitated yourself

• Manipulation – if your loved one exhibits manipulative behaviour, don’t question or challenge them on it. Instead, use some light humour, as appropriate, to work around any attempts of lying or bargaining 

Remember, people in dementia care struggle to recall recent events, but often have clarity of what happened decades before. It helps to talk to them about the past, listening to music or watching films they used to enjoy, and implementing other objects and activities that don’t spark confusion. This will encourage feelings of safety and reassurance.