Seniors are no different than the rest of the population when it comes to feelings and fears. When seniors have dementia or are cognitively impaired, they are not able to share those feelings and they the feelings may manifest as behaviors. Strokes, that impair the brain’s function, can also lead to behaviors that are atypical for the person. Other behaviors may be due to the senior’s lifelong or recent onset of mental health diagnosis like depression. Depression in seniors often does not present like depression in the younger adult. The senior may demonstrate aggression rather than withdrawal.
The behavior may have elements that are not consistent with social rules. This is most often seen with dementia. The senior may use the waste basket for the toilet, they may self touch in front of others or they may undress in public places. These behaviors are not controllable by the senior. If they occur, the senior is in need of help. The local Agency on Aging may have resources. A geriatric psychiatrist can also be a resource. Depending on the level of disability of the senior, a psychiatric hospitalization may be necessary to evaluate the behavior and provide interventions. Because a senior has a late in life behavioral diagnosis does not mean that the family has to be concerned about familiar transfer of the condition. The behavior is due to the dementia and the organic or physiologic changes in the brain from the disease process.
The behavior is most often directed to the caregiver. Often the senior is living with a lifelong spouse and that is the person that takes the brunt of the behavior. The spouse may not tell others about the behavior because of fear or shame. As a family member, ask about it. It is a huge burden for a person of any age to manage these behaviors.
The couple who has been together for many years develop their own way of communicating and interacting. When one of the seniors is no longer able to participate in this relationship, it is very difficult for the other partner to identify problems in the relationship since it is so long lasting. The partner with normal function wants to help their loved one and often exacerbates the behavior by expecting a normal response. The cognitively impaired senior is unable to respond within the long standing model and both partners get frustrated. It may be necessary to have someone in the home with the couple to manage the situation.
There are many behavioral, non medicinal approaches to manage behavior. They must be tailored to the senior and their history, needs and disease process. A professional like a Navigator or expert in dementia care may be able to assist you. These individuals do not carry the baggage that families carry and can be objective about approaches. Often the interventions are very simple, but just not visible to those in the trenches. Things like hunger, constipation, fear or pain may lead to behaviors.
Sometimes the best conservative, behavioral interventions are not successful in the management of behaviors. In that case, medications may be necessary to help the senior cope with their life and its stressors. There are many such options. Most often the medication is used in context with the behavioral interventions.
Paranoia or fear that others are attempting to hurt or harm you is a common behavior of the senior with dementia. They may be afraid to eat thinking that food is poisoned. They may not want to be in the home because they think it is wired electronically and other are listening to them. They may feel that others are looking in their windows and want all blinds and shades closed. They may feel that their spouse of decades is having an affair or is out to harm them. These symptoms typically cannot be redirected away. Meaning that you cannot convince the senior that they do not exist. Often trying to convince the senior of the false nature of the belief will escalate the behavior. If this is a problem behavior you will need outside help to resolve this behavior.
Two thought processes that may occur in seniors with dementia are delusions and hallucinations. Delusions are false beliefs. They would include paranoid beliefs or beliefs that are not grounded in reality. The senior may think that there home is infested with listening devices. Hallucinations are different than delusions in that the individual actually hears, sees , feels or tastes when there is no actual reality. The senior with dementing disease may have frank hallucinations seeing or hearing people in the house that are not there. The family should not always assume that the delusions or all false. There may be someone who is actually coming into the home and attempting to harm the senior and the senior is not able to describe the actual situation. Other family members, friend or neighbors may in fact be preying on the senior without caregivers or other family being aware,
There are many other situations that can occur
The previous overview is only a brief summary of the safety needs of seniors. They are some of the most common, but each individual will have unique exposures based on their life style, resources and physical environment. Calling a Navigator or expert in the management of seniors and their challenges can help the family and caregiver identify options to keep the senior safe and to maintain their dignity and autonomy.