Responding to Difficult Behaviors in a Loved One
by: Sound Options, Inc.
A wide range of factors including personality, dementia, pain, depression, loss of independence, fear and family dynamics can cause loved ones to exhibit difficult behaviors. We delve into the hard questions and give advice and tips on how to respond in effective and positive ways.
How do I handle my elderly parent who needs but refuses to allow any caregiving help in the home?
Keep in mind that any kind of change is very frightening for many elders and that fear of the unknown or fear of losing independence can be greatly intensified. Show your understanding. Ask what their fears are and try to allay them. Assure your loved one that you will help them find a caregiver they like, and that you will monitor the caregiver. Explain that having a caregiver will help them remain as independent as possible, and will help them be able to stay in their own home.
Some elders respond better to “trying out” a caregiver for short period of time, such as a few afternoons a week. Once the elder has gotten used to having the caregiver on an infrequent basis, you can work to gradually increase the amount of time.
You can ask the elder’s physician to intervene. Some physicians will even write a “prescription” for a caregiver. If you will be going with the elder to a doctor’s appointment, and want to give the doctor information about the elder in confidence, you can write up a list of concerns and requests, and fax it to the physician a couple of days before the appointment. Be sure to put a note on the cover sheet stating that you are requesting the list be read before the appointment.
If nothing works, your loved one adamantly refuses to have any help, and you feel the situation is unsafe, you can contact Adult Protective Services (APS). APS will send a social worker to talk with and assess the elder to determine whether further action should be taken.
When you begin to interview caregivers, involve your parent in the process. Once caregiving begins, your parent may make unreasonable demands. Do not defend the caregiver to your parent or get into an argument. Assure them that you will get to the bottom of the problem.
How do I handle my elderly loved one that is a danger on the road but refuses to give up driving?
This is a serious problem that cannot be overlooked and can be one of the most difficult to overcome.
You can confidentially ask the physician for a letter stating that the individual should no longer be driving. Send the letter to the Department of Motor Vehicles (DMV) suggesting that the elder’s license be taken away. The DMV will likely require that the person come in for testing. If the situation is critical, contact a supervisor at the DMV immediately.
If the DMV ends up taking the license away be understand of how difficult this is for the elder, and help them find alternate modes of transportation. Transportation for seniors is usually inexpensive and available in many areas, and will help them not to feel so trapped at home.
If you absolutely have to, take the car keys away, but if you fear the person may still try to drive, put “The Club” on the steering wheel. You can also remove the distributor cap or have a notch put in the car keys so they won’t work. Allowing the elder to keep their keys may help them feel more secure.
How do I handle elderly loved ones who can no longer take proper care of their bills and finances?
Convincing a parent that they need help with their finances may be very difficult, so plan ahead. One solution is to get your parent a “companion” credit card with a low limit added on to your own credit card account. This way you will get the bill and they won’t have to carry cash around that may get lost or stolen.
It is critical to obtain Durable Power of Attorney (DPOA) for both health care decisions and financial matters as soon as possible. This gives you legal authority if your loved one becomes incompetent to handle their own decisions. Your parent should be of sound mind when signing a DPOA. If the dementia is already severe, contact an Elder Law Attorney specializing in guardianships.
How do I handle my elderly loved one who exhibits bizarre behavior and uses inappropriate/foul language?
Bizarre, aggressive or unusual behavior that is out of character may be one of the first signs of dementia. Be aware and don’t dismiss these early warning signals. Seeking help at this early stage will greatly help your loved one and reduce your frustrations. It will be important for a physician to determine whether there is a physical cause for the change in behavior. These behaviors can often be controlled with psychiatric medications.
You can set limits of acceptable behavior. Correct the person when inappropriate behavior occurs and when foul or embarrassing language is used. Never resort to bad language yourself. Try to keep calm. If you need to, walk away until you regain composure. Try not to take the behavior personally. Remind yourself that this is not your “true” parent, but rather a result of the brain’s dysfunction.
If you are being verbally abused (“I hate you… I never want to see you again.”) do not respond. Don’t take it personally, and don’t let your emotions get the better of you. If you are called an offensive name, do not respond. Acknowledge the person only when you are being called by your correct name. If the behavior doesn’t stop, walk away.
How do I handle an elderly loved one who has become suspicious and paranoid?
Do not make light of the situation, and do not argue or try to talk the person out of their fears. Calmly acknowledge how awful it much must be to feel that way and assure the elder that you don’t think they are crazy. Make them feel safe, loved and assured of your continued support. Report the symptoms with examples to their doctor. If you get an unconcerned attitude from the doctor that it’s just part of the aging process, insist on taking them to a geriatric psychiatrist or for an evaluation. With the proper medication and behavioral management, the fears may be greatly reduced.
How do I handle my elderly loved one who prefers to stay in bed or do nothing -- “waiting to die”?
This could be a ploy to get more attention, or it could be a sign of depression. Carefully evaluate what’s going on. Drop in unexpectedly a few times and observe the individual’s level of activity. If you suspect depression, ask their physician to consider prescribing an antidepressant. There is such a wide range of effective medications available today that there may be no need for your loved one to suffer.
Get your parent enrolled in the local Senior Center or Adult Day Center to have something to look forward to , friends to see, and varied activities to engage in. Realize that you cannot supply all the social interaction or activities on your own, day after day. You can go with them to the Center a few times, have lunch and introduce them to everyone to encourage the making of new friends. Many centers will be able to help arrange transportation.
If your parent wants to sleep all day but is up all night, there are a few things you can do to alter this pattern. In the morning, open all the windows and drapes to let in fresh air and sunlight; plan activities, exercise and visitors. Getting out for an hour or two of sunlight daily can help regulate an elder’s circadian rhythm. Ask your doctor about prescribing medications that may help them sleep at night. Make sure they are not getting any caffeine from coffee or chocolate in the evening. Also, ask their doctor to regularly review of all of their medications to see if anything could be causing daytime drowsiness. If possible, switch those medications to be taken at night.
How do I handle an elderly loved one who refuses to take showers and change their underclothes?
Realize that people with dementia can be very fearful of showering or bathing. If this is the case with your loved one, find ways to increase their sense of safety. You could try using a shower chair or giving bed bath. If the person is afraid of having their hair shampooed, you can try a device that allows for shampooing and rinsing outside of the shower or tub. If all else fails, see if you can find a non-rinse “shampoo”.
You can try reminding the elder that cleanliness is important for their health, and that they will feel better after a refreshing shower or bath. They may not realize that they smell bad, and letting them know that may encourage them to bathe.
For some individuals, if they agree to shower regularly, you can try a “contract”. Write up what they are willing to do, and have everyone sign it. If they later refuse to shower, you can show them the signed contract and remind them that they agreed to shower.
How do I handle an elderly loved one who is driving me crazy as I try to deal with all of their problems?
Set reasonable but strict limits on your involvement and ask for specific help from family and friends. Set a schedule of who will do what/when with everyone involved. Find out what resources for help are available to you. If there are not enough family members or friends to help, enlist professional support. Your Sound Options Eldercare Consultant can help you find support and respite.
Get into a support group, which will help you feel less alone and provide you with valuable tips. Make sure to get respite time away from the elder on a regular basis. Do nice things for yourself that help you relax, such as going for a walk, talking with a friend, going to a movie, getting a massage, or taking a warm bubble bath.
Although it is incredibly difficult to do, see if you can shift your perspective. Think of your parent as a patient who is ill and fearful, and who has many losses. Forgive them for getting old, and try to have compassion regarding their loss of ability to think clearly. Walk a mile in their walker, and remember the likelihood that some day you, too, will be old. Try to think about good memories, and the things that your parent has done for you. Remember that although you are in a very difficult situation, you have an opportunity that will pass more quickly than you realize.
A fantastic resource that we recommend for further in-depth information is a book called, Understanding Difficult Behaviors by Anne Robinson, Beth Spencer, and Laurie White. It covers difficulties that can arise out of the activities of daily living such as bathing, dressing, toileting, sleeping, eating, and also looks at agitation, paranoia, verbal outbursts, wandering, and much more.
Published on November 30, 2012.