John was a “frequent flyer” in my work area. Able to propel his wheelchair down the hall from where he lived to our neighbourhood, his favourite activity was to create havoc in our dining room. He’d move from table to table, touching dishes and cutlery with hands which had been everywhere. John wasn’t popular–that’s an understatement.
Staff would move John back up the corridor to his own neighbourhood, reset the tables and repair the damage. Often on the return journey, he dug in his heels and yelled. He sensed their impatience and responded with anger.
Over several months, I learned a method that worked with John most of the time. It was best for all concerned if I caught him before he got to the dining room, but that was more for our convenience than his. I would position myself in front of him with the hugest smile on my face, as if he’d just made my day. I’d take his hand and say with enthusiasm, “Hi, John! How are you? I’m so glad to see you.” His angry features would dissolve and the most beautiful smile would make its way across his face.
John had no idea who I was. But my actions said to him, “we are friends,” and he loved being among friends. We’d walk companionably back up the hall, his anger dissipated.
Respect, creativity and a sense of humour
If there is one statement that is true of all people with dementia, it’s this: there is no statement that is true of all people with dementia. Little is typical; nothing works all the time. Respect, creativity and a sense of humour are essential. Sometimes a little magic fairy dust helps as well.
Behaviours, unmet needs or mysteries
Actions which are seen frequently among some people with dementia have been called “behaviours” in the past. This label, both medically-based and derogatory is used less frequently now. The Eden Alternative philosophy (https://www.edenalt.org ) talks about “unmet needs” as the source of many of these actions. It is often the case that something led to anger or wandering or anxiety, and if we can identify it, we can help. Sometimes, there are no answers. but it behoves us to ask questions because each answer is a triumph.
Is it an emotional cause?
Mabel’s outburst of anger took me by surprise. I’d asked her if she wanted one of two entrees for lunch and this normally passive lady yelled at me. I blinked a few times, as I absorbed her barrage, and then stepped away quietly. A few minutes later another staff member was able to get her order and life went on.
You learn to accept an occasional blip like this, but if possible it can be helpful to ask the question “why?” Especially when it’s out of character or it becomes an unusual pattern (this wasn’t the first time Mabel had snapped that day) we need to ask “why?” Sometimes Mabel has a problem she can’t tell us about.
- Is she frustrated by an inability to communicate, a task that’s too difficult or she doesn’t understand? At our home, the dietary department loved to give dishes fancy names, and I was forever reminding staff to drop the extras and ask residents if they wanted the chicken or the tuna.
- Is she afraid because this familiar environment is suddenly unfamiliar to her? Does decision-making cause anxiety in her?
Is it an environmental cause?
Alice reacted negatively to noise and confusion. She ate her breakfast in the dining room because at that time it was quiet and she liked to watch the street from her window. Sometimes she would start lunch or dinner in the dining room, but as the noise level escalated, she would begin to yell and have to finish her meal in her room with a private sitter. She loved children and music, but many of those activities were too stimulating for her to attend. Our music therapist visited her one-on-one and had much more success. 
Other residents find a boring afternoon with nothing much happening will agitate them. Even the decor can cause problems. I once worked in an area for people with dementia which had bright yellow walls and a busy flower border down the middle of the room. When the room was finally painted a soft green, the general agitation became less.
Some people also react to seeing their reflection in the mirror.
In review, environmental causes could be:
- loud noises
- crowds, confusion
- an overly stimulating environment
- a boring environment
- garish decor, mirrors
Is it a physical cause?
Have you heard the term “hangry?” We can all relate to a time when hunger left us impatient and angry. Maybe Mabel’s problem was just that she didn’t want questions, she wanted food! Perhaps she was dehydrated, which happens among the elderly so easily. Could she be constipated or be struggling with chronic pain? Finally, I can’t tell you the number of times unusual behaviour turned out to be a urinary tract infection. Checking urine became the first point of questioning.
Some physical causes:
- hunger or thirst
- constipation
- chronic pain
- a urinary tract infection
Not every cause can be found, and not every snarl or rebuff needs this level of investigation. But when I figured out what bothered one of my residents and made a small change which helped, the sun shone more brightly for all of us!
Next week: What changes could be made?
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Hello Ann
You are such a blessing as you pen the understanding and feelings of those less fortunate than us, yet speak words of empathy, grace and compassion. I am wondering if a friend or a family member would read your blog to someone with dementia and how they would respond.
So well thought out, with love .
Paul