Behavioral concerns
- A family member has started getting lost. We can only find him/her after searching for a long time. We are worried. How can we solve this problem?
- My grandma cannot sleep at night. What can I do?
- My grandma always says that my mother has stolen her money. What can I do?
- My grandma is not happy all day. What can I do?
A family member has started getting lost. We can only find him/her after searching for a long time. We are worried. How can we solve this problem?
We understand your feelings and recommend that you try the following methods to reduce the chances of your relative getting lost:
First, find out the reason why they are getting lost (eloping). If it is not solely getting lost, but other reasons like unwillingness to be trapped at home for a long time, solve these problems first.
If getting lost is due to his/her disorientation, you can start by considering security and orientation. First call the police and tell them that the person getting lost has dementia. Otherwise, the police may mistake it for a simple family problem that the family can solve by themselves.
Consider the following methods:
1. Install hidden and complex locks at the front door. Patients will give up opening the door if they do not know how to open these locks. Or install additional locks in higher or hidden positions. However, some patients may become emotionally unstable if they cannot open the door. If this happens, try to divert their attention to other things so that they do not spend too much time at the door.
2. Install an alarm at the front door. When the door is opened or closed, it will trigger the alarm and draw your attention. This method is suitable for houses with a gate outside the wooden door. If there is only one wooden door, the patient may already have reached the lobby or entered the lift by the time you hear the alarm, as living quarters in Hong Kong are small. If it is public housing, the patient may already have gone to other wings of the floor, increasing the difficulty in searching for them.
3. Embroider the name and contact number of the elderly person on their clothes and have them wear a name card or bracelet with their contact information. If an elderly person gets lost, passers-by can contact you or other family members according to the information found. There is one drawback to wearing a bracelet: it may be covered by a jacket or long sleeve. Even the police will seldom touch the body of an elderly person because they are worried that they will over-react. Normally, this will only be useful when a patient is physically dealt with in an accident and emergency unit or in the hospital, when medical staff will intentionally look to see if there is a bracelet.
4. If an elderly person gets lost, remain calm and think about possible places he/she may go, starting your search with these locations. Therefore, knowledge of the persons daily routine and schedule are very important. Meanwhile, someone should stay at home as the person may go home by themselves. This family member can be responsible for contacting the others outside of the home. If the wandering person has their identity card with them, the police will call their home when they are found.
5. Tell estate security and your neighbours about the person's tendency to get lost, so that they can help in taking him/her home. Family members should also teach them how to deal with the incident: let the elderly person sit down and drink some water, then call their family to take them home. This is what the security staff and neighbours can do. They may not be able to take the elderly person home, as he/she may not trust them; also, the family members may have gone out to search for him/her, leaving the home empty.
6. Regularly take photos of the elderly person and make both hard and soft copies of a notice (poster) in case they get lost. When this happens, the information can be sent to relevant parties like the police and TV stations immediately. When using the media, it will be important to provide additional information on what was the patient wearing at the time he or she got lost.
7. During everyday life you can also tell other family members like the children or grandchildren of the elderly that they may get lost, and ask them to pay attention during family gatherings and notify others if anything happens. Very often, the elderly person will wander away during a group gathering at, for example, the home or a restaurant. Children have an innate sense of responsibility, and you can take advantage of this and enhance their care for the elderly. Most of the time, children will be resistant towards elderly people, especially those with dementia. Therefore, enhancing their care for the elderly can improve relationships.
8. If you are unfortunately unable to find the elderly person during the daytime, dont continue to search at night, because he/she will also find somewhere to rest due to fatigue. At night, even in urban areas, visibility is reduced to several feet. You should therefore go home to rest and discuss where you should search tomorrow, leaving night searches to the police. Be confident, as you have a good chance of finding the lost person if you follow the above strategies. Be prepared for calls in the middle of the night. There are few people on the street during the night, and people like public transport drivers will be curious if an elderly person is still on the road or in a car at that time. The police also understand the circumstances of getting lost, thus they too may find the elderly wanderer during the night.
9. Taxi and radio stations can also help, the former charging $250 for each instance of assistance. If you tell them your needs, they will announce them over their dispatch system.
10. When the elderly relative is found, you can inform one family member and ask him/her to inform the rest so that they wont continue to search. Family members will be relieved and can now concentrate on preparing some simple hygiene necessities and food. The person will also be scared, so family members should hold back their anger and provide gentle comfort. You may also serve the person some easy to swallow food and help him/her to wash with tissues/towels. If the elderly person wears a diaper, take some clean trousers and diapers for immediate use, then go home after completing any formal procedures.
My grandma cannot sleep at night. What can I do?
Sleeping problems are seen in a lot of dementia patients because their circadian rhythm is disturbed, among other reasons. The following suggestions may help:
- Let your grandma engage in more activities in the morning, such as exercise, going out, doing household chores, or doing things that are active, so that she will become tired (but not over-tired) at night time.
- Try not to let her take too many naps during the daytime.
- Sunlight is a good regulator of our circadian rhythm, so she does need to get out on a regular basis if possible.
- Give gentle reminders or hints that this is now night time and the time to sleep.
- Aviod going to bed too early.
- Make her bed and bedroom comfortable, playing soft music beside her bed if that appeals to her.
- Avoid giving her too much caffeine (e.g. tea) during the daytime and particularly in the evening.
- Avoid giving her too many fluids in the evening, so that she does not need to get up to go to the bathroom.
- Do not let her become hungry in the middle of the night. Give her a light snack if necessary just before bed or when she first wakes up.
My grandma always says that my mother has stolen her money. What can I do?
Suspicion and accusations are commonly seen in people with dementia. They are usually due to forgetfulness and may also be the result of delusion.
Your grandma may forget where she put the money or she may intentionally hide the money to avoid it being stolen.
If there are only two or three people in the home and she loses her money, her logical deduction will be that someone within the family must have stolen it. Therefore, do not be upset, approach the problem with a sense of humor, and try the following suggestions:
- Approach her in a calm manner and try to help her find the missing money.
- Whenever she receives some money, teach her how to make a note/reminder to remember where it is put. For example, put a piece of red tape on the drawer where she puts her wallet.
- Teach her always to put her money in the same spot. Each time, remind her of the red tape, which is an indication of where her money is.
We used to believe that people with dementia cannot learn new things. More recent research and clinicians' observations, however, have found that with repeated drilling, people with dementia are able to retain new information. However, we do know that because of their failing memory, caregivers will have to keep repeating what they say or do in order to comfort a person with dementia.
If your grandma's delusional belief is strong and has resulted in her acting out aggressively, she will need to consult a psychiatrist.
Although your mother will certainly feel wronged and become unhappy, arguing with your grandma will not help. Arguments will only aggravate your grandma's emotions. Your grandma is suffering from a medical disease and she herself cannot help herself.
Help your mother or whoever is the primary caregiver with household chores, so that he or she won't be stressed out and will still have the patience and energy to look after your grandma. We cannot blame the caregiver for having a bad mood all the time because s/he is the one looking after the patient the entire day. Taking care of someone with dementia is not easy. Caregivers need support too. Otherwise, they will experience mental and physical exhaustion leading to inability to care. A vicious cycle leading to deterioration of the caring relationship and quality may then be introduced.
My grandma is not happy all day. What can I do?
Sometimes unhappiness and depression come from the awareness that something is wrong with one's memory, and the experience of unpleasant events (such as difficulty in falling asleep at night or losing money). We have to differentiate between unhappiness and depression. Depression can also have a medical cause and will need to be treated.
Depression may be expressed in the form of crying, low mood, agitation, hostility, suicidal ideas, resistance to guidance, refusal to eat, losing interest in doing things that usually elevate her mood, etc. Depression will need to be diagnosed by a doctor and treatment will be required. If she is very sad and/or has suicidal ideas, you should definitely seek professional help. If the doctor prescribes medication for her, try to ensure her drug compliance.
Here we focus on unhappiness, not depression. Being unhappy about something is usually considered as more transient in nature. If the unhappiness you observe in your grandma is consistent with many of the signs of depression mentioned above, then please take her to the doctor.
Below, we will be talking about how to help a person who is unhappy. We need to be alert to the signs associated with the unhappiness and whether there are any noticeable underlying reasons. Then we can attempt to solve the underlying problem(s). Of course, we should seek professional help whenever necessary.
In terms of the home environment:
- Use pleasant and comfortable colors for, e.g., the wall, the curtain, her bedding
- Put photos showing events in the past that bring forth happy memories nearby, such as her birthday or a grandchild's graduation ceremony, etc.
- Provide comfortable sunlight or lighting (avoiding pale, harsh, glaring light) to avoid agitation or depression resulting from darkness
- Cover mirrors if your grandma has a misidentification problem, i.e. mistakes her own image in the mirror for a stranger in her home
- Simplify and tidy up the environment so that she won't be confused by many items in the home that she doesn't know what to do with
- Provide finger food in obvious places so that she can take it whenever she wants. Eating is important to Chinese people and it has been found to be related to our perception of our quality of life.
In terms of relationships and activities:
- Make good use of items at home for chit-chat. For example, talk to her about her favorite colors, ask her to tell you about what she was doing at the time she took her pictures, and so on.
- Try to cheer her up by doing things that would please her, such as going to a restaurant for dim sum, visiting her favorite grand child, or going for a picnic.
- It is extremely hard for a person with dementia to spend an entire day sitting at home. She may not know how to make sense of the environment or what to do with that much time. It would also be depressing for you and me if we were in the same situation. Therefore, finding time to spend with her on a regular basis to break the monotony of the day will be helpful in boosting her morale.
- Family understanding and collaboration are important in helping someone in the family with dementia. Take turns to take your grandma out to do something, so that everyone can contribute and also take a rest from time to time.
TAG: Behavioral concerns