Repetitive behavior may signal person looking for comfort, security, familiarity

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By JULIA ELDRED

A person with dementia may do or say something over and over. This can be a word or phrase, question or activity, or undo something that has just been completed. In most cases, the person is most likely looking for comfort, security and familiarity.

The main cause of behavioral symptoms in dementia is the deterioration of brain cells. This causes a decline in the individual’s ability to make sense of the world around them. With repetition, the person may not remember that they have just asked a question or completed a task.

A person’s environment can also cause symptoms or make them worse. People with dementia who ask questions repeatedly may be trying to express a specific concern, ask for help, or cope with frustration, anxiety, or insecurity.

Because people with dementia gradually lose the ability to communicate, it is important to regularly monitor their comfort and anticipate their needs.

How the brain develops

The brain develops from the back to the front. The back of the brain, at the back of the head, controls emotions and feelings. The front of the brain, the forehead, is the regulator or stop sign. The front of the brain, the last to develop, isn’t fully developed until around age 25.

With dementia, the front of the brain deteriorates first. This means a person’s filter and regulator are gone early in the disease, leaving emotions and feelings later.

C3P Support Framework – Tools for interacting with repetitive behaviors.

Changing the Person (with dementia)
Changing the People (the caregivers)
Changing the Place (the environment)

Changing the person

● Focus on the emotion behind the repetition
○ Look for a reason behind the emotion – hot, tired, cold, hungry, in pain, need to eliminate, etc.
○ Zero in on the Emotion – What are they feeling? – anxious, frustrated, fearful, etc. Ask what they are feeling and reflect on their answer (It sounds like your ________). Affirm their feelings (It must be hard to feel ________).

○ Turn the repetitive behavior into an activity.
■ Tapping – listen to music and feel the beat.
■ Running hand over table – give a cloth and ask for help dusting.
■ Folding shirt over and over – give a basket of washcloths and ask for help folding them.
■ Moving items around on the table – ask for help sorting .coins, buttons, beads by color, nuts and bolts, etc.
■ Any meaningful behavior that matches their movement .

Changing the People

● Stay calm and be patient
○ Questions. Remember memory is affected. They may not remember they just asked a question.

○ Don’t argue or try to reason with logic.
○ Remember your emotions.
- A person living with dementia will pick up on your emotional energy.
- They will mirror your energy.
- Use fewer words and wait 30 – 90 seconds for a response.
- Use actions to demonstrate a desired action.● Provide an answer to questions
  - ○ Give the person the answer that they are looking for, even if you have to repeat it several times.○ Address the emotion behind the question.
- ○ Divert their attention to another activity or topic.● Accept behavior and work with it.
  - ○ If it’s not harmful, go along with it.
- ○ Remember that resistance meets resistance.
● Join a support group
- ○ Provides a safe place to voice concerns, challenges and frustration.
- ○ A great resource for ideas.
- ○ Creates community and reminds you that you are not alone.

Change the Place

● Manage Noise Environment
- ○ Noise can create anxiety for those living with dementia.
- ○ Extra noise can result in sensory overload.
- ○ Large groups of people and activity are overwhelming.
● Remember to be aware of the emotion behind the action – worry, fear, confusion, anxiety, etc.
● Use memory aids if still meaningful.
- ○ A clock with significant times marked clearly.
- ○ A calendar with appointment days circled and past days marked off.
- ○ Sticky notes to label objects or remind of tasks.