Tools for Caregivers

Causes of Problematic Behavior

Environmental Control

The dementia environment in a care home, from Social Care Institute for Excellence

Environment control involves anything external, such as using schedules or placement of furniture or lighting. Some suggestions are:

• eliminate clutter
• reduce noise or other stimulation
• develop and follow regular routines and daily schedules
• provide cues to help with transitions. Ex: a lap blanket can signal nap time.
• use timers as reminders and to set limits
• use well known/loved items to maintain familiarity in unfamiliar places like motels or airplanes.

The Canadian Psychological Assn. puts out a fact sheet about Environmental Adaptions to Dementia [10]. You can also access this sheet from our LBD Reference page.

Infection control

To prevent infections, make sure a person with dementia:

• drinks plenty of water
• uses good personal hygiene
• avoids choking
• avoids pressure sores
• doesn't have any unusual skin itching, lesions or pain

Once an infection is present:

• It should be addressed medically. Treatment depends on the type of infection.
• Symptoms vary with the infection, but include fever over 101 degrees, chills, swollen red areas, obviously infected areas, nausea, abdominal pain or a sudden increase in Lewy body symptoms such as confusion.
• More: 8/23/13 Rollercoaster blog - LBD and Drugs - Part 5 - Lewy Safe Drugs

Pain Management

Teepa Snow talks about "How to Recognize Pain in Late Stage Dementia"

With age, arthritis and other painful illnesses become common. Decreasing this pain decreases stress. The first step is often to identify that your loved one isn't just being obnoxious or irritable, or even frustrated, but is actually in pain. They may not be able to tell you about it, or just as often, may not even realize that the pain is there...they just feel bad, and act it out. Ask specific questions using touch and hand gestures to help to identify where the pain might be.

Treatment:

Pain treatment can be difficult. Even identifying the presence of pain can be difficult.

• As a person loses the ability to think, they simply feel bad but not know why. Using gentle questions and pointing to different parts of the body can help.
• Dementia can impair language skills. A person may say the wrong word, or none at all. Watch the gestures and ask for more information.
• Pain may be delusional; real only to the person. Make sure this is the case, then consider placebos.

Pain decreases comfort and increases Lewy body symptoms, few pain drugs are recommended. Therefore, non-drug options should be tried first.

In any case, consider non-drug options first, before resorting to pain drugs.

Non-drug options

• Engagement skills, to identify issue, comfort and distract
• Alternative therapies, such as touch and massage
• Enhancing activities, such as music and humor to distract and calm
• Rehabitation therapy, to improve movement and strength and to find less painful ways of doing tasks.
• For more about non-drug options for pain, see the 4/29/16 Rollercoaster blog.

If non-drug options aren't enough

• Acetaminophen (Tylenol) is usually safe in small doses for short times.
• Rather than drugs like Advil and Aleve, which have side effects that can affect the GI tract and heart, some doctors recommend a very mild narcotic. However, narcotics tend to be constipating.
• Read more about pain drugs and LBD in the October 10/9, 16 and 30/2015 Rollercoaster blogs.