Exploring Common Misunderstandings in Dementia Care
Here are common behavioral questions caregivers frequently encounter when caring for individuals with dementia, along with explanations that align with understanding these behaviors through models like Teepa Snow’s Gem State.
Misunderstood Behaviors
- Why dementia patients accuse caregivers of stealing This behavior often stems from a loss of short-term memory, paranoia, or a feeling of loss or depletion. The individual may genuinely believe something is missing or has been taken because they cannot recall where they put it or that they themselves moved it.
- Why they ask to go home when already home This is a common expression of longing for familiarity and safety. Their current environment, though physically home, may no longer feel secure or recognizable due to cognitive changes. They are expressing a desire for comfort and the “home” they remember.
- Why bathing triggers anger Bathing can be overwhelming due to sensory sensitivities (water temperature, noise, touch), loss of privacy, fear of falling, or a feeling of being invaded. It can also be a disruption to their routine or a trigger for embarrassment if they need assistance with personal care.
- Why dementia patients hide objects Hiding objects can be a way to feel a sense of control, to keep prized possessions safe (from their perceived threat of stealing), or a part of hoarding tendencies. Sometimes, it’s simply forgetfulness; they place an item somewhere for safekeeping and then forget where.
- Why they follow caregivers everywhere This behavior, often called “sundowning” or a form of “pacing,” can be driven by anxiety, a need for reassurance, fear of being alone, or a desire for engagement and activity. They may feel lost or insecure when the caregiver is not in sight.
- Why they refuse medications Refusal can be due to side effects, confusion about taking pills, a feeling of being controlled, or simply forgetting they have already taken them. They may also mistrust the caregiver or the act of taking medicine itself.
- Why they repeat questions constantly Repetitive questioning is often a sign of anxiety, a search for reassurance, or a failure of short-term memory. They may not retain the answer due to cognitive decline, or they might be seeking comfort and connection with the caregiver.
- Why they suddenly become suspicious Suspicion and paranoia can arise from hallucinations, delusions, disorientation, or misinterpretations of their environment. Their cognitive changes lead them to perceive threats or malice where none exist.
- Why evenings trigger agitation This phenomenon, known as sundowning, is common. It can be caused by a variety of factors including fatigue, hunger, changes in light, disruption of their internal body clock, or the accumulation of daily stresses and sensory input.
- Why they stop recognizing family This is a heartbreaking symptom of advanced dementia where the brain’s ability to store and retrieve memories deteriorates. Recognition of familiar faces and relationships is often one of the last functions to be significantly impacted, but its loss indicates a profound progression of the disease.
