In the middle stage of his Alzheimer’s disease, my husband, Harvey, when home alone, would open the mail and mark it up with heavy circling or underlining. He would then put it in all sorts of places in the house. This frustrated the stew out of me when I came home from work, and I would stomp around the house, muttering to myself.
Then I realized that Harvey just wanted to be helpful. I had taken away most of his daily chores, so getting the mail was one of the last items he could manage on his own. He needed to be needed. Once that sank in, I began to look at most of his annoying behaviors in a different light. And I began to look for ways to keep him engaged and feeling loved and needed in the family, and not just a burden.
Difficult behaviors in persons living with Alzheimer’s disease and other dementias cause much grief for their caregivers. Also anger, frustration, sadness.
But what if we look behind the behavior to the internal emotion inside our loved one that is provoking the behavior? Persons living with dementia have emotional lives. It’s the expression of that emotion that causes the behaviors. They can sense your emotional state, too, and often, will reflect it back to you. So if you are anxious, your loved one may become anxious themselves.
So emotions lead to behaviors. Persons living with dementia cannot regulate their feelings as well as before their diagnosis, so emotions are often expressed as behaviors.
Looking further, we can ask,”What is causing the emotion behind the action?”
It is usually an unmet need.
So. A need leads to an emotion which leads to a behavior.
Guess what? This is true for all humans!
If I need sleep, I but cannot get to bed because of chores that need to be done, I get cranky. And when I feel cranky, I usually snap at the people I love.
As humans, we all need love, and we all feel unlovable at some point in our lives. That unmet need to be loved can cause a myriad of emotions—sadness, longing, nostalgia, anxiety, anger, frustration. And how we respond to those feelings is as unique to each individual as we are unique among ourselves.
If we are open and aware of what is going on in our emotional lives and in our behaviors, what need is going unmet, we can learn about ourselves, and hopefully, adjust or eliminate the more destructive outward displays.
But persons living with dementia cannot do that. They cannot self-reflect or self-regulate.
We, as their care partners and caregivers, must interpret what is behind the behaviors. And this takes work!
How much better to remain calm in the face of the behaviors and try to understand the emotion and the unmet need behind it. This takes a tremendous force of will for many of us, tamping down our reflexive response to their sometimes destructive behaviors. If we can do that, then the next step is to try to put ourselves in the mind of our loved one with dementia, entering their world, so that we can discern the underlying need. And when we address that need, rather than focusing on the behavior, we are dealing with the cause, and not the symptom.