Training: Managing Challenging Behaviors Training
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Alzheimer’s disease can cause a person to act in different or unpredictable ways. Some individuals become
anxious or aggressive. Others repeat certain questions or gestures. Each person with Alzheimer’s disease is
different, so the behaviors or changes they experience will also be different. For the person with Alzheimer’s
disease, changes in behaviors can be caused by:
- Physical Discomfort (illness, medications etc.)
- Over Stimulation (loud noise, busy or active environment etc.)
- Unfamiliar Surroundings (new places, inability to recognize home etc.)
- Complicated Tasks (difficulty with activities or chores etc.)
- Frustrating Interactions (inability to communicate effectively etc.)
While there are many different behaviors exhibited by persons with Alzheimer’s disease, only the most
challenging to caregivers will be highlighted in this guide.
A person with Alzheimer’s disease may do or say something over and over. They may repeat a word, question
or action. In the span of one hour, a person with Alzheimer’s disease may ask the same question 10 times. In
most cases, the person is probably looking for security and familiarity.
REPETITION: THINGS YOU CAN DO
Look for a reason behind the behavior and eliminate it.
- Answer the person. Even if you have to repeat the answer several times.
- Use memory aids. Remind the person with notes, clocks, calendars, or photographs.
- Respond to the emotion not the behavior. Focus on how the feel not what they are doing.
- Engage the person in activity. The person may be bored and need something to do.
- Provide structure. Engage the person in a pleasant activity.
- Stay calm and be patient. Reassure the person with a calm voice and gentle touch.
- Accept the behavior and work with it. If it is not harmful, let it be.
- Consult a physician. Repetitive behaviors may be a side effect from medications.
- The person may also pace or undermine what has just been finished. These actions are often
harmless for the person with Alzheimer’s disease, but can be stressful for the caregiver.
When a person with Alzheimer’s disease suffer with hallucinations they can see, hear, taste or even smell
something that is not really there. For example: they may see the face of a former friend in a curtain or they
may see insects crawling on his hands. In other cases, they may hear voices talking to him and may even talk to
the imagined person.
HALLUCINATIONS: THINGS YOU CAN DO
Consult a Physician
Ask a physician to evaluate the person to determine if medication is needed or medication currently being used
might be causing the problem. In some cases, hallucinations are caused by schizophrenia, a disease unrelated to
- Have a physician look for physical disorders such as kidney or bladder infection, intense pain,
dehydration, or alcohol or drug abuse – conditions that cause hallucinations.
- Have the person’s eyesight and hearing checked and make sure they wear their glasses and or hearing
Respond with Caution
Do not argue with the person about what they see or hear. For
example: “Can you hear them?” You may want to answer with
words such as “I know that you hear something, but I do not.” In
this way, you are not denying what the person hears or getting
involved in an argument. Unless the behavior becomes dangerous,
you might not need to intervene.
Suggest the person come with you on a walk or sit next to you in
another room. Frightening hallucinations often subside in well-lit
areas where there are other people. You might also try to turn the
person’s attention to other features in the room. Other potential
distractions include music, drawing, and conversation, looking at
photos, or counting coins.
Check Out the Reality of the Situation
Ask the person to point to the area where they see or hear
something. Glare from a window may look like snow to the person
and dark squares on a tiled floor my look like dangerous holes.
Hallucinations can be frightening to the person and the caregiver. On some
occasions, the individual may see threatening images or just ordinary pictures of
people, situations or objects from the past. Although you can create an environment
to manage wandering, you may not be able to control the person’s hallucinations
or prevent them from occurring.
AGGRESSIVE OR COMBATIVE BEHAVIOR
Aggressive or combative behaviors may be verbal (shouting, name-calling etc.) or physical (hitting, pushing
etc.). These behaviors can occur suddenly without apparent cause, or result from a frustration situation.
Consider the following factors as a possible source of frustration:
- Dressing: The person who cannot get his arm through a sweater may grow increasingly upset and start
to trash around.
- Bathing: The person who is frightened by running water in the bathtub may simply try to push your
hand away, while at other times the person may resist or strike you.
- Eating: The person who does not like a certain type of food may refuse to eat it.
Deal with combativeness by trying to examine the underlying causes:
- Physical Causes: Is the person tired because of inadequate rest? Are medications such as sedatives
and tranquilizers creating side effects? Is the person able to express the fact that they are in pain?
- Environmental Causes: Is the person over-stimulated by loud noises, people or physical clutter? Is the
environment unfamiliar? Does the person feel lost or abandoned by the caregiver?
- Poor Communication: Are you asking too many questions or making too many statements at once?
Are your instructions simple and easy to understand? Is the person picking up on your own stress and
irritability? Are you making the person more frustrated by being overly negative or critical?
AGGRESSIVE OR COMBATIVE: THINGS YOU CAN DO
- Be on the lookout for frustration. Look for early signs of frustration in such activities as bathing,
dressing, or eating and respond in a calm and reassuring tone.
- Do NOT take the aggression and combativeness personally. Keep in mind that the person is not
necessarily angry at you. Instead, he may misunderstand the situation or be frustrated with his own
- Use distractions. Do not persist in making the person perform a particular task, especially if he has
repeatedly been unsuccessful. If you see the person getting frustrated with buttoning a shirt, try to
distract them with another activity such as putting on a pair of pants. After time, you can return to the
shirt or take the person to a quiet room, have a cup of tea or go for a walk.
- Avoid teaching. Instead offer encouragement, but keep in mind the person’s capabilities and do not
expect more than they can do. Avoid elaborate explanations or arguments.
- Decrease your level of danger. Assess the level of danger for yourself and for the person. Ask
yourself, “How much trouble am I in and what can I realistically do about it?”
Whatever the situation, it is important to try to understand what is causing the person to become angry or
upset and resulting in aggressive or combative behavior.
Due to memory loss and confusion the person with Alzheimer’s disease might see things differently. They may
become suspicious of those around them and accuse others of infidelity and other improper behavior. These
false ideas are delusions and can sometimes originate in a misinterpretation of a situation. One common
delusion is that family members are stealing.
- Let them know you care.
- Do not argue.
- Offer a simple answer.
- Duplicate list items.
SUSPICIOUS THOUGHTS: THINGS YOU CAN DO
Let Them Know You Care
Listen to what is troubling the person and try to understand their reality. Be reassuring and let them know you
Do Not Argue or Try to Convince
Allow the person to express his opinions. Agree with their assumptions and acknowledge their thoughts.
Offer a Simple Answer
A person with Alzheimer’s disease may accuse a person of various activities or misinterpret certain situations.
- Share your thoughts with them, but do not overwhelm the person with lengthy explanations or reasons.
- Switch their attention to another activity.
- Try to engage the person in an activity or ask them to help with a chore.
Duplicate Lost Items
If a person is looking for a specific item, have several available. For example, if the person always is looking
for their wallet, purchase two of the same kind.
All human beings need to be touched, caressed and held. For people with Alzheimer’s disease and caregivers,
this need is especially important. Alzheimer’s disease affects people in varying ways. One person may have an
increased interest in sex while another may have no interest.
Changes in the sexuality of people with Alzheimer’s disease include the following:
The person may forget his marital status and begin to flirt or make inappropriate advances towards members of
the opposite sex.
Suspicious thoughts are especially harmful when children or teenagers are accused of stealing by
grandparents who have Alzheimer’s disease.
The person may attempt to dress or undress at inappropriate times and in unusual settings. For example: a
women may remove a blouse or shirt simply because it is too tight and she feels uncomfortable. The person
does not realize or understand that clothes should not be removed in public places.
The person may forget social etiquette and fondle themselves in public. It may appear the person is trying to
harass others, but he really does not understand his behavior is inappropriate.
The person may make sexual advances to a stranger who resembles a former spouse or companion. In addition,
the person may forget they are married and approach a person in a sexual manner.
Physical illness may cause the person to lose interest in sex or make sexual intercourse difficult or painful.
Reactions to medication may also reduce sexual desire.
Depression can reduce interest in sex by the patient and their spouse or loved one. Some caregivers have
reported experiencing changes in sexual feelings toward their loved one after providing daily caretaking
SEXUALITY: THINGS YOU CAN DO
- Respond carefully to threats and accusations. If the person levels accusations or becomes extremely
suspicious, do not waste time arguing. Instead, try to distract the person with another activity or
reassure them with a hug or touch.
- Look for a reason behind the behavior. Keep in mind the person exposes themselves they may simply
need to go to the bathroom. If the person begins to take their clothes off, they may want to go to bed.
- React with patience and gentleness. If the person is engaging in unusual sexual behavior, carefully
remind them that the behavior is inappropriate. Then lead the person to a private place or try to distract
with another activity. But take care not to get angry with the person or laugh and giggle at the behavior.
Anger and ridicule cause negative reactions.
- Adjust the person’s clothing. Provide the person with pull-on pants with no zipper.
- Increase the level of appropriate physical contact. Give the person plenty of physical contact in the
form of stroking, patting and hugging. In many cases, the person is anxious and needs reassurance
through touch and gentle, loving communication.
The person may become unreasonably jealous and suspicious. For example: the person may think that his
wife has a boyfriend and accuse her of going to see him.
- Adjust to changes in sexual desire. As the disease progresses, a spouse may choose to sleep apart,
especially if the person becomes overly demanding, jealous or irrational.
- Seek outside help to deal with sexual issues. If you consult an outside expert about sexual problems,
make sure the professional understands the disease and will discuss sexual issues openly.
Alzheimer’s Association National Office, 225 N. Michigan Ave., Fl. 17, Chicago, IL 60601
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Our vision is a world without Alzheimer’s
Formed in 1980, the Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer’s care,
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