Wednesday, May 27, 2020

Alzheimer’s & Dementia Behavioral Triggers

What are behavioral triggers? all human beings have certain likes and dislikes, in this instance we are talking about situations that are out of our control that affect us in a negative way, upset us. When you are affected by memory impairment you become more sensitive to certain things that may be occurring in your immediate surroundings in that specific time, loud music, crowds, unfamiliar places, people, and a lot of talking in the background, these are what we call triggers. In a normal setting if we are in a situation that makes us uncomfortable we have the ability to make changes that make us feel better or walk away from whatever it may be that is upsetting us or causing us to be anxious.
An Alzheimer/Dementia patient in this situation, will react very differently, they feel powerless and they manifest their discomfort in a negative way they may start pacing back and forth, will try to exit seek, will attempt to communicate their discomfort and when they see that they are failing to do so, they will get very frustrated and may get aggressive or combative. Why? Because many times they can’t express their discomfort properly, they may not be able to verbalize what is making them anxious, so they react adversely to the situation.

I recall aa episode where a patient of ours would get very anxious if we played Mexican music, he would start heading towards the front door and attempt to leave. It took us a few days of this to realize that the trigger was the music that was causing his anxiety. That was an easy one to figure out; I wish I could tell you that all situations were that easy.  We had another lady that would start pacing back and forth almost exactly at 2:30 every day; her trigger was that she couldn’t verbalize that she needed to go to the bathroom. After realizing that, we scheduled for her to be taken to the bathroom at 2:20, and that solved that issue.

You have to become a detective and figure out what their triggers are, it will save you a lot of unfortunate situations. It is very hard to describe a trigger because it can be anything. Pay attention to what they watch on television, the news, what movie are they watching, it is a war, an end of the world movie, is it about vampires? They process information very differently than us; they may think that what they are watching is real. And they may react accordingly. How would you react if they were announcing the end of the world and everybody is in war mode? Of course, not everybody with Alzheimer’s / Dementia reacts with a meltdown, some may be completely oblivious. This is why you need to pay attention to how they react.

When attempting to describe a meltdown that affects my patients, I always tell people to refer to a Netflix show called “AtypicaL” pay attention to the main character “Sam”  he is a young high functioning adult with autism. When I first discovered this show, I thought to myself eureka! Finally, something that I can refer to, as the main character navigates life; he encounters certain situations that cause him to have meltdowns. I will be referring to the character in this show a lot; you have to watch it to understand why. It is not until you find yourself in the middle of a meltdown, that you realize that you are ill-equipped to handle the situation. In the Day Center setting where I use to be the staff supervisor and the activities director. The fantastic staff where excellent at deescalating meltdowns, they got so good at it, that it got to a point that it was rare that I had to intervene. They were the great detectives of behaviors; they knew what made their patients happy and what caused them to have anxiety. 

When out and about in the grocery store, hairdresser, the restaurant always be very vigilant on the cues that they are giving you, pay attention to their body language, and their facial expressions, whenever they are in unfamiliar settings they may have a meltdown. Nobody wants that, you don’t want it; the other patrons definitely don’t want it. My sister had an incident with one of her patients. They had gone to the grocery store, and out of the blue her patient started yelling at her, “get away from me, why are you following me” she told him that his wife had asked both of them to go to the store. She repeated this several times until he calmed down, and they quickly left the store. My sister completely missed that he hated to go to the grocery store that was his trigger.
It is essential that when you are in a difficult situation always be mindful of your tone of voice, body language, and your gaze because the words out of your mouth may be as sweet as honey but if your eyes don’t convey that same emotion you will lose this battle. It’s amazing how in tune they can be to Emotions, they sense when you are not being genuine with your intentions.

For our mom, her trigger is being out of her habitat for a long period of time. What is her habitat you may ask? Her garden first and her home second, we have tried several times to have her stay with me or my sister, and oh my, we end up in such a chaotic situation. That we have decided that it is in the best interest of everyone involved that she stays in her home with a caregiver, that she insists (my mom) she doesn’t need. Our mom’s trigger is being out of her comfort zone, her habitat as we call it.

I feel that I keep repeating myself, but you need to be aware of their surroundings, be sensitive to their needs. They trust that you will take good care of them, you are their champion.

Be Prepared, Be Informed, Be Empowered.

I send you lots of positive virtual energy.
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With gratitude-