Principles of Behavior Management with Dementia – Principle No. 4

There is an art and a science to caring for individuals with a dementing illness. There are now well established caregiving approaches for the different symptoms of this disease.  And, the best treatments require an understanding of what losses in functioning occur as a result of the disease. These losses will be in mental, emotional, behavioral, and self-care capacities.

This CoHealth blog on behavior management, the fourth in a series, addresses the need to recognize the person’s remaining strengths, also known as residual strengths, in the face of all the deficits that are evident. The person is gradually losing her communication and reasoning skills, the ability to remember the names of loved ones and to remember important events, and even to carry out routine activities. So, for example, if there are residual skills in grooming and hygiene, provide opportunities for her to do this activity herself, and then recognize and reinforce this positive behavior by pointing out how well she does on the task.

There are two very good reasons for this. First, by reinforcing the desirable behaviors, there is a greater chance that they will continue in the future. So, attention, praise, positive comments all will help to reinforce the behaviors, and will increase the likelihood that they will be carried out again. A second, perhaps more important reason is to strike a balance between the losses and the successes the patient experiences. Dementia is riddled with declines and losses.  Successes give the person an opportunity to feel good about something, to derive a sense of positive self-esteem in the face of all of the other losses that are taking place. Help the patient to continue doing whatever self-care is possible and try to avoid any unnecessary feelings of failure, or taxing the person beyond her capabilities. Tap into those residual strengths, provide opportunities for success, and reinforce the desired behaviors whenever possible. Ideally, the caregiver will allow her to continue doing whatever she can, even if it takes longer than if the caregiver were to do it himself. The sense of accomplishment and reward for carrying out a simple behavior can offset the many negatives she sees in her world. And, for awhile, they will help the person feel good about herself again.

As we better understand how dementia impacts the people we care for, we will develop a better appreciation of how to minimize the causes of problem behaviors, and how to help the person function at her highest possible level.  For more information, see our online program on managing problem behaviors in dementia and differentiating among depression, dementia, and delirium.