Principle of Behavior Management and Distraction with Dementia – Principle 6

This blog addresses the use of distraction as a technique to minimize behavior problems in individuals with dementia. As said previously, when we understand what the underlying causes are for the undesirable behaviors, it is much easier to circumvent, or prevent them. Caregivers, both paid and unpaid, can adopt these approaches when the unwanted behaviors surface, regardless of whether the patient is at home, or in a residential setting, or a nursing setting.

Distraction is used when dealing with the argumentative or combative patient, directing him on to another topic or a different point of discussion. For example, when the patient is demanding to “go home” or “take a bus ride downtown,” rather than try and debate with the person and explain the reality of his situation, it is much more effective to shift the focus of the conversation. Instead of a dose of reality and explaining why he can’t go home or already is home, engage him in a conversation for a few minutes about his home. What was home like, who was at home, who did he live with, where did he grow up, what was it like in his family growing up? Shifting to this more desirable, pleasing conversation defuses some of the tension that may be surfacing, and importantly, avoids the power struggle that we are not going to win with the demented person. Logic and reasoning can be very ineffective with patients who have any type of cognitive impairment.

However, while defusing the situation, caregivers should always try to weave through the conversation reassurances that the person is safe and secure in this setting. These reassurances help to minimize the anxiety and distress that are easily triggered when the dementia person feels unsafe or threatened in any way. Even though there are other occasions when a reality orientation approach is necessary (i.e., where he is, why he is there, etc.), distraction is the preferred intervention for these occasions.

A better understanding of how dementia impacts the people we care for will minimize the causes of problem behaviors, and help the person function at his highest possible level.  Other educational programs for caregivers can be found on our website, http://www.cohealth.org/, including understanding Alzheimer's disease for family members and fundamentals on behavior management.