How to Help Someone with Alzheimer’s Manage Emotional or Difficult Situations

Tips for Alzheimer’s caregivers during difficult situations

Behavioral changes are a common experience in Alzheimer’s disease. As cells in the brain deteriorate and contribute to cognitive decline, areas that control behavior are often affected.

While each person living with Alzheimer’s displays behaviors unique to them, common experiences include:

• wandering
• suspicions and delusions
• nighttime confusion (sundowning)
• repeating information
• hallucinations
• restlessness or agitation
• physical or verbal outbursts

Wandering

Wandering in Alzheimer’s disease typically occurs as a result of memory decline. When a person with Alzheimer’s is unable to recognize their surroundings or is confused about where they are, they might wander to seek a sense of familiarity.

Wandering is best prevented rather than addressed in the moment. But if you’re with a person with Alzheimer’s disease and they’ve gotten lost or act confused about where they are, stay with them and offer reassurance and comfort.

You can try to redirect them by using familiar people, places, or activity statements, like: “Let’s go find [familiar person], I bet they will be so happy to see you!” You can also gently hold their hand or arm to guide them.

If you’re unable to locate a person with Alzheimer’s disease within 15 minutes, contact 911 and report a missing person with dementia.

Suspicions and delusions

Suspicions and delusions in Alzheimer’s disease are false assumptions and firmly held untrue beliefs. Often, caretakers experience the brunt of these behaviors. A person with Alzheimer’s might accuse you of stealing from them, for example.

Tips to help during these moments include:

• Don’t take offense.
• Avoid arguing or trying to convince them otherwise.
• Listen and allow them to express their thoughts.
• Provide a simple, direct answer.
• Duplicate frequently “lost” items so one can always be easily found.
• Shift focus to a new activity.

Nighttime confusion

Known as “sundowning,” nighttime confusion is a time of increased disorientation, anxiety, and agitation that some people with Alzheimer’s disease experience during the evening and night. It can result in a variety of behaviors.

Improving sleep habits and medical treatment may proactively help it.

If you’re with a person with Alzheimer’s disease who has just woken up and is upset, you can:

• Approach them slowly and calmly.
• Reassure them everything is OK.
• Ask them if there is something they need.
• Allow them to get up and move freely with supervision.
• Calmly remind them of the time.

Repeating information

More than just memory decline can cause a person with Alzheimer’s to repeat words and behaviors. For many people experiencing communication barriers, repeating words, phrases, and activities is an attempt to communicate effectively.

When repeating becomes insistent and accompanied by heightened emotions, you can:

• Look for underlying causes, like an unaddressed need or want.
• Focus on the emotions to determine how the person is truly feeling.
• Respond with an answer as many times as needed.
• Be patient and stay calm; don’t tell them to “stop asking.”
• If it doesn’t cause any harm, allow it to continue.

Hallucinations

Hallucinations are false sensory experiences, like hearing or seeing things that aren’t there. If you suspect a person with Alzheimer’s disease is experiencing a hallucination, you can:

• Assess the safety of the situation.
• Offer reassuring words or gentle touch if the hallucination is upsetting.
• Verbally acknowledge the emotions accompanying the hallucination. For example: “I know this is frightening for you. I’m going to take care of you.”
• Use music, physical activity, or conversation to shift focus.
• Move to a well-lit area.
• Turn off background noise.
• Respond honestly about not sharing the experience, but be validating. For example: “I know you see something, but I don’t.”

Restlessness and agitation

Many different things in Alzheimer’s disease can cause feelings of restlessness, needing to move, or getting upset in certain places. A new environment, changes in routine, and unfamiliar caregivers can all be triggers.

You can help a person with Alzheimer’s work through these moments by:

• staying calm and nonconfrontational
• asking permission to engage with them
• reassuring them they’re safe and that you’re there to help
• reducing external stimulation, like sounds, lights, and unfamiliar people
• offering guided choices between two redirection activities, like listening to music or taking a walk

Physical or verbal outbursts

Physical and verbal outbursts can be some of the most challenging behaviors to work through in Alzheimer’s disease. When they happen, first make sure you and the person are safe. It’s OK to call 911 or emergency services if you’re not comfortable or feel the situation is beyond your control.

Once safety has been addressed, you can approach the situation by:

• assessing unmet needs that may have caused the outburst, like pain, hunger, thirst, or poor communication
• speaking in a soft tone and focusing on reassuring statements
• trying a relaxing activity, like listening to music
• shifting focus away from something that may have caused the outburst
• avoiding restraining physical contact unless there is the potential for serious injury

What are the best ways to communicate with someone with Alzheimer’s?

It’s important for a caregiver to recognize that behaviors and communication challenges in Alzheimer’s disease are part of a progressive medical condition. They’re not something you can change with in-depth explanations, punishment, or arguing.

Staying calm, empathetic, and supportive is paramount.

General rules for effective communication in Alzheimer’s disease include:

• Always remain calm.
• Approach slowly and from the front.
• Speak slowly and clearly.
• Maintain eye contact.
• Ask one question at a time.
• Allow plenty of time for a response.
• Use “yes” or “no” questions if verbal conversation is limited.
• Do not argue.
• Demonstrate what you mean with visual cues or other sensory engagement.
• Repeat what was said for clarity.
• Always include the person in conversation; don’t talk about them or as if they’re not there.
• Encourage nonverbal communication with gestures.
• Offer clear, simple instructions for small, attainable goals.
• Engage in conversation one-on-one and in a place with limited distractions.

Alzheimer’s disease affects everyone differently and at a different severity. Not everyone will need you to simplify your instructions, for example, or won’t be comfortable communicating in a group setting.

As you learn the person’s preferences and needs with Alzheimer’s disease, you’ll be able to customize your communication method to what works best for them.

Coping with difficult emotions

People living with Alzheimer’s disease experience emotions fully, but areas of the brain that regulate those emotions are affected by the disease’s progression. These changes in the brain can cause exaggerated emotional responses, particularly to negative emotional stimuli.

Other factors, like limited communication, functional declines, and medication side effects, can add to the intensity of emotions. Heightened responses of anger, sadness, anxiety, fear, and frustration are common as Alzheimer’s disease progresses.

When a person with Alzheimer’s disease is experiencing a difficult emotion, reassurance, validation, and support are key.

You can help them cope by:

• addressing underlying causes contributing to difficult emotions, like pain or discomfort
• listening to and validating their feelings
• providing reassurance that they’re safe and you’re there to help
• using soothing words or gentle touch to help them focus
• offering engaging distractions, like music, walking, or reading
• providing comforting, familiar objects or photographs
• eliminating as much external stimuli as possible, like background noise and activity

When a person with Alzheimer’s disease is experiencing a difficult emotion, do your best to respond to statements as neutrally as possible, without adding to their distress.

For example, if they’re expressing anxiety about getting home because their spouse, who is deceased, will be worried, avoid reminding them their partner has passed and they now live in a care facility.

Instead, a neutral way to respond might be: “They care about you so much. They know you’re safe with me. We’re going to do a lot of fun things today.”

How to help manage stress

Stress can be a trigger of extreme emotions and difficult behaviors in Alzheimer’s disease. It’s not always possible to prevent stress, but there are ways to be proactive about managing it.

Tips to help reduce stress in Alzheimer’s disease include:

• Make sure all basic needs are met.
• Modify the environment for safety and accessibility to promote independence,
• Simplify tasks.
• Monitor regularly for personal comfort.
• Create a calm, quiet environment with familiar items and privacy.
• Maintain a consistent daily routine.
• Provide an opportunity to exercise or spend time in nature.
• Keep daily schedules light to prevent exhaustion and overstimulation.
• Encourage a consistent sleep-wake schedule.
• Promote sleep hygiene habits.
• Identify relaxing hobbies like listening to music, watching TV, or looking at magazines.
• Avoid sudden changes to caregivers, location, or surroundings.

Personal self-care tips

As a caregiver, it’s easy to fall into the habit of giving all your attention to the needs of others and none to yourself. Neglecting your own needs, however, can result in burnout and make you less capable of providing quality care.

It’s important to take time to rest and recharge. Even in the middle of a challenging situation, you can take a moment to reset. Allowing yourself this courtesy can keep you calm and patient.

Self-care strategies to try include:

• taking an hour or a day to pamper yourself
• meditating
• learning a mind-body art, like yoga or tai chi
• exercising
• focusing on healthy lifestyle practices, like balanced nutrition, quality sleep, and regular activity
• picking up or revisiting a hobby
• listening to music
• reading
• journaling
• doing creative arts

If you need some in-the-moment options for when stress is at its max, consider:

• deep breathing exercises
• progressive muscle relaxation
• structured counting
• taking a short walk
• splashing your face with cold water

Takeaway

Managing emotions and difficult situations in Alzheimer’s disease can be challenging. As symptoms arise from changes to the brain’s structure and function, these experiences can’t always be controlled.

By remaining calm, focusing on reassurance, and prioritizing the comfort of the person with Alzheimer’s, you can navigate most circumstances effectively and safely.

Remembering to take care of yourself can help prevent burnout and feelings of overwhelm as a caregiver.