Remember This - 2012: First Seminar

Remember This - 2012: First Seminar

Behaviors as Communication


“Remember This” Seminar Series

This 2012 series of lectures, designed to address crucial topics in dementia and memory care, is presented in conjunction with the opening of Cohen-Rosen House, a new memory care residence. The seminars are sponsored by the Hurwitz Lecture Fund at Charles E. Smith Life Communities. Here are notes from the first lecture:


 “Behaviors as Communication”

Presenter: Jennifer Lubaczewski FitzPatrick, LCSW-C, Jenerations Health Education, Inc.


Who needs to worry about Alzheimer’s?  What’s considered "normal" behavior?  What’s considered abnormal?

Normal aging signs experienced by everyone:

  • More “tip of the tongue” moments occur.
  • Reflex and reaction times slow down.
  • Intelligence remains, but brain size (as well as other organs) shrinks.
  • Benign senescence, otherwise known as forgetfulness (Where did I put my glasses, my keys?) is common. For this, simple interventions can help, such as putting keys in the same place every day or writing lists for shopping and tasks.

Some behavior associated with aging is never normal:

  • Short-term memory loss: more than not being able to recall some of the presenter’s points; not  remembering going to the program last night.
  • Poor judgment: wearing clothing that is inappropriate for the weather.
  • Confusion: being confused about  whether someone is your husband or your brother.
  • Personality changes: anger, combativeness, or no longer caring.

With these symptoms, it’s time to get a medical evaluation.

  • Is it a reversible condition, perhaps caused by medications, depression in older adults, infection?
    Is it irreversible? While there are other causes of dementia, 7 of 10 permanent dementias are considered to be Alzheimer’s.

What we do know about Alzheimer’s?

 What we know is less than what we don’t know. What we do know is this:

  • Average course of disease is ten years.
  • Vocabulary slowly diminishes over time.
  • The five risk factors highly associated with Alzheimer’s disease are: age, family history, heart disease, diabetes (these two health conditions can be managed to reduce risk), major head injury, and concussion.
  • Loss of vocabulary, loss of memory, increased frequency of illusions, delusions and hallucinations, and sometimes a return to a native language all impact communication. Patients have a harder time understanding us and we have a harder time understanding them. 

As caregivers, we often feel helpless and frustrated as wandering, agitation and irritability increase. What could those behaviors mean? How should we deal with them? We need to become good detectives.

Caregiver Strategies 

  • Wandering — Could they feel restless, need more exercise? Try a walk together.
  • Agitated, crying, irritable — Could they be sad about something from their long-term memory? Frightened because a common piece of furniture suddenly seems to be something threatening? Worried that the passing siren is coming for them? Could they be hungry? Be calm and reassuring. Keep a log and try to identify triggers: What time of day does this behavior occur? Who is around (or not around)?
  • Combative, screaming, shouting, fighting — Dementia patients are easily startled and often defensive. Always make eye contact, constantly reintroduce yourself, and take your time. Moods are contagious—if you tense up because you anticipate a fight over bathing, relax.
  • Disrobing — Could they be uncomfortable? If there are some outfits they will wear without disrobing, just use those clothes.
  • Masturbating or urinating in inappropriate places — Have they forgotten toileting skills? Are they experiencing sexual feelings? Set a regular toileting schedule.
  • Repetitive questions/conversations — If you do lose your patience, you always get a second chance to be patient.

When is it time to intervene?  

Key questions to ask: What is being done to protect the safety of the patient and others? Do they wander, leave the stove on or get lost? 

If you can say yes to any of these behaviors, the person should never be left unattended. Have a good doctor on your team. See an eldercare attorney for advice on asset management, advance directives and estate planning.

[Jennifer Lubaczewski FitzPatrick is founder of Jenerations Health Education, Inc., adjunct instructor at Johns Hopkins University, and educational consultant for the Alzheimer's Association.]

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