Understanding Challenging Expressions in a Person Living with Dementia

Caring for someone with dementia is a rewarding and intimate experience, creating a special bond between the care partner and care recipient. But we’d be lying (and anyone who has provided dementia care would know it) if we said there weren’t moments of frustration, exasperation, and confusion. 

At any given moment, a person living with dementia may switch from contentment to anger, understanding to confusion, peace to agitation. 

Many people—experts included—call these actions ”behaviors.” However, at Bella Groves, we like to steer away from this term as behavior can imply an element of control. For example, a parent might order their children to be on their best behavior for the babysitter, or a prospective candidate may behave professionally for an interview. 

A person living with dementia does not choose to act aggressively toward their loved one or lash out when they don’t get their way. They are not misbehaving; this is simply how the changes in their brain are telling them to express themselves. For that reason, we prefer to call these challenging acts and attitudes expressions. 

Common Types of Challenging Expressions 

As much as we’re starting to learn about and understand dementia, it’s still not a textbook, one-size-fits-all disease. Everyone with dementia may react differently to the changes in the brain; some may show symptoms and expressions that others never will and vice versa. However, despite some inconsistent symptoms, there are a few expressions that are common for many individuals living with dementia. 

Aggression (Verbal or Physical): An individual with dementia may lash out at their family members, being inappropriate or insulting. They may even attempt to physically assault the person trying to care for them. 

Apathy: Changes in the brain can result in someone with dementia becoming apathetic or disinterested in hobbies or activities they used to enjoy. 

Sundowning: Sundowning occurs when someone with dementia begins to act more confused, restless, and irritated during the late afternoon and early evening.  

Suspicion and Paranoia: A person with dementia may suddenly experience paranoid delusions, accusing loved ones of taking their money or poisoning their food. These suspicions come with the idea that “everyone is out to get them.” 

Wandering: Sometimes, a person with dementia will become confused or disoriented about their location, leading them to pace or even wander away. 

Responding to Negative Expressions 

When someone you care for is lashing out or acting aggressively, it can be hard not to take it personally—especially if they are making comments about you or your caregiving abilities. But it’s important to remember that oftentimes their dementia is “talking,” not them. In fact, in many cases, these challenging expressions are simply a form of communication. Your parent or family member may not have the words, line of reasoning, or even the physical capability to express their feelings, wants, and needs. 

Because of this, it’s often up to the care partner to determine what is causing the expressions in order to provide solutions. Here are some practical tips on getting to the root of challenging expressions and what to do from there. 

Always Start with Positivity 

If your parent or family member with dementia is acting in a way that’s frustrating you, it can be tempting (or even second nature) to act visibly frustrated or short-tempered. However, this can only exacerbate the situation, as your family member could mirror your frustration. 

Even though it can be challenging, approach the problem with positivity and compassion by wearing a smile and meeting them at their eye level (for example, kneeling if someone is seated) to communicate with them. Doing this will make them feel safe, secure, and respected. 

Attempt to Find the Underlying Cause 

Remembering that challenging expressions are often motivated by something, try to understand what could be causing their actions. Are they hungry, thirsty, cold, or hot? Are they bored or inactive? Are they in a new, unfamiliar place, or is there something different about a familiar place? Did you prepare food they didn’t like, or is their favorite sweater not available to wear because it was in the wash? 

Once you have figured out what could be causing the expressions, you can either work to meet their needs or explain in a calming voice why you cannot. (“Would you like to check with me to see if the sweater is finished in the wash, or would you like to wear the black one instead?”) 

Change Your Perspective 

At Bella Groves, we call this Orient to Their Reality. By putting yourself in the position of the person living with dementia, you can more easily empathize with them and work to lessen any frustration or agitation. 

For example, instead of losing your patience when your parent refuses to eat their lunch, say, “You’re right, that soup wasn’t very warm. I wouldn’t like to eat cold soup either. Would you like me to warm it up, or would you like a sandwich instead?” 

Instead of getting frustrated when you can’t understand what your parent is asking for, imagine how difficult it must be for them to try and explain something that nobody understands. By orienting to their reality and seeing things from their point of view, you can solve problems together instead of creating more problems for each other. 

Support, Safety, and Comfort First 

Managing challenging expressions can be frustrating and distressing. But chances are, these behavioral expressions are simply your parent’s way of communicating. And regardless of the many aspects of dementia care, the priority is always ensuring that your loved one feels safe, comfortable, seen, and supported. By understanding common expressions and how to manage them, you can provide this for your parent. 

For more tips and strategies on dementia care, we invite you to learn more about Bella Groves. We are a residential dementia care community in San Antonio, Texas, that provides dementia training and coaching to local families, businesses, and community members. Visit our website to learn more.