Of all of the changes the family sees in their loved one with Alzheimer’s dementia, the most frightening is personality and behavioral changes.  When the senior with dementia acts childish, irrational, stubborn, suspicious, paranoid, or becomes physically combative, the caregiver can be frightened.  The caregiver can feel that the relationship is over, this person is now a stranger.

These behaviors are not only frightening for the caregiver but even more so for the person with dementia.  Preventing behaviors is always the goal, and so much easier that dealing with a full burst of anger.

Preventing bad behaviors:

  • be alert and aware to what is going on in the environment – if the last time Grandpa became angry were there too many people, too much talking, too much noise, just too much stimulation?
  • arguing with a person with dementia never works, the person just doesn’t have the reasoning skills any longer to engage in finding solutions – divert attention and head off any confrontations
  • respect and protect the elder’s dignity , there is a real reason why bathing is such a hard task for someone with dementia – being undressed is a huge loss of control
  • make every task as simple as possible – breakdown the task into one step at a time – even though this slows progress – slow and happy is much better than fast and unhappy
  • reassure, and reassure again and again – the elder is very afraid of being abandoned – even the most demanding elder is basically afraid of abandonment

The elder with dementia doesn’t mean to be difficult. Difficult behaviors are a means of communication by the elder. The elder knows that they are missing something everyone else understands. The changes the elder feels they are no longer able to communicate with words. So the elder will try to gain control over their environment through – behaviors.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



When a family member or friend is visiting the elder in the Nursing Home, here are four things to look for:

1. Be aware of the elder’s pain. Pain is the most underreported problem in nursing communities. This applies to the general nursing home population and even more so for those with dementia. Sometimes the elders can’t express their pain in words, so those who know them need to be alert and able to read their body language. Signs of pain in elders with dementia may be increased restlessness.

Elders with chronic pain should have routine orders for pain medication. Orders for pain medication written “as needed” are not appropriate for chronic pain. When the order is “as needed” for someone with arthritis, that means we have to rely on the nursing assistant to notice that when they bend the elder’s knees and observe a grimace, or the joint may be swollen or warm to the touch, the elder is hurting.

When elders suffer from any kind of chronic pain they don’t sleep well. Fatigue is another symptom. Or they may not eat well or start to withdraw. A nursing assistant is there to assist, and it lays a heavy responsibility on them – for which they’re not trained – to observe and communicate pain accurately to the nurse.

This is when the family can be of tremendous help and support to the staff. When the family members observe signs of pain, they can communicate effectively by stating the behavior, area of the body, and provide any history the nurses need.

I noticed that Mom is rubbing her knees,” a daughter might say. “She has had problems with arthritis in the past and it must be bothering her again.” The daughter might have said that after spending hours with her mother. Nurses saw her mother only at brief intervals.

Book excerpt: Please Get to Know Me – Aging with Dignity and Relevance available at Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing



In a Nursing Home, family members aren’t always the recognized authorities on their loved one’s condition. Yet, they are an invaluable resource for the nursing staff. Family and friends have the one-on-one time, usually for hours, that the facility isn’t able to provide. The best time for the staff to catch a change in condition is when they assist an elder to get up for the day or help her get into bed.

However, that is when problems occur because the staff member may:

  • Not be the usual caregiver
  • Be a caregiver who’s not perceptive
  • Be the caregiver who sees a change but assumes that “everyone already knows”
  • Be someone with poor communication skills
  • Be a new nursing assistant or one with little experience

Such a situation places responsibility on the front-line workers who have the least amount of education. Such workers may think of their job primarily in terms of the tasks they have to accomplish. When asked specific questions, they usually have the answers, but didn’t realize they needed to pass the information on to the nurse.
That isn’t an uncommon problem, and questions naturally arise. For what should the family watch and listen? What is the most effective way to communicate the observation without seeming confrontational or judgmental?

Book excerpt: Please Get to Know Me – Aging with Dignity and Relevance available on line at Amazon

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing


Aggression in the confused elder can be predicted by asking yourself a few questions:

  • What happened right before the elder started; hitting, pushing, biting, etc.?
  • Was the aggression caused by a basic human need; hunger, thirst, pain, need to use the toilet, too tired (maybe out too long on errands), uncomfortable clothing, uncomfortable shoes, anything that might cause physical discomfort.
  • Was the aggression caused by something in the environment: too much noise, too light, too dark, too hot, too cold, clutter, mirrors, unfamiliar people, unfamiliar surroundings, or maybe just too active an environment?
  • Medical problems: hearing, seeing, infection, or possibly a problem with medication.

It is a very sad fact that elders with aggression issues are so often labeled as being difficult. When many times the problem is the approach of the caregiver. The environment or the elder is ill and no one is identifying the problem.
Once again I think of George, who was walking around for two days with a sock rolled up in the toe of his shoe. His foot hurt as the caregiver pushed that shoe on, and George who always walked straight and tall, now limped away. Two days he suffered for something we wouldn’t suffer with for 15 minutes.
When the elder cannot tell you what the problem is you need to be a detective.


Virginia Garberding RN
Certified in Gerontology and Restorative Nursing