National Alliance for Caregiving
Family Care Resource Clearinghouse




Understanding Difficult Behaviors: Some Practical Suggestions for Coping With Alzheimer's Disease and Related Illnesses

by Anne Robinson, Beth Spencer, and Laurie White four stars
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This manual is a must-have for any caregiver to someone with Alzheimer's disease (AD). It is the definitive work on understanding and managing difficult behaviors as related to AD and other dementias.

It offers practical suggestions on: anger/agitation; sleep problems; paranoia/delusions; eating/feeding; dressing; incontinence; wandering; screaming; repetitive actions; bathing; and wanting to go home.

The materials were written for lay caregivers and professionals, including direct care staff in long-term care facilities, and other professionals working with families and sufferers of dementia. The suggested coping strategies come from a number of sources, including families, the Alzheimer's Association, books and articles.

Contents also include understanding why difficult behaviors occur (along with problem-solving strategies); the importance of good communication skills, selected readings and audio-visual materials.

Immediately the authors suggest that there is a cause for every kind of difficult behavior. This may seem like a cliche, but it is still true that many carers forget, especially when exhausted or frustrated, that these behaviors do not manifest out of thin air. It is important to uncover the factors that may be triggering these behaviors, and what elements you have control over in terms of being able to change.

Also, right up front, the authors urge caregivers to not carry the burden alone, suggesting it is OK to ask for help. Good advice also not always taken.

The section on communication skills lays out the advice in bulleted form, which is followed throughout the book. This material is profound and extremely accessible. For example, the authors discuss several points in your approach to communication skills: setting the tone (e.g. calming), things to think about when you are speaking (e.g. talking to the person in a place that is free from distractions), what to do when performing a task together (repeat instructions in exactly the same way), what to do when you are having trouble being understood (be sure you are allowing enough time), when you are having trouble understanding (try to stay calm and patient), things not to do (don't order the person around), and when verbal communication fails (try distracting the person).

These are just examples; each item has several points that are discussed. The introcuctory solution is in bold-face, with the rest of the paragraph/bulleted item in regular face. The subheads are in all-caps, making this book extremely easy to use.

The rest of the book follows the same format of posing the problem and then defining a multitude of solutions/suggestions. In "Problems With Eating," for example, there are topics ("Possible Causes") and subtopics (ranging from physiological to environmental causes) and then lists of specific causes. Then the chapter discusses (in bulleted lists) coping strategies, with many further points under each bulleted item. There are many pages of suggestions in this section. Then it is followed by "Other Considerations" such as keeping in mind the person's past history with food, and being aware of proper hydration.

If anything is missing in this book, it would come as a suprise. This is the most detailed advice a family could ever hope to have. Check with your local Alzheimer's chapter to learn if this book is in the library. It is equally valuable for professional as for lay caregivers. But it is a must for all.

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