By Jan Dougherty

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The changes in memory and thinking caused by a dementia diagnosis like Alzheimer’s disease will lead to a change in how a person with the condition will respond (behave) to added stress and new situations. After all, the person’s former ability to communicate feelings or self-regulate emotions are changing due to the progressive illness. Behavioral “expressions” in people living with dementia are common as the person can’t use words to communicate what he/she is feeling. Behavioral expressions are NOT about revenge, retaliation, resentment, etc. They ARE about discomfort – physically and/or emotionally.

Common behavioral expressions encountered during travel or visits with family and friends can include: 

· physical expressions –pacing, restlessness, or wandering off, sleep changes, more confused and disoriented

· emotional expressions – depressed, withdrawn or lacking interest, irritable, anxious, speaking out of turn, swearing, refusals to go

· psychiatric expressions – believing things that are untrue, made-up stories (delusions), seeing things that aren’t there (hallucinations)

Often times these same expressions are seen at home even without travel or visits with family and friends. They usually represent the person who is tired, overwhelmed by a situation, bored, or having difficulty interpreting what is happening or being said. With the added stress and changes caused by visits with family and friends or travel to new places, caregivers should be prepared to respond and diffuse these expressions. 

Here are 10 Tips to assist with behavioral expressions:

1. Recognize when a behavioral expression is beginning. For example, a person rarely just starts yelling out during a family gathering. Usually, we see that she is getting more upset and agitated as time goes by. Don’t wait until you see an unwanted expression. Intervene as you see something happening. 

2. Stop what you are doing. Imagine you continue to stay at the family gathering, telling your family member, “just give me 30 more minutes.” Not only does she not understand how long 30 minutes will be, but she continues to get more upset before yelling at the kids having fun. A better approach is saying, “I am feeling a bit tired. Why don’t we head out?” Or, “Let’s go inside and find a glass of lemonade.” 

3. Get to a quieter place whether it be leaving altogether or just getting to someplace without all of the noise or stimulation. Let’s say you are out for dinner and the restaurant is really loud and he is displaying rude behavior toward the server. In this case, you might suggest taking a walk outside while the server gets your food “to go.” You will find that a calm and quiet environment is helpful as expressions present.

4. Don’t argue. Don’t criticize. Don’t confront or blame/shame him for his expression. Keep in mind that he can’t manage his emotions right now and has very little to no insight into the situation. Take a breath as you will need to manage your emotions to be helpful to him as you move forward.

5. Respond to the emotion. That is, acknowledge that you see that she is upset, angry, anxious, bored, in pain – or whatever you are seeing. You are giving words to an emotion that is being expressed. Don’t ignore her emotion. You are validating what she is feeling.

6. Apologize that they are feeling this way. Let’s face it, none of us like to feel upset, angry, anxious, bored, or in pain. It feels better when someone who cares about us notices that we are carrying a negative emotion. Showing empathy toward your loved one will help. Let him know you are sorry that he is upset. For example, as a response to the family member yelling at the kids you might say, “I’m sorry the kids were so noisy. I can see that it upset you.” No further explanation is needed. You’ve acknowledged the feelings.

7. Provide a pleasant distraction now that you hopefully are someplace a bit more calming. Have things readily available you can use during travel or visits. This usually entails a favorite food or beverage, a favorite topic to discuss, listening to some favorite music, or a TV/movie on demand. Sometimes you might give the person something to do to help you and get the focus away from whatever the irritant has been.

8. Readjust your plans for the day (or tomorrow). Flexibility is the name of the game. So you needed to leave the family reunion a bit early, or you had to opt-out of a tour, or you can’t go to breakfast with the kids. Hopefully, you planned for this and recognize that getting some added rest and quiet will help with the situation.

9. Let others know how they can help. It is essential to communicate honestly and openly with family and friends about the changes happening in your loved one well before the trip or visit takes place. When they are informed about more usual behavioral expressions in your loved one and how they can respond, they are more likely to help you. If not, they will probably scold the person (or ignore them) which will only lead to escalating the situation.

10. Watch for sudden or extreme changes in behavior as this often represents that a new or chronic medical condition could be appearing. Call your person’s medical provider ASAP or get to a local urgent care or emergency department for further evaluation.

Please don’t take behavioral expressions personally. Your loved one is trying to do their very best during travel and/or visits with family and friends. The more prepared you are to identify these expressions early and respond, the greater success you will have and your loved one will be far more comfortable in the long run.