Have you ever woken up from a frightening or stressful dream, only for lucidity to linger just out of reach for a few minutes? That sense of disorientation, of confusion, of alarm, feeling like things are amiss but not fully understanding why? Experiences like those may be the closest analogs we have to what individuals suffering from dementia go through on a regular basis.

 

As the memory loss progresses, and the symptoms escalate, the primary objective of memory care becomes soothing discomfort and distress—and by extension, easing the burden of care for the family caregivers.

 

Perhaps the most daunting challenge at this stage is managing and minimizing the triggers for dementia. While it’s not really possible to avoid triggering the patient altogether, there are steps you can take to limit the frequency and severity of these episodes.

 

Dementia, Behavioral Changes, and the Impact of Triggers

 

To understand triggers and how they might cause emotional distress for a dementia patient, it’s necessary to understand how dementia and its symptoms can impact the patient’s behavior.

 

Initially, the signs may consist primarily of odd bouts of forgetfulness and inattentiveness. As their condition progresses, though, those initial symptoms will escalate, and each dementia symptom will develop into a new challenge.

 

Confusion, dissociation, and difficulties with spatial awareness may follow. You might also see periodic episodes where the patient struggles to express themselves clearly with language. There may be changes leading to poor judgement and lack of restraint, and eventually they will reach a point in cognitive decline where they need supervision or help with tasks critical to their independence.

 

This dementia behavior is due to how their particular diagnosis is progressively wearing down the “hardware” that makes up the nervous system. Throughout all of this, the “software”—their mind, their cognition, and to some extent their body itself—is making earnest attempts to adjust and accommodate in order to cope with the damaged brain cells.

 

The end result that’s visible on the outside is a patient that is doing their very best to carry on as normal, all while they are steadily losing access to the tools that they previously used to do that.

 

How this affects behavior will vary, both by patient, and from moment-to-moment. But you might see the patient become more irritable and easily frustrated. You may see a decrease in energy and motivation similar to a depression diagnosis. There may be times when the individual makes choices that are confusing or alarming, like going for a job wearing a dress and slippers.

 

These shifts and episodes will be cause for concern, and many will be the source of significant stress for a family caregiver. But anyone who has had to care for a dementia patient will likely tell you the most worrisome and difficult are the times when the patient becomes frightened, combative, or even outright violent (often for reasons that are unclear or not immediately apparent).

Such outbursts are frequently due to “triggers,” and learning to navigate and manage these triggers for dementia is a critical part of providing memory care for patients with these conditions.

 

Understanding Dementia Triggers: What They Are, and Why They Happen

 

You might be surprised to learn that angry outbursts aren’t necessarily a dementia symptom, strictly speaking. For the most part, it’s a response to symptoms (and frankly, a natural and understandable one).

 

Those dealing with dementia are facing cognitive impairment problems like frequent confusion and disorientation. Delusions and hallucinations are common. Memory loss has a tendency to turn familiar people, spaces, and events into frighteningly unfamiliar experiences. And many of the ways the mind seeks to protect itself through this process only complicate matters and add to the stress.

 

So it should come as no surprise that dementia patients often respond like they’re terrified. Even close family or long-term caregivers may at some point look like a stranger to them. But what exactly is provoking these reactions in the moment? Why do they go from a relative level of calm to a fight-or-flight response seemingly at the flip of a switch?

 

That’s where triggers come in. Most often, patients are provoked by a specific stimuli or change in their environment that they are unprepared for or unable to adjust to as they normally would.

 

You can think of triggers as falling into roughly three categories: internal, external, and physical. We’ll discuss triggers along these dividing lines for the sake of clarity, but be aware that they tend to blend together, and outbursts are often the result of multiple triggers occurring simultaneously.

 

Types of Dementia Triggers

 

Internal triggers are those that are caused by or related to the patient’s own emotional and mental state. Of the three types, this is the hardest to anticipate, influence, or manage, as human emotions are unpredictable things under even the best of circumstances. With dementia patients, you have the added factors of memory issues, communication struggles, and altered brain function.

 

Dementia often leads to psychological states and behavioral symptoms that mirror those of mental health conditions. They may experience feelings of sadness and despondency like a depression patient. Their fears and stress responses may be magnified similar to an anxiety condition. And they may engage in repetitive or ritualistic behavior like hoarding, fidgeting, wandering, etc.

 

Again, there may not be much you can do for them in this regard, and there may not be much in the way of advanced warning when they’re experiencing something that day that’s different than their baseline.

 

External triggers are the most common, and they’re the ones we have the most control over. That might include everything from environmental factors, to sensory stimuli, to the patient’s routine, and beyond.

 

Dementia patients are already facing a great deal of unfamiliarity, even when in places or with people that otherwise wouldn’t be new to them. Because of this, they depend heavily on things that feel predictable, and they struggle with things that feel like a surprise. Changes, even small ones, can be traumatic, so where they are and what they’re doing are critical factors.

 

And even unexpected sensory input can be startling. The sudden start of a vacuum, or a dish that’s dropped and shatters. Bright flashing lights, or being bombarded by questions from someone they’re speaking with. Any of these might be cause for alarm for them, and can lead to an angry outburst.

 

Finally, we have physical triggers, which primarily refers to pain, discomfort, and other unpleasant sensations. These triggers are sometimes why patients will be reluctant to take medication or bathe, or why outbursts might follow a period of forgetting to eat or drink.

 

Examples of Potential Triggers That Might Upset Seniors with Dementia

 

Again, you can’t fully anticipate or prevent triggers and outbursts. What will cause agitation will vary by person, and may not be problematic every time. And a measure of alarm on their part is to be expected (and unavoidable). The goal is not to eliminate them, but to limit them wherever possible.

 

Below is a list of some common factors and triggers that might result in someone suffering from dementia becoming upset:

 

  • Unmet physical needs, like sleep disturbance, hunger, thirst, etc.
  • Overstimulation—such as loud or overwhelming conversation, excessively bright lighting, potent smells, uncomfortable clothing, physical pain, etc.
  • Understimulation—boredom, loneliness, restlessness, etc.
  • Unexpected changes to routine
  • Seeing new visitors, or when regular visitors don’t show
  • Relocating to a new environment
  • Changes in the decor or layout of their environment
  • The removal of objects they regard as important
  • Shifts in their independence and self-sufficiency
  • Changes in treatment or medication
  • Arguments, discussions of contentious subjects, or reminders of their memory issues

 

Strategies for Managing Dementia Triggers

 

First and foremost, it’s critical to remember that dementia is not easy for the patient either, even if they don’t remember their experiences as a whole. They have plenty of reasons to be afraid, upset, sad, or confused, and none of that is necessarily anyone’s fault. Beyond that, due to how biochemistry works, it’s possible for feelings to linger even when memory does not.

 

In other words, managing triggers is as much about helping them be as comfortable as possible as it is about minimizing the stress and difficulty faced by the caregivers.

 

  • Prioritize predictability and familiarity. Stick to regular routines and schedules. Surround them with items and environments they’re well acquainted with.
  • Try to prepare them for any changes or surprises in advance. Tell them beforehand if they’re going somewhere, switching rooms, seeing someone new, or even just to remind them of their regular schedule.
  • Keep their environment calm. Limit volume, avoid bright lights, and reduce distractions.
  • Be gentle and calm when speaking and interacting with them. How you treat them, and how well they can anticipate what to expect from you, will have a big impact on their emotional state.
  • Help them to get comfortable and stay comfortable. Sleeping, eating, hygiene activities, managing pain—all are areas where they might need assistance. They may not always be able to fix it on their own, or even communicate what they need, so be proactive if necessary.
  • Offer reassurance and support. They may need gentle reminders or help remaining calm, but nobody likes to be told “calm down,” or “you already asked me that.”
  • Understand that it’s hard to adjust to life without independence and minimal control. While necessary for their health and safety, it will at times feel to them like they’re being “parented,” and it’s not a fun experience.
  • Be ready for them to feel distressed whenever an aspect of their care changes. As they decline in self-sufficiency, are restricted from certain activities, or have to endure new treatments.
  • Monitor closely for side effects with any medication they take, and especially when there are any changes to those prescriptions. Discuss any physical or behavioral changes with their doctor.
  • Help them fill their time with activities and entertainment that aren’t too taxing, but don’t leave them bored and understimulated. No one likes being cooped up all day with nothing to do.
  • Keep track of things that have distressed them in the past. Some triggers may be specific and unique to them, and can be properly avoided if you can identify what’s led to an outburst.

 

It’s not always easy helping someone with dementia, but those suffering from one of these conditions depend on the assistance of others as the condition worsens. Hopefully this information can aid you in navigating some of the most challenging aspects to providing care, and help you make the most of the time that’s left.

 

We at Inhomecare.com hope to help you and your loved ones. Visit our site and take the first step toward a safer, more independent future today!