Behavioral and
Environmental Management

It is advised to develop behavioral intervention strategies with the family members and caregivers prior to utilization of pharmacological management. The algorithms included in this document offer a variety of treatment suggestions. Caregivers may need education on how to improve suboptimal communication in order to achieve desired behavioral results. Examples of suboptimal communications include:

• Making more than one request at a time
• Speaking too fast or with poor diction
• Not allowing time for the person living with dementia to respond
• Not using more than one sensory modality
• Not maintaining eye contact
• Not assuming a comfortable, relaxed posture
• Not identifying and verbalizing the patient’s affect
• Not using simple, direct statements

Redirection helps to improve communications, and helps the patient refocus in order to be calmer, cooperative, content, and safe. Physicians can refer caregivers to the Redirection Tip Sheet in the back of this book.

It is critical for caregivers to create an environment that conveys safety, familiarity, comfort, and friendliness in order to avoid triggering uncontrollable reactions. These include adequate lighting, comfortable temperature, easy and comfortable furniture, calming music, and stimulating activities. See the Resources for Caregivers for additional resources.

Care Refusal

The caregivers should be coached on dealing with difficult behaviors including the refusal of care is occurring. Many factors may be involved in these situations, including anger, stubbornness, uncooperativeness, anxiety, and verbal or physical agitation or aggression. The most common forms of care which are refused are medications, eating, bathing, and clinical appointments.

Caregivers should be encouraged to:

• Communicate that the request and refusal is understood
• Remember who the patient was previous to dementia
• Avoid arguments
• Focus on pleasant experiences

Refer the caregiver to resources to assist with these behaviors. See Resource Sheet.