Try: It is important to have the cr examined by medical providers at the onset of problems treat pain with an analgesic at bedtime if approved by physician try vitamin e for ‘restless legs’ also discuss with doctor stopping or changing diuretic medications that may be contributing to this problem for sleep apnea breathing difficulties characterized by heavy snoring help person lose weight if obese see doctor and discuss eliminating sedatives that may be contributing to this problem have an evaluation for depression done if early morning awakening e g waking regularly at 4 00am is a problem antidepressants given at bedtime may help sleep have all medications carefully evaluated for side-effects use psychotropic medications to take the edge off agitation use only under the supervision of a physician in some older adults with dementia these medications can have the opposite effect by making people more agitated use otc sleeping medications only as a last resort be aware that their effectiveness is only short term but may be helpful in establishing a more regular sleep cycle however sleeping medications may add to confusion on waking

Materials: n/a

Categories: Behavior Challenging, Emotional Psychological, Medical Physical

Information: n/a

References: Mace nancy & rabins peter 1999 the 36-hour day baltimore the john’s hopkins university press robinson anne spencer beth & white laurie 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

Keywords: Dementia sleep

*This information is listed as a Tip and is not explicitly medically licensed

Try: First have a thorough medical evaluation particularly if wandering begins suddenly consider possible physical causes such as illness fever hunger pain swelling etc allow cr to wander if environment is safe and secure place familiar objects furniture and pictures in surroundings help direct cr with clearly labeled rooms for example door decorations or name plaques may be useful for finding bedroom; a picture of a toilet or a brightly colored door may help person locate the bathroom decrease noise levels and number of people interacting with wanderer at one time go for a walk around neighborhood in a mall around home walking or other exercise often reduces agitation that leads to wandering and also helps person to sleep better remove items that may trigger desire to go out shoes coat purse coat rack etc distract with conversation food drink or activity try to involve the cr in household activities such as folding laundry washing dishes which will help him her feel useful limit activities to 20-30 minutes or less depending on level of impairment make sure the cr isn’t wandering because he she needs to use the bathroom look for signals such as fidgeting with clothes at night be sure the bathroom or a commode is easily accessible try plastic a large digital clock by the bed to orient the cr to time

Materials: n/a

Categories: Behavior Challenging, Emotional Psychological, Medical Physical

Information: n/a

References: Mace n & rabins p 1999 the 36-hour day baltimore the johns hopkins university press robinson a spencer b & white l 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

Keywords: Dementia wandering

*This information is listed as a Tip and is not explicitly medically licensed

Try: Place night lights throughout the house try locks on doors that are out of sight or reach install slide bolts on either top or bottom of outside door use dead bolt locks models are available that require a key for exit or entrance it is important to think about exiting in an emergency if key locks are being considered try child proof door knob covers that prevent potential wanderer from turning door knob covers are available at toy stores or medical supply stores may be inadvisable for caregivers who have arthritic hands place warning bells above door bells that jingle when door is opened will signal caregiver try monitoring devices available in a wide price range which alert caregivers that exit door has been opened order a ‘toddler monitor’ available through children’s stores and catalogs a small device attached to a person’s clothing will set off a beeper when person goes outside of a 25-50 foot range make house accident proof keep medications toxic substances such as cleaning supplies sharp objects alcohol and matches locked in cupboards or closets put locks on outside gates fenced in back yards allow people to wander safely use a safety gate across doors and at top or bottom of stairs this may help keep the wanderer in a limited area where he she can explore safely consider using a bean bag chair for sitting and resting this may be helpful because they are comfortable yet difficult to get out of by themselves the wanderer may need assistance in sitting down and getting out of the chair provide the wanderer with some type of identification medic-alert bracelet available at many pharmacies identification labels sewn in clothing emergency identification card in wallet purse or pocket have a current picture of person available in case he she becomes lost a videotape of person may also helpful alert neighbors and police that a memory impaired person lives at residence keep a list of important phone numbers e g neighbors police physician and family members use brightly colored outdoor clothing such as jacket coat pants reflectors sewn onto sleeves or pant legs may be helpful to police involved in searching for the person keep walker or cane if used in the same place at all times improve lighting throughout environment especially at night crs need about three times as much light to see properly as younger people

Materials: n/a

Categories: Behavior Challenging, Emotional Psychological, Medical Physical

Information: n/a

References: Mace n & rabins p 1999 the 36-hour day baltimore the johns hopkins university press robinson a spencer b & white l 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

Keywords: Dementia wandering

*This information is listed as a Tip and is not explicitly medically licensed

Try: Weigh weekly to make sure the cr is not losing too much weight loss of five pounds in six weeks for example is of concern provide comfortable clothing such as jogging suits and tennis shoes it the cr wanders a great deal try to get him her to rest for a half hour every few hours with feet raised to prevent swelling give frequent drinks of water or juice to prevent dehydration the cr with dementia will often forget to drink or not recognize thirst dehydration can be dangerous and may increase confusion check feet often for swelling or blisters elevate feet when swelling occurs provide opportunities for exercise particularly when person are waiting for a meal or activity exercise might also include signing rhythmic movements dancing etc with help from families develop a social medical history that includes

Materials: n/a

Categories: Behavior Challenging, Emotional Psychological, Medical Physical

Information: On the person’s style or coping with change and stress patterns of physical exercise and lifetime habits both at work and at home this information may be helpful in determining whether the wandering is related to previous lifestyles develop areas indoors and outdoors where people can explore and wander independently reduce amount of noise and confusion in the environment for example change of shifts loud speakers noises from housekeeping activity delivery of food or supplies are all potentially stressful situations reinforce where bathrooms and other public areas are by having rooms clearly labeled painted bright colors or marked with lights or awnings try a yellow strip of tape across doors to prevent wanderers from entering the strip is easy to get through in case of an emergency allows patients to keep their doors open to see and hear what is happening inside or outside their room have a plan of action in place in case someone wanders away from facility information

References: Mace n & rabins p 1999 the 36-hour day baltimore the johns hopkins university press robinson a spencer b & white l 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

Keywords: Dementia wandering

*This information is listed as a Tip and is not explicitly medically licensed

Try: Check whether the cr appears to be too hot or cold on awakening internal thermostat may change with dementia provide adequate lighting during evening hours shadows glares or poor lighting may contribute to agitation and hallucinations provide nightlights or soft lighting while sleeping to cut down on confusion during night and to aid in finding bathroom make sure there is a clear well lit pathway to the bathroom practice the route during the day place a commode or hand held urinal next to bed if finding the bathroom is a problem make sure the cr goes to bathroom before going to bed try to change environment as little as possible have the cr spend less time in bed try getting the cr out of bed at an earlier hour of keep him her up later until they are tired many people require only six to eight hours of sleep per night make sure that the bed and bedroom are comfortable and familiar to the cr a favorite blanket or pillow or bed clothes may be helpful maintain a set bedtime and waking routine once a good routine is established continue bedtime rituals from the past e g a glass of milk before bed or music on radio at bedtime try bedrails they may help to remind some people that they are in bed for others however bedrails may be confusing and may lead to falls if the older adult tries to climb out of bed try to prevent daytime napping unless person seems very fatigued in evening hours then try a short rest or nap after lunch make sure the cr is getting adequate exercise try to take one or two vigorous walks a day cut down on caffeine coffee tea or soft drinks during day and eliminate any after 5 00pm make sure the cr is not hungry at bedtime try a light snack before bed some herbal teas may have a calming effect warm milk often helps promote sleep avoid bathing or other upsetting activities in late afternoon or evening unless warm baths relax the cr allow the cr to sleep on couch or in armchair if refusing to get into bed make the house or an area of the house safe for the older adult to wander in alone at night safety proofing a house for a safe night of wandering may include gating off stairs special locks or alarms on doors to outside blocking off kitchen or locking up dangerous items making sure windows are locked try a softly playing radio beside the bed hire a companion at night or work out shifts so that primary caregiver can get sleep gently remind the cr that it is dark out and time for sleeping consider allowing the cr to be up at night if this can be accomplished safely and without destroying the caregiver’s routine for sundowning agitation and wandering in the late afternoon evening try to distract put on music give the older adult something to hold feel or fiddle with; go for a walk; try a craft activity; turn on the television try closing blinds or curtains to shut out darkness turn lots of lights on to brighten atmosphere and combat shadows try to be rested for better coping at the most agitated time of day try to minimize noise confusion and the number of people around during the most agitated time of day try a rocking chair in nursing homes or adult foster care homes increase staffing volunteers or family visits at that time of day to permit more one-to-one attention try a breathing chair – they are soft comfortable and easily cleaned however older people may need assistance getting up be aware that shift changes are often noisy confusing times of day which can contribute to agitation

Materials: n/a

Categories: Behavior Challenging, Emotional Psychological, Medical Physical

Information: n/a

References: Mace nancy & rabins peter 1999 the 36-hour day baltimore the john’s hopkins university press robinson anne spencer beth & white laurie 1992 understanding difficult behaviors ypsilanti mi eastern michigan university

Keywords: Dementia sleep

*This information is listed as a Tip and is not explicitly medically licensed

Try: Find out who the cr considers to be authority figures make cut outs of the authority figures and tape them on the walls and doors in the house where the cr cr’s bad behavior occurs alot for example if cr is ex-military cut out pictures of a well known military leader such as general george patton when the cr disobeys remind him or her that the authority figure would not approve you could also try the same approach with someone that the cr really adores such as a favorite family member for example if the cr cr’s niece is very special put several pictures of her around the house remind cr that the niece would not like it when he or she disobeys

Materials: Scissors tape pictures of the cr cr’s authority figures and favorite family members

Categories: Behavior Challenging, Communication, Emotional Psychological, Fully Aware, Somewhat Aware

Information: n/a

References: Adapted from the internet website www ec-online net eldercare skill builders by staff writer 1998

Keywords: Disobeys difficult behavior agitated

*This information is listed as a Tip and is not explicitly medically licensed

Try: String cheerios to hang outside for birds make a fresh fruit salad sweep the patio fold towels have afternoon tea remember great inventions play pictionary paint a sheet cut out paper dolls identify states and capitals make a family tree poster color a picture of our flag cook hot dogs outside grow magic rocks water house plants reminisce about the first kiss play horse shoes dance make homemade ice cream make christmas cards sort playing cards by their color write a letter to a family member

Materials: Needle string cherries fresh fruit broom tea bags and mugs pictionary game paint set and brushes old bed sheet of solid color paper doll kit scissors crayons paper hot dogs and grill magic rocks kit horse shoes and stick watering can radio or tapes cds ice cream maker and supplies green and red construction paper various colors of glitter glue stationary and pen

Categories: Sage, Topic, Behavior Challenging, Emotional Psychological, Social

Information: n/a

References: eldercare skill builders 1998 available at

Keywords: Activities bored anxious paces pacing isolation depression mood

*This information is listed as a Tip and is not explicitly medically licensed

Try: Make homemade lemonade dust around the house weed the flower bed have a spelling bee fold clothes have a friend visit with a calm pet cut pictures out of greeting cards or magazines wash or polish silverware bake homemade bread sort objects by shape or color sing old songs tell me more when cr talks about a memory put silverware away make a valentine collage take a ride take a walk reminisce about 1st day of school

Materials: Lemons and squeezer pitcher feather duster dusting cloth word list greeting cards magazines with pictures silver polish bread making supplies objects of different shapes and or colors tapes cds of old songs valentine making supplies construction paper scissors glue

Categories: Sage, Topic, Behavior Challenging, Caregiver Needs&Support, Cognitive Intellectual, Emotional Psychological, Social

Information: n/a

References: eldercare skill builders 1998 available at

Keywords: Activities bored anxious paces pacing isolation depression mood

*This information is listed as a Tip and is not explicitly medically licensed

Try: Clip coupons sort poker chips rake leaves use the carpet sweeper read out loud bake cookies look up names in the phone book read the daily paper out loud ask someone with a child to visit listen to polka music plant seeds indoors or out make a family photo album toss a ball color pictures

Materials: Sunday newspaper and ads poker chips rake carpet sweeper books cookie baking supplies phone book polka music flower vegetable seeds potting soil planters photo albums and photos ball coloring book and crayons

Categories: Sage, Topic, Behavior Challenging, Caregiver Needs&Support, Cognitive Intellectual, Emotional Psychological, Social

Information: n/a

References: eldercare skill builders 1998 available at

Keywords: Activities bored anxious paces pacing isolation depression mood

*This information is listed as a Tip and is not explicitly medically licensed

Try: Collect articles videos and books about the dangers of nicotine and discuss these with the cr if the cr is a chain-smoker discuss how the cr is putting the caregiver’s life and others in danger from the second-hand smoke make a plan with the cr to quit decide if using a patch or trying nicotine chewing gum would work better for the cr consider helping the cr get involved in a local support group

Materials: Research articles videos and books skin patches and or chewing gum

Categories: Behavior Challenging, Communication, Emotional Psychological, Medical Physical, Personal, Social

Information: n/a

References: n/a

Keywords: Addictions smoking support nicotine

*This information is listed as a Tip and is not explicitly medically licensed