We’re revisiting this episode because its insights remain as powerful and relevant today as when it first aired.

Lisa shares more real-life case studies from her 30 years of experience working with people living with dementia that highlight common behavioral challenges that often accompany this condition on a day-to-day basis.  In this episode, Lisa describes a variety of different challenges and situations that are so common to dementia along with intervention strategies and positive outcomes that caregivers can use with their everyday struggles.  

You don’t want to miss this enlightening episode!

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

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Welcome back everybody to another new episode

of the truth lies and Alzheimer's Show. I'm your host,

Lisa Skinner, and today I want to share with you some more case

studies that highlight various behavioral challenges in people

living with Alzheimer's disease and dementia, and then give you

effective strategies in case these situations arise. Now, one

of the things I want to emphasize, and I've mentioned

this many, many times before, on other episodes of the truth,

lies and Alzheimer's show is some of the strategies and the

techniques that I offer and share with you don't necessarily

work for every given situation. And this is why I can't

overstate that we all need to assemble a really strong

toolbox, because what will happen is I'll give you a

suggested strategy for a situation that comes up. You

might try it sometimes, and it'll work beautifully and

diffuse the situation from escalating any further, but

other times it just won't. We're dealing with human beings here,

and they have their good days and their bad days, just like

the rest of us. So what might be effective in one situation, if

that same exact scenario happens again, and you try the technique

I share with you, it just might not work that time. So the goal

here is to give you enough strategies that if something

doesn't work, you have other tools to choose from that are

already within your toolbox. And of course, you know it stands to

reason that the more of these tools you have to pull from, the

better chances you have of diffusing any given situation.

That's the entire goal here is to just be equipped and prepared

as best you can, because these situations can prove to be very

difficult, and part of the reason is is that not every

solution will always work in any given situation. So here is a

case study that the woman suffers from emotional

outbursts. And last time I presented this case study

episode, I mentioned that these are all true stories of things

that actually do come up on a day to day basis at any given

time, unexpectedly. Not really sure what the trigger was. They

just these behaviors just show up out of the blue. And so this

woman, I'll call her ETHEL. She's 81 years old, and she is

in moderate stage of Alzheimer's disease. And the challenge here

is she experienced a sudden emotional outburst, often crying

or becoming angry over minor frustrations, which leaves her

caregiver unsure how to respond. And she does this frequently. So

here are some intervention strategies for this particular

situation, if it happens to you. So one of the things that we'll

need to pay attention to and focus on is identify, try to

identify what triggered that sudden emotional outburst. It

could be one of many, many, many things. So what I recommend is

that you as a family member or you as a caregiver, start

keeping a journal to track when and why emotion these emotional

outbursts occur, identify specific triggers, such as

changes in routine or. Unmet needs. And this will be a little

challenging at first, until you start to recognize patterns of

what sets off the person sets the person off, displaying

whatever the behavior might be. And in this case, it's an

emotional outburst. And then once you start seeing patterns,

it'll be easier as time goes on to you know, if that emotional

outburst happens and go, Oh, this triggered it last time,

maybe it's the same thing today, but you're going to have to go

through a process of elimination to kind of dial that in. So

first and foremost, as a caregiver, you definitely want

to offer comfort to Ethel or your person through gentle

touches and reassuring words and validate those feelings during

the Episode activities like listening to soothing music or

gardening, were introduced to Ethel so she would be able to

express her emotions in a healthier way, and then the

outcome, hopefully for you, will be similar to this one, because

by understanding triggers and providing emotional support, the

frequency of Ethel's outbursts actually decreased, leading to a

much more peaceful environment and positive outcome for both

Ethel and her caregiver. So this case study is a sample or an

example of a person with vascular dementia. He's 874,

years old, and he just has lost interest in doing any

activities. His name's Joe. So Joe was once an avid golfer and

socializer, but he started to show disinterest in activities

that he previously enjoyed, leading to social isolation. So

some intervention strategies for this situation include

reintroducing the activities his caregiver gradually reintroduced

Joe to golf by visiting the driving range, allowing him to

engage without the pressure of a full game. Now, this gentleman

had vascular dementia, if the caregivers taking him to a golf

course to the driving range, he's probably early on with his

cognitive impairments. But this is just an example of an

intervention that worked, and you can modify it to the stage

that the person you care for is in at the time they organize

small gatherings with friends from the golf club, providing

familiar social interactions that did spark his interest or

renewed interest, and then exploring new activities such as

painting or puzzles helped Joe discover New interests that he

could enjoy at his own pace, and that is an operative statement.

At his own pace, he just doesn't have the cognitive abilities

that he once had, and sometimes we forget that about our people

that we care for so we have to meet them where they are in

their stage. So the outcome for Joe was with gentle

encouragement and social support, Joe did begin to

participate in activities, again, significantly enhancing

his mood and reducing his feelings of isolation, which is

so incredibly important for people living with dementia.

The next story, the scenario is difficulty with personal care.

Care, and we see this a lot in people living with Alzheimer's

disease and dementia. And this lady, Sarah, she's 79 years old,

and she's just in her early stage of Alzheimer's disease,

but the behavioral challenge is that Sarah resisted assistance

with personal care tasks such as bathing and dressing, leading to

hygiene issues and caregiver frustration. So a great

intervention strategy. And I have seen this work over and

over and over again, and I've actually talked about it pretty

frequently, is creating a regular routine, a consistent

daily routine was established For Sarah, incorporating

personal task care tasks at the same time each day to foster

predictability, and this is such an important approach to people

with cognitive impairment, because they thrive on

familiarity, and a routine represents familiarity. So

really important to to incorporate a consistent daily

routine. But what the kid what her caregivers did was they

offered her choices in clothing and grooming products, which

ended up empowering her and ultimately reduced her

resistance. It gave her back a little bit of her independence,

and felt like she had a say in things. And then they praised

Sarah for her cooperation and independence during personal

care, which reinforced positive behavior. So the outcome for

Sarah was with a structured routine and choices, she became

more willing to engage in personal care, improving her her

hygiene and overall well being. Is that going to work every

single time somebody becomes resistant to wanting to take a

bath or a shower, get dressed or brush their teeth or all the

other personal hygiene services we provide for the people we're

taking care of no but this is a fundamental, proven technique

that has shown to work, but you might need to have a few other

strategies and techniques in your toolbox to pull out if that

doesn't work in at any given time. Michael is a 77 year old

man with Alzheimer's disease in his moderate stage, and the

behavioral challenge here was due to his cognitive decline and

his frequent forgetfulness. Now Michael routinely and frequently

forgot names of family members and significant events, and that

led to tremendous frustration and embarrassment during family

gatherings. So the caregiver, their intervention strategy for

this particular episode, created a memory book filled with photos

and names of his family members, along with significant events

for Michael to reference, gave gentle reminders about family

members and events during conversations, using cues to jog

his memory, and it was effective. Then they encouraged

Michael to share stories about his life, and this helped

reinforce connections with his family, allowing for cognitive

engagement, and that's an ultimate goal for us. The

outcome for Michael was in using these memory aids and

storytelling not only helped him remember his family members

better, but also strengthened his emotional connections with

them. This lady, she's 80 years old, and she has Lewy body

dementia, and she has been having some. Some reactions to

medications that she's on. So the behavioral challenge was in

that she was having paradoxical reactions to certain

medications, which stands to reason why she had was showing

and displaying increased agitation and anxiety instead of

relief. So what that caregiver did was monitor these negative

reactions by maintaining detailed notes on every time she

was given the medication and the reaction that followed, and then

shared this information with her health care provider. The

caregiver, worked closely with health care professionals to

adjust her dosages and switch medications, finding

alternatives that better suited her needs. And then by trying

some different holistic approaches versus pharmaceutical

approaches, and she tried aromatherapy and relaxation

techniques like hand massages, those were introduced to help

manage her anxiety without relying solely on medication. So

the outcome for in this scenario was through careful monitoring

and collaboration with this woman's health care providers,

her medication regimen was optimized, leading to decreased

agitation and improved overall well being. Here is a study that

looks at or case scenario that looks at compulsive behaviors,

which happen a lot. This is Steve. He's 82 years old, and he

has Frontotemporal dementia. And if you don't, if you're not

aware, Frontotemporal dementia is the brain disease that

attacks the temporal lobe of our brain, which is in the front

part of our head, and it really will impact our emotions, our

thought processes, our ability to reason situations out, and in

most cases, in a lot of cases of Frontotemporal dementia, the

person ends up reacting on pure, raw emotion because they've lost

a lot of the ability to differentiate between a big deal

and something that's not that big a deal, like we do when we

have a healthy brain, everything tends to be a big deal to them

in a lot of situations. So Steve developed compulsive behavior,

and some of the things that he was doing was he was repeatedly

checking doors and windows, which of course, created

distress for both himself and his caregivers. So the

intervention strategy that his caregivers try was to offer a

structured routine, which again is a consistent daily routine

established to provide structure. It worked in this

particular behavioral situation, and it actually ended up

reducing his need for compulsive checking behaviors, the

caregivers provided reassurance that the doors and the windows

were secure and that reduced his anxiety related to his safety,

He was concerned about his safety

when these compulsive behaviors do emerge, caregivers redirected

Steve to engaging activities such as playing cards or doing

puzzles to get his mind on something else. And the outcome

for Steve with the interventions that his caregivers implemented

was with a structured routine and reassurance Steve's

compulsive behaviors were minimized, leading to a much

calmer environment. So again, flexing a. Variety of tools to

assemble in your toolbox that any of these situations, if they

might arise, and the chances that they will are pretty good,

you have more than one option to try to try to diffuse the

situation. So let me give you a few more. This one happens

frequently, and this woman, her name's Joan. I'll call her Joan.

She's 78 and she suffers from incontinence, and as a result,

extreme embarrassment, which is understandable. She's aware

she's incontinent, and she's in the moderate stage of

Alzheimer's disease. And what happened to Joan is she began

experiencing incontinence, leading to feel feelings of

embarrassment and reluctance to participate in social

activities. So what the caregivers did for her was they

established a regular bathroom schedule and encouraged Joan to

use the restroom at set times, which ultimately reduced the

frequency of accidents. The caregivers also provided

discreet and comfortable incontinence products, which

helped Joan feel more secure during outings, and also

reassured her that incontinence is common in people living with

dementia, encouraging her to participate in social activities

without fear of embarrassment. So the outcome for Joan was

positive. So by engaging or implementing a consistent

schedule and supportive products, Joan felt much more

confident and engaged socially, experiencing fewer accidents and

a greater enjoyment in participating in activities. She

wasn't just completely overwhelmed with the worry of,

am I going to have an accident? I've seen this strategy used so

many times in care homes where people who do have incontinence

problems are put on a toileting schedule. And it's effective. So

that's one thing that y'all can try. Adam is an 83 year old man,

and he lives with vascular dementia, so he's had strokes or

mini strokes, and his behavioral challenge is that he is often

fixated on past events frequently reliving memories of

his military service, which sometimes leads to distressing

emotions for him. So the intervention strategy that

worked for Adam was that the caregivers facilitated

discussions about Adam's military experiences. This is

called memory sharing, allowing him to express his feelings and

thoughts by talking about his military experiences and

processing those feelings and thoughts, then they created a

Memory Box, which contained photos and memorabilia from his

service in the military, which provided for Adam a tangible way

to engage with his past positively when fixation leads

to distress, caregivers can gently redirect conversations to

more current topics or activities that the person has

enjoyed, and the outcome For Adam was by allowing him to

share his memories in a supportive environment, the

caregivers helped him process his emotions, leading to

reduction in distressing fixations. The next example is

in displaying anger and frustration. And this is Lola.

She's 78 years old, and she's in her early stage of Alzheimer's

disease. And what Lola was displaying. Is expressed anger

and frustration, particularly when a task became overwhelming

or challenging, impacting her interactions with her

caregivers. So their intervention strategy was to

provide supportive, empathy and patience, invalidating her

feelings, and this is important, without dismissing them, they

validated them, they acknowledged they understood

what she was feeling and why she was feeling the way she was

feeling. Then they broke her tasks down into smaller,

manageable steps, providing assistance as needed, to reduce

frustration during during daily activities, and that worked for

Lola. Then they praised Lola for her efforts and successes, no

matter how small they were, which boosted her confidence and

her motivation. So in this scenario, the outcome was with

placing these supportive strategies in putting them in

place, Lola's outburst of anger decreased, and she actually

became more willing to engage in daily tasks with a positive

attitude, because the way they went about structuring the tasks

lifted her concern of failing, which just is a constant

reminder of her cognitive challenges. So that was

effective. This gentleman named Clark, he's 80 years old, and he

also lives with Frontotemporal dementia, and he socially

withdrew as a result of the impact that the brain disease

was having on The temporal lobe of his brain. He became

completely withdrawn. He preferred to isolate himself

rather than engage with family or friends. So the caregivers,

what they did for him was he, they personally invited him to

small family gatherings, emphasizing the importance of

His presence and the enjoyment of his company, that's sweet.

Then they planned activities that align with his interests,

such as gardening or watching sports, to encourage his

participation. The caregivers then facilitated connections

with familiar faces, ensuring that interactions were

comfortable and enjoyable to Clark. So the outcome in this

example was it gradually, Clark began to engage more with his

family and friends, thus reducing his feelings of

isolation and enhancing his overall quality of life. I'm

going to share one more with you. This is a little unusual,

but it does happen. I've seen it myself. And this woman, I'm

going to call her Emily, she's 82 years old, and she suffers

from Alzheimer's disease, and her behavioral expression is in

overeating and compulsive eating. That's what she

exhibited, compulsive eating behaviors, often consuming

excessive amounts of food and then becoming angry and

irritable and distressed if she was denied the food.

So the intervention strategy for her was to implement structured

meal times, establish regular meal and snack times to create a

predictable eating schedule, helping to manage her cravings.

They made healthy snacks readily available for her, and they also

allowed her to snack between meals without over indulging. So

the other strategy they used was. Is they involved her in

meal preparation by providing her with a sense of purpose and

distraction from her compulsive eating habits. I've seen this

implemented so many times, and it's it's very effective. So the

outcome for her was with these structured meal times and

healthier options, her overeating and compulsive

behaviors decreased, which for her, promoted better nutrition

and better overall health. Seems like she was afraid that if she

didn't eat something and indulge in it, then that was probably

the last meal she might ever get. And with the strategies

they implemented, she realized there would always be food for

her, and it kind of, you know, helped with those behavioral

expressions. So I don't want to overwhelm you by giving you too

many tools and too many strategies. It's a lot to

digest, but I'm going to continue providing these for

you, so eventually you will have an arsenal of tools in your

toolbox to use when these situations arise. So that'll be

our episode for the truth, lies and Alzheimer's today. I'm Lisa

Skinner, your host, and I want to take a moment to thank

everybody for spending part of your day with me. And as always,

I look forward to having you back for next week's episode of

the truth lies and Alzheimer's show. So till then, I'm Lisa

Skinner, your host, and I hope you all have a wonderful and

positive and blessed week. See you next week, bye, bye.