The Greek philosopher Heraclitus is credited with saying, “The only constant in life is change.” For most of us, this reality is just a part of everyday life. Some of us even thrive on change. But for individuals living with a form of dementia like Alzheimer’s disease, change is rarely enjoyable. In fact, even small changes to the environment can feel unsettling.
That’s why taking someone with dementia out of their familiar environment can be challenging. Let’s explore:
Why Is a Change of Environment a Challenge for Those with Dementia?
People who are living with dementia comprehend change differently than those of us unaffected by the disease. Changes that we may not even notice can cause them to exhibit disruptive behaviors like anxiety, aggression, or stress. Since these individuals are already dealing with so much disorienting change, it can be like an allergic response. The smallest changes – to us – will cause a reaction in someone overwhelmed by the disease.
Dementia can affect how the brain processes new information and makes sense of unfamiliar surroundings. As memory, reasoning, and perception change, familiar routines and environmental cues can become increasingly important. When those cues disappear or suddenly change, the person may become confused, frightened, or overwhelmed.
In many ways, it’s similar to a young child experiencing change for the first time. When you don’t understand what’s happening around you and you feel like you have no control over the situation, it can be very scary. Your loved one may be lashing out because it’s the only way he or she can gain some sense of control over what’s happening, no matter how illogical that may seem to you.
What Can You Do to Help?
Unfortunately, there’s no way to organize your or your loved one’s life that doesn’t occasionally force them to change environments. You also can’t always know or anticipate when a changing environment will prove upsetting in some way.
It’s not always as straightforward as moving to a new place, going to a hotel, or a hospital visit. Behavioral challenges could also be triggered by:
- Making changes to their current environment, such as getting new furniture, painting the walls, or even rearranging the house in some way
- Changing their daily routine or caregiver arrangements
- Having guests over
- Changing their clothes or being given a bath
As you can see, “environmental changes” can really encompass many things, and it’s very difficult to avoid them completely. So how can caregivers be proactive and manage and reduce stress-related behaviors at these times?
Here are some suggestions that can help both individuals with dementia and their caregivers navigate change in as calm a way as possible:
Do your best to create a relaxing and calm environment
Dementia makes it difficult for an individual to “filter” stimuli, which can result in an environment being completely overwhelming and chaotic.
Make sure your loved one’s environment is as calm as possible. Remove clutter and get rid of any stressors, such as mirrors, that could cause trepidation or anxiety.
Evaluate whether the situation is too chaotic or loud. Is the television or radio on? Are multiple people having conversations? Adjust accordingly.
Finally, do your best to remain calm yourself, since those with dementia will often mirror your emotions. Don’t raise your voice or otherwise crowd your loved one. Try to move him or her to a quiet space to help them stay calm.
Whenever possible, avoid triggers that can induce stress
Every person living with dementia has their “triggers,” so you need to know what may cause issues for your loved one specifically.
Crowds, background distractions, glare, and general noise are typical triggers, but it might be something very specific to your loved one. So, be on alert, keep a list of what seems to cause issues, and do your best to counteract these potential triggers where possible.
If you’re planning an outing, consider whether the place you are going to is likely to have these triggers. For example, if you want to take a trip to the beach, consider going at a time when it is less crowded. Scout out areas for convenient parking. If you’re going to a restaurant, you can even call ahead for advice.
Check your loved one’s personal comfort
It’s possible your loved one may be in discomfort. This is a common cause of behavioral issues.
Make sure they’re not too cold or too hot. Ask if they need to use the bathroom. Check to see if anything is causing them pain, or if they’re hungry, thirsty, or simply tired.
It’s also possible the behaviors could be due to an infection, illness, or even a side effect of their medication.
If there is a sudden or significant change in confusion or behavior, it is worth contacting a health care provider. Delirium caused by infection, dehydration, medication effects, or another health issue can make someone with dementia seem suddenly much worse.
Have a familiar object on hand to help reassure them
If your loved one is distressed, give them a favorite item or anything else that brings them comfort.
At the same time, speak to them using reassuring language, saying things like, “You’re safe here,” “I’ll stay here until you feel better,” or “I’m sorry you’re upset.”
Make sure your loved one gets enough exercise
Unwanted behaviors can sometimes be triggered if your loved one is bored or restless.
Find some time for physical activity when appropriate, whether that’s taking a walk together, doing something physical like gardening or dancing, or another activity your loved one enjoys.
Physical activity, of course, also offers broader benefits for health and well-being.
Use redirection techniques
Redirection is an oft-used tool that can help caregivers get their loved one’s mind out of their current situation and onto something that’s calming and reassuring.
If your loved one is showing distress of any sort, play some calming music, bring out an old photo album, or otherwise redirect their attention so they’re focusing on something constructive.
Make sure your loved one has enough social stimulation
Staying social is good for our health.
Make sure your loved one is participating in activities they enjoy and has opportunities to interact with other people. Social engagement can support mood and well-being while helping someone remain involved in activities and relationships that are important to them.
Another option is to look into an adult day program in your area, so your loved one can be around others while still receiving the attention they require.
Remember that it’s not their fault
It’s easy to get frustrated with your loved one if it feels like they aren’t cooperating or if they get distressed due to environmental changes.
We have to take a breath and guard against any blame or irritation.
Remember that he or she is not acting this way on purpose. It’s due to the nature of their disease.
By recognizing the cause of the behavior and realizing it’s not “personal,” you may be better equipped to handle the situation with grace, compassion, and efficiency.
Does Moving Make Dementia Worse?
It may worry families that a permanent change of environment – to a memory care community, for example – can worsen dementia. This notion is misguided, but a major transition is better if planned.
Given all that we have explained so far, it is true that a move to an unfamiliar environment is likely to be disruptive. The move may temporarily increase confusion and lead to agitation or distress.
However, we shouldn’t see this as an acceleration of the underlying dementia. Instead, it’s the natural response of an overwhelmed brain to a big change in environment and routine. The reward is that the memory care environment will hopefully offer the structure, socialization, care, and engagement that will be more beneficial in the long run.
What’s more, we also need to acknowledge that avoiding the disruption of a move isn’t always the safest or most supportive option. Dr. Brent Forester discusses this concept in his article, How to Live Well with Dementia – it’s not conducive to quality of life if people are kept ‘safe’ at home if this sacrifices engagement and socialization.
What About Taking Someone with Dementia to the Hospital?
A hospital visit can be a stressful experience, with unfamiliar faces, clinical surroundings, disrupted sleep, noise, and unpleasant tests. However, hospital visits can be necessary. So, we must find ways to offset the stress, both before and during the visit:
- Keep a hospital bag ready (medications, insurance information, provider contacts, and advance directives)
- Share that the person has dementia and explain how they usually communicate, behave, and respond to stress.
- Have a family member, friend, or caregiver stay with them, especially during an ER visit or overnight stay.
- Bring familiar items for comfort
- Reduce noise, clutter, and unnecessary stimulation where possible
- Watch for signs of pain, dehydration, infection, medication side effects, or other medical problems that may show up as sudden changes in behavior.
- Help the person eat, drink, move around safely, and manage everyday tasks they may struggle with in an unfamiliar setting
- Let the team know what is normal for the person so they can distinguish their usual dementia symptoms from delirium or another sudden medical change.
- Start discharge planning early and ask what extra support, equipment, home health care, or follow-up may be needed once the person returns home.
How Can You Make a Move to Memory Care Easier?
While the transition may initially be challenging, there are things we can do to make the move to memory care easier.
We can bring familiar belongings and decorate their room to remind them of home.
At Bridges, we strongly encourage sharing as much information as possible ahead of time with our team. This ensures team members can help new residents settle into their new environment by matching their routines and preferences. With planning, you can even visit the community several times and get to know the team.
For example, if they typically eat breakfast around 10 AM, we wouldn’t want to disrupt that schedule. If we know they like a particular genre of music, we can play some of their favorites to help offset agitation.
It’s important to remember that a difficult first few days don’t necessarily mean the move was a big mistake. We typically find that most family caregivers notice a difference over time as their loved ones seem calmer and more engaged with structure and personalized daily programming at Bridges.
Read more about our approach in the Bridges guide to memory care. Also, see our advice on transitioning to memory care.
Helping Someone with Dementia Adjust to Change
Change is sometimes unavoidable, but how we approach it can make a difference. Familiar routines, reassurance, attention to comfort, and a little preparation can all help someone with dementia adjust when their surroundings change.
These situations can also be difficult for family caregivers. Bridges® by EPOCH offers regular caregiver support groups and educational programs for families looking for advice, shared experience, and additional support.
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