If an older person has a sudden change in behavior, it is important to document what you are observing and schedule a doctor visit. Often people assume the declining behavior is just a part of the aging process. However, there can be many reasons for the change. Medical, environmental, and caregiving issues need to be evaluated in order to determine the best response. Often a simple modification may remediate the problem.
If a Senior becomes agitated, an important first step is a physical exam. One common problem is an undiagnosed UTI which may not carry symptoms that the older person can recognize or verbalize to you. Another problem might be a build-up of wax in the ears which causes voices and tv sounds to become mumbled. This can create problems when in common areas where there are many competing noises. If this condition has been building slowly, the Senior may not have noticed, but becomes more annoyed and frustrated, often pulling away and isolating themselves. There can be many treatable medical problems with quick and effective remediation and only a physician can determine the cause. It will be helpful to bring your documentation of what you have observed, the duration, and other contributors which you may notice so that the doctor can have a full picture of the problem.
Environmental issues can be so subtle that family members may not notice, but which can impact the Seniors life in ways that result in changes in behavior. Are there changes in temperature, schedules, or lighting making life more uncomfortable or less predictable? Have furniture or mirrors been rearranged so that the environment seems unfamiliar. A new mirror in the room, or a window with curtains left open at night, can give a reflection to a person with dementia that appears as though they are being watched, causing that person to be uncomfortable or resistant to being in the room after sunset.
Has there been a change in caregivers or caregiver routines. Some people with memory and perception deficits are still very attuned to facial expression and tension in their caregivers. They may not be able to verbalize the reason why they are uneasy, but observing the caregiver’s moods and subtle interactions may give you a clue as to what the Senior is experiencing. If this is a family caregiver, you may be seeing signs that they need some assistance or respite time while they accomplish this very demanding job.
When my mother had macular degeneration and was no longer able to distinguish facial features, she moved to a new senior residence. She told us that no one seemed friendly and she was very unhappy. I observed her, in her wheelchair, as she went to the dining room and noticed that people walking by would smile and then move on. So, I observed her from in front of her and saw a beautiful woman who was staring ahead through her glasses, (which did not improve her vision but made her eyes look good), but who was acknowledging no one. So, I suggested that when a figure the size of a person approached she should tilt her head up towards them, smile and say hello, Mom tried that, and it was amazing-suddenly everyone was friendly. Once they spoke together she was able to explain that she would not be able to recognize them and would they kindly say their name when they said hello. Mom had not realized that her behavior and appearance was being interpreted as wanting privacy, which the others were respecting. It all changed with a smile!
It is important that we all be alert to cues and subtle clues as we strive to provide the most comfortable and rewarding life in this stage of a Senior’s life journey. If you have found strategies that have been effective with your loved one, please share them with me and I will post them for the benefit of all. Sometimes a simple fix is all that is needed. Most important is that initial trip to the doctor to rule out a medical issue that can be hard to identify, but which can often be corrected.