What prompted the writing of my previous post was, as I said on the onset that I am often contacted by a family member or a caregiver who is struggling with a behavior that continues to escalate and attempts to redirect his or her behavior have failed.

Although this is a very condensed version it does depict what I have been referring to. I was contacted two weeks ago in regard to an 87-year-old woman who suddenly has turned on her caregiver. She is reporting to all that know her that this caregiver left her unattended and did not help her after she fell, still disappears and leaves her unattended and afraid. The caregiver feels she is more delusional and really should be started on some medication for delusions. The caregiver has been working with this woman for months, and is quite hurt that her client could turn on her like this after all the wonderful care she has given.

I visited this woman’s home with the caregiver present and engaged this woman in a general conversation regarding the recent changes in her life. She explained that she had a caregiver daily for 5-8 hours. A few weeks ago after the caregiver left for the day the woman fell, and it was many hours before she was found. She hurt her arm which is now in a sling, and is much more dependent and feeling much more depressed than she has in the past.

Since her fall and return home from the hospital, she now has 24-hour care and is never left alone. She denies this and was very firm that she is left alone for periods of time.

As the conversation continued, what unfolded was a clearer explanation of what was happening in her mind and why she has been very accusatory and angry. When the caregiver goes to the bathroom or kitchen, runs out to get the mail or bring in groceries she forgets she left. Even when she was told just one minute prior to the caregiver’s brief absence, once the woman realizes she is alone she panics and screams. The experience of falling and sustaining an injury and not being able to get immediate help has caused her to become extremely anxious and afraid. She feels loss of control.

In this case, I reassured her that this sense of panic is not unusual and that we truly understand her fear. She is mildly impaired and is aware that she struggles with short term memory loss. Although her caregiver can say “I am going to the kitchen and I’ll be right back,” after a few seconds she realizes she is alone, panics and feels abandoned. We discussed methods to use so that she feels comfortable, safe and never alone.

The caregiver said that in retrospect it all makes sense, and if she realized what the triggers were she could have made the necessary adaptations. In the future she will not only tell her client where she is going, but she will offer to have her keep her company while she is cooking, doing laundry, etc.

There are other issues such as a changed sleeping pattern due to increased anxiety, and we will need to address this behaviorally; if it continues we will discuss with her physician. This is just one example, but again very often one can figure out the triggers and alleviate the precipitating events that lead to “difficult behaviors”.

It is important to note there are certainly instances that medications are needed, however medication is not the only solution or the best solution. Non-drug interventions should be used first unless the behavior cannot be controlled from the onset and the behavior is potentially dangerous to the individual or others.


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