Commonly Occurring Behaviour Themes

The person may recognise that they get befuddled, and that they have a poor memory, and this can lead to checking things restlessly to make sure everything's right and they haven't forgotten to do something. Try the following.

Reminder label

Try printing a label for the wall with a simple reminder of what will happen in the day, for example to say that a carer will come to cook lunch and tea, or to say that you phone them however many times it is every day. If they worry they've forgotten to do something, the reminder could say there's nothing they need to do - they can enjoy some music or watch the television. 'Talking buttons' are available that can play a short message you've recorded, and this may help by becoming their first point of reassurance they can consult.

Activity / entertainment

Obviously, having an activity or entertainment to do will help distract and occupy them.

Structured daily routine

Having a reasonably structured daily routine may also help them feel more in step with the time of day and what's normal for them to be doing. Take opportunities to 'signpost the time' throughout the day - for example saying "It's eleven o'clock so here's your elevenses, I'll let you know when it's lunchtime in an hour or two".

The restlessness described in the theme above may result in constantly feeling the need to see and be in contact with someone whom they regard as their 'thinker-in-chief', which may result in following that person around or making frequent phone calls to them.

Follow the potential solutions above for restlessness.

If you're at home with your loved one all day but need time to yourself without being followed around then you might try the following suggestion. Get a 'sand timer' / 'hourglass' (there are some brands that come in one of a variety of times, e.g. 5, 10, 15, 20, 30, or 60 minutes, and with a plastic tube around the hourglass for safety, and with brightly coloured sand to make it more visible - e.g. see Amazon or eBay). Try labelling this that you'll be back before the sand runs out and they should carry on listening to the music (or whatever activity) until then. Obviously, you'll need to make sure you do come back within the time, and reset or take away the timer. We don't know whether this will work for you, but please let us know whether it does or not, using our contact form, so we can improve our advice to others.

Again, this may come out of a feeling they're forgetting to do something or they need to check everything's right - although also consider that it may simply be they've forgotten they've asked the question or they've forgotten the answer, and the same thing has triggered the question again. Which of these it is will probably be clear from what the question's about, and whether that tends to be a recurring theme on several occasions. For example, if they keep asking whether that's a new hat then it's probably just that they keep seeing it, are interested in it, and are making conversation.

Be patient and answer the question each time, without telling them they've already asked it (since that would be upsetting for them). If it gets too much you could subtly put the hat out of view, or alternatively you could try putting it on their lap so they can satisfy their interest.

Where the questions indicate they're worrying they've forgotten something then follow the suggestions above for restlessness.

Disorientation of ages

Someone with dementia may be disoriented in terms of their age and situation - for example they may think of themselves as being 39 and having small children when in reality they're 80 and those children are grown up.

It's therefore not surprising if this leads to problems with identifying family members and friends, or accepting who those people are - if they're 39 then their spouse can't be the 80 year old they see before them; if their children are about 9 then a grown-up claiming to be their child must be a strange imposter. Similarly, their grandchild may be confused with their child, and their child with their spouse, based on the ages they're expecting.

As with other cases of disorientation, it isn't helpful to confront or disprove their view of reality directly (especially by showing them how old they look in a mirror). Instead, try to find a solution that moulds their understanding - perhaps for future occasions rather than expecting to be able to do so for this one. For example, having photographs on the wall of their children at a couple of age steps up to the present adults might help, labelled with who they are and perhaps 'growing up' and 'now'.

Forgetting details

If disorientation isn't the issue, as dementia progresses the person may not be able to remember your name, or your relationship (though they may well remember that you're someone they know). However, they will retain the feeling that you're someone nice. Don't take it personally if they forget who you are - that's entirely the dementia and no reflection on their affection for you either in the past or now.

They may ask where a family member is, when that person no longer lives with them. This is particularly difficult if that person (such as a spouse or parent) has passed away - in that case also see our section on supporting bereavement of someone with dementia, including deciding whether to tell them of the death.

If the person asked for has passed away, or you know your loved one wouldn't accept the reality that, for example, their child has grown up and is living elsewhere with a family of their own, then consider approaches along the line of:

• he'll be at work/school at this time of day
• do you think he's popped out to the shops? (though be careful not to make them wander to the shops looking for him if they're left on their own later)
• I haven't seen him this morning, he can't have gone far
• do you think he's tinkering with the car? (or some other hobby the person had).

They may think of themselves as, for example, being 39 and having small children they need to pick up from school, or they may think they need to go to work or are at work now.

Divert their direction

It isn't helpful to confront or disprove their view of reality directly - instead, try to find a solution that diverts them into a slightly different direction. For example, in the case of picking up children from school, if practical you could go for a short walk with them (without saying your destination) and the walk itself may satisfy their memory of walking (to school) at that time of day. If they think they need to go to work then you could say it's a holiday; if they think they're already at work and you know what that work involved then you could try to think of something for them to do (avoiding anything they'll realise they're unable to do).

Mould their understanding

Also consider a solution that moulds their understanding - perhaps for future occasions rather than expecting to be able to do so for this one. (For example, if they think their children are still young, try having photographs on the wall of their children at a couple of age steps up to the present adults, labelled with who they are and perhaps 'growing up' and 'now'.)

Someone in a care home may think the other residents have been visiting them in their own home and are now overstaying their welcome.

This is a difficult one to resolve without confronting their view of reality or leaving yourself open to being told to ask the others to leave. If it appears that the problem is your loved one wants some quiet you could try going with them to their bedroom, perhaps on the pretext of looking for something. Alternatively, you might try saying things like "It's nice to have other people about for a bit of company" or "The carers/helpers will want to give them their tea first - maybe after that, eh?".

A visiting carer might also get asked what they're doing in the house - in this case the answer could be "Your son Fred asked me to pop in to say hello and cook your lunch". If asked why Fred isn't doing it himself then it's because he's busy working today.

Someone with dementia may not fully recognise their own home, instead thinking of somewhere they used to live. It's not uncommon for someone to say occasionally that they want to go home even though they're already there – their view of 'home' may be a mixture of a past home, the situation of living with a loved one, and simply where they feel comfortable.

See our section on disorientation in place or situation.

They may start collecting things and putting them somewhere, potentially hiding them and forgetting where they are. This may be for one of several reasons, for example:

• they see something they think will be useful and they want to have it somewhere for when they need it
• they see something they like or are interested in and they carry it around until it's eventually put down
• they want to ask someone about it (for example what it is), so they take it to wait for someone to ask
• they think it was in the wrong place
• they worry about it getting lost or stolen (and hide it to prevent it being stolen).

In a care home, of course, there may be no distinction made between things that are theirs and those that belong to other residents, if they don't understand that it isn't their own home and all their own things.

A box or tray for 'useful things'

Where things are collected for being useful later on, try having an open top box or a tray where the things most often end up (perhaps labelled something like "Useful things") so that at least they can be found again more easily.

Learn the hiding places

If things are being hidden away then you may find several different places they tend to use. If something needs to be retrieved, perhaps because they're asking for it, say "It may have been tidied away" and go looking for it. If it can be left where it is then it may be best to do so.

Have spare keys, and keep irreplaceable items safe

Whether someone has become a collector or not, always have working spare keys for all doors (and windows) in case the originals are lost. Keep irreplaceable items, such as valuable documents, somewhere safe such as at your own home, and if you're able to we'd recommend keeping irreplaceable photographs safe by scanning them and reprinting copies.

Check the bin

Be aware it's possible they may start hiding things in a bin, or throw something away that shouldn't be - you may need to check before the bin is emptied.

Money can crop up in a variety of themes, such as:

• worrying they haven't got any money to pay for things (which may not be a matter of whether they have any in their purse/wallet, it may be they're thinking back to a time when they had little and they can see around them there must be expenses to pay)
• wanting to make sure they don't owe anyone anything (which may be that they know they're not capable of handling the paying)
• they've had money stolen (which may be they thought they had more in their purse/wallet than they did, or they've hidden some elsewhere, or they've given some to a grandchild - but don't discount the possibility they're right)
• wanting to go to the bank (which may relate to any of the other issues).

The sorts of things to explain in order to reassure them are:

• they have enough money from their pension (or if they think of themselves as working age then from their pay)
• these days it all gets paid straight into their bank where it's safe, and the bank does the paying for things (if necessary you might say the bank pays automatically, or when it's checked the bill, or when you tell them it's ok).

There may be a change in behaviour in late afternoon or early evening - something known as 'sundowning'.

In this case try to consider all the potential causes and factors described in the section on interpreting behaviour, and also try the general helpful techniques.