Can we go now? Handling repetitive behaviors
Repetitive behaviors such as asking the same question again and again can be stressful and irritating for family caregivers.
Sometimes it feels like your relative with dementia is purposely repeating questions or statements just to annoy you. This is rarely the case. More likely, your relative is trying unsuccessfully to feel a sense of control. Behaviors that surface later in dementia—repeatedly tapping fingers, rubbing arms or thighs, fidgeting with things or pacing back and forth—are also a means of self-comfort.
Responding in a calm, reassuring manner is easier when you understand that physical changes in the brain often lie behind these behaviors. A person may not know that she is repeating herself. He may not know when or how to stop doing something, so he continues spooning his soup bowl when there is no more soup! Your relative may be completely unaware of his repetitive behaviors. You’re the one who may be upset.
What’s behind repetitive behaviors?
Pain. Pain can cause people with dementia to rock, pace or move in other rhythmic ways when they are uncomfortable. A person who is hungry may constantly ask, What’s for lunch? A person who feels cold may repeatedly check closets for a blanket or a sweater.
Depression and boredom. Repetitive actions or gestures may be the only way a person who feels depressed can express herself or cope with certain places, situations or people. Feeling bored or unsure of what to do can prompt someone to repeatedly ask, What do I do now?
Emotions. Your relative may be expressing an emotion such as fear, anger, or anxiety, and need reassurance. Wringing her hands or tapping fingers on a table may be a way that she is trying to comfort herself. She may be feeling vulnerable, especially in a new or unfamiliar environment with unfamiliar people. Being separated from a loved one can cause constant questions such as, Where’s Tom?
Lack of comprehension. Asking What are you doing? may indicate that he doesn’t understand what you or someone else is doing.
Environment. Coats, shoes, purses, and umbrellas can prompt questions like Is it time to go now? And too much stimulation—too many people, too much activity or noise—can trigger statements like Let’s go now. Let’s go now.
What can you do?
Consider these approaches to interrupting or redirecting a repetitive behavior.
- Apply our Behavior Detective approach to observe when behaviors occur and what might be causing them.
- Respond with your full attention. Sometimes people with dementia no longer know how to get attention and may be using questions as an attention-getting device. Focusing on them and responding to their emotional needs can sometimes break the cycle of repetition for a while.
- Respond calmly. Frustration or anger in your voice is likely to escalate your relative’s anxiety. If you find it difficult to conceal your frustration, try remaining silent.
- Try ignoring the behavior or questions. If there is no response or reinforcement, the behavior may stop. However, some people may be very upset when they are ignored and become more agitated. For others, ignoring may eventually work. Be patient while you learn what works and doesn’t work.
- Try a gentle touch when a verbal response does not help. A hug, holding hands or a gentle shoulder massage can be more reassuring than words.
- Try giving the person a note with the answer on it. For example, if the person repeatedly asks When is lunch? When is lunch? write out Lunch is at 12 o’clock. Give the person the piece of paper. Sometimes, having the answer to look at can stop or at least diminish the question being asked repeatedly.
You can find many more suggestions and strategies in the Repetitive Behaviors chapter of our book, Coping with Behavior Change in Dementia: A Family Caregiver’s Guide.
Change your own attitude
Sometimes, despite our best efforts, repetitive questions or movements will not stop. If the behavior is not stressful or a safety threat to the person with dementia, it may help to recognize that this is part of the disease. Changing your attitude to one of acceptance can sometimes help you cope with repetitive behaviors caused by changes in the brain.