The ABC Way to Understand Alzheimer's Behavior
A person with Alzheimer's disease may sometimes act in ways that are upsetting or seem aggressive. He or she may hit, scratch, or fight with the caregiver. This does not always happen. But if it does, it is likely to be when the person is in the middle stage of Alzheimer's disease. This stage can last for up to four years.
These actions can be upsetting and are often hard for caregivers to manage. It helps to have a plan. One that many people find easy to remember is called ABC. Here is what this means:
- A means Antecedent. This refers to events that happen just before an upsetting action.
- B is the Behavior. This means any upsetting or aggressive action done by the person who has Alzheimer's disease.
- C refers to the Consequence. This includes events that happen after the behavior. Sometimes, these events can make the situation worse.
Here is a story about people we are calling Mary and Robert Jones. In this story, Mary is the caregiver for her husband, Robert, who has Alzheimer's disease. As you will see, in this story many things go wrong.
A. The Antecedent. What happened before the behavior?
Mary slept too late and now is in a hurry. She wants her husband Robert to quickly get out of bed, take a shower, eat, and get dressed before a driver arrives to take them to his doctor's appointment. Because of her late start, Mary yanks off the bed covers and yells at Robert to get up. He does not understand the words but reacts to her tone of voice. Mary gets angry when he pulls the bed covers back up. "So that's the way it will be. I'm in charge here," she yells.
Mary then drags Robert out of bed and rushes to get him dressed. Now he must balance on one leg rather than sit down to pull up his pants. This is not their usual routine when Mary takes her time helping Robert get ready for the day.
B. The Behavior.
Robert loses his balance because Mary is rushing him so much. He grabs her arm for support and does not let go. When she yells, he grabs even tighter. Robert is now digging his nails into Mary's arm.
C. The Consequence. The events that followed the behavior.
Mary loses control and smacks Robert in the face (something she had never done before). He hits her back. Mary thinks he is fighting, though it may be that he is just afraid and doing to her what she did to him.
One problem leads to others and Mary now worries that Robert will hurt her again. She questions whether she can care for him at home and wonders whether Robert must go to a nursing home.
Now let's look again at this story using the ABC way. Mary can see that the problems started when she rushed around and did not think of how Robert would react. She now knows she must avoid these types of situations.
- Mary learned that because Robert has Alzheimer's disease, he cannot be rushed. While she should not feel guilty, she should realize how her actions made this worse.
- If Mary is ever late again, she will call the doctor's office and ask if they can make a new appointment or come in later in the day. This is better than expecting Robert to change his behavior.
- Mary will make a list of what happened just before Robert's upsetting behavior. She will look for causes of what went wrong and figure out ways to avoid them.
- Mary will also think about her own actions and what did or did not work well.
- Mary will use the ABC way to help Robert to be more cooperative in the future. This is a way to understand what happened, and figure out ways to better manage in the future.
The examples given in the ABC post and the poster with a Down's Syndrome brother are so sad and heartbreaking. My brain injure husband developed Dementia/Alzheimer's symptoms as a result of his injury. I had some moments similar to the couple in the ABC post, - although I thank God, never hit my husband. After a small electric wall fire, when I tried to rush him out of our home, I realized that he simply can't react quickly. Unfamiliar people and activities (firemen and police)made him panic. Like the ABC explanation, I learned that it was my responsibility to start his day early enough to eat, dress and make his appointments in time. I learned that my husband was my first priority , - even if I had to reschedule a medical appointment. I located a dentist who worked with brain injured patients and would allow him to miss an appointment if he was feeling sick that day. I tried to pick up on the anger in his voice, and apologize, - ask softly what he needed me to do - what did he need. I learned to talk with him and remind him that I was trying but that sometimes, I didn't understand. A soft conciliatory approach helped a lot - even when I didn't feel I was wrong. Flare ups still occurred. There was the time I put the bacon in the frying pan when I saw that he had them both on the counter. He smashed the ceramic stove top in a rage (he had wanted to make his own breakfast), and I called him a Lunatic. There was the time I called the police for my own safety because he couldn't (notice I said "couldn't") calm down from a rage. AS for Mary with the younger D.S. brother, my heart goes out to her and him. Mary must, absolutely must get her brother into a skilled facility where his feeding will be supervised. The fact that he has lost an enormous amount of weight is a Red Flag danger sign and will be fatal if there is no intervention. Mary must go to her brother's doctor immediately and have him admitted. Go to the County or State Dept of Social Services or health and Human Resources and apply for LTC Medicaid. Some States and Counties require a 'triggering event' such as admittance to an emergency room and hospital before he will get the skilled nursing home care he needs. The skilled facility can treat her brother for his stroke, get his weight back where it needs to be for his health, and teach Mary better coping methods for caring for her brother at home - if she wishes. Mary, you must not presume that skilled nursing home admittance is forever. Also, once stabilized, you may be able to take him home on weekends or longer. There comes a time at which we must be humble, realize our limitations, and do what is best for the person we love. I am concerned that Mary's post is one month old. An additional minor consideration is that should your brother die under your care, and you observed his deterioration without taking prudent steps to intervene, you could be brought up on manslaughter charges. As a full time care giver myself, I know how exhausting it is. Even the caregiver can not always think clearly. Don't be preparing for your brother's death. Do what is needed to keep him fed and alive. Let God take care of his time to die. Down's Syndrome people are the sweetest, and I'm sure Mary loves her brother very much.
I care for my younger brother since the death of my Mom. 5 years. He is 54 and Down Syndrone. Last yr he had a stroke while visiting our siblings. A test shows the right side of his brain to be white. The dr said he has Alzheimer. I just wonder what stage he is in or if there are stages so I can determine when it is close time so I can let the other siblings know to come spend time with him. They live hrs from me. KY. Pa. and I am in AL. He no longer wants to eat. Drinks from a straw and wants nothing with any consistency. I have to almost force feed him instant mash potatoes and the rest of the food is puddings, ice cream, baby food stages 1 and 2 only and these have to be mixed with his ensure.....seems he has no taste buds. He takes the food out of his mouth a lot. Our newest big thing is he is having a lot of problems walking. walks to the left....stroke was to the right. Could this be the problem? He is taking the patch and pill for Alzheimer. His top weight has been 122. He now weighs 103. My regular email is mlcc520@mchsi.com if anyone has any suggestions. I have to constantly watch him and seldom get to do anything other than check email on here. Thanks and God Bless Mary