When a resident with Alzheimer's disease perseverates, what should the nursing assistant do?

According to the Alzheimer's Association, over 6 million Americans have Alzheimer's dementia, and for many, a common and challenging symptom is perseveration—the involuntary repetition of words, questions, or actions. Understanding what to do when a resident with Alzheimer's disease perseverates is crucial for nursing assistants to provide calm, compassionate, and effective person-centered care.

Quick Summary

When a resident with Alzheimer's repeats a word, phrase, or action, a nursing assistant should respond calmly with reassurance, redirect their attention gently, or simply answer repeated questions consistently using the same words each time to prevent agitation.

Key Points

• Validate Feelings: Acknowledge the resident's underlying emotions—like anxiety or fear—rather than focusing on the factual error of their repeated question.

• Redirect Gently: Shift the resident's attention to a new, simple, and enjoyable activity, like looking at photos or having a snack, instead of confronting the repetition.

• Answer Consistently: If the resident repeats a question, provide the same simple, calm answer every time without reminding them that they just asked.

• Manage the Environment: A calm, predictable environment and consistent daily routine can reduce the anxiety and confusion that often trigger perseveration.

• Avoid Conflict: Never argue, scold, or reason with a resident who is perseverating, as this will only increase agitation and distress.

Understanding Perseveration in Alzheimer's

Perseveration is a common and often frustrating symptom of Alzheimer's and other dementias. It is not an act of defiance but a neurological symptom caused by damage to the brain's frontal lobe. Residents with Alzheimer's who perseverate may repeat a phrase ("What time is it?"), a question ("Is my son coming to visit?"), or an action (folding a napkin over and over). The repetition is often a way for the resident to cope with anxiety, confusion, or a changing environment. Recognizing this behavior as a symptom of the disease, rather than a deliberate action, is the first step toward a more effective and compassionate response.

The Three-Step Approach for Nursing Assistants

Instead of becoming frustrated or attempting to correct the resident, nursing assistants can employ a simple, three-step strategy to manage perseveration. This approach focuses on empathy, redirection, and consistency.

Step 1: Validate and Reassure

The resident's underlying emotions—anxiety, fear, or boredom—often trigger perseveration. Dismissing their concerns can escalate the behavior. Instead, validate their feelings with a calm and reassuring tone.

• Example Response: If a resident repeatedly asks for their daughter, a good response is, "Your daughter loves you very much. She will be so happy to see you." This addresses the feeling behind the question (missing their daughter) without focusing on the factual inaccuracies of their short-term memory.
• Key Action: Maintain a gentle, calm, and patient demeanor. Use reassuring body language, such as a soft touch on the arm, if the resident is receptive.

Step 2: Redirect with a Positive Distraction

Once the resident feels heard, gently shift their focus to a new, positive activity or topic. Redirection is most effective when it is calm and non-confrontational.

• Simple Redirections:
  • Offer a favorite snack or drink.
  • Engage them in a simple task, like folding towels or looking at a photo album.
  • Suggest a walk to the dining room or another familiar area.
• Important Note: The distraction should be something the resident enjoys and finds engaging. Avoid high-stress or complex activities.

Step 3: Respond Consistently, Not Correctively

If the resident continues to ask the same question, the best response is to answer each time using the exact same simple, soothing words. Do not remind them that they have already asked. This prevents unnecessary conflict and provides a predictable, calming response that requires minimal cognitive effort from the resident.

• Example: If the resident asks, "What time is it?" repeatedly, the NA should answer, "It's three o'clock" every time, in the same calm tone. Avoid saying, "I just told you." Consistent repetition from the NA is less jarring than a changing or confrontational response.

The Importance of Environment and Routine

Environmental factors can exacerbate perseveration. A chaotic or unfamiliar environment can increase a resident's anxiety. A predictable routine provides a sense of security and can help minimize confusing situations.

• Minimize Environmental Triggers: Reduce noise, clutter, and overstimulation. Ensure the resident's personal space is familiar and comfortable. Keep frequently used items in the same place.
• Maintain a Schedule: A consistent daily schedule for meals, activities, and rest can help reduce uncertainty. Use visual cues, like a written schedule or pictures, to reinforce the routine.

Communication Best Practices

Effective communication goes beyond just words. Nursing assistants must pay attention to non-verbal cues and their own body language.

• Use Simple Language: Speak in short, clear sentences. Avoid complex instructions or abstract concepts.
• Maintain Positive Body Language: Approach the resident from the front, use a warm facial expression, and make eye contact. Your non-verbal cues can convey reassurance more effectively than words.
• Listen to the Underlying Emotion: Don't get caught up in the exact words. Instead, listen for the feeling or need the resident is trying to express.

What to Avoid When a Resident Perseverates

There are several common mistakes that can worsen the situation. Being mindful of these can significantly improve outcomes for both the resident and the caregiver.

1. Do not get frustrated or show irritation. This can increase the resident's anxiety and agitation.
2. Do not try to argue or reason with them. Logic and facts are not effective in managing dementia-related behaviors.
3. Do not tell them they are wrong or remind them that they just asked the question. This only causes frustration and embarrassment.
4. Do not engage in long, detailed explanations. These are difficult for a person with Alzheimer's to process and can cause further confusion.

Comparing Effective vs. Ineffective Responses

Effective Response	Ineffective Response
Validate the resident's feelings with empathy and reassurance.	Dismiss or ignore the resident's question or action.
Redirect gently with a new, simple activity or conversation topic.	Correct the resident by pointing out that they have repeated themselves.
Answer consistently using the same simple words each time.	Engage in arguments or lengthy explanations about the facts.
Maintain a calm tone and positive body language.	Exhibit frustration or a short temper.
Provide a predictable routine and a calm environment.	Allow for a chaotic environment and an inconsistent daily schedule.

Conclusion: The Long-Term Perspective

Managing perseveration requires patience, empathy, and consistency. By validating feelings, redirecting gently, and responding predictably, nursing assistants can create a more peaceful and supportive environment for residents with Alzheimer's disease. Remember that perseveration is a symptom of a progressive disease, not a personal flaw. The key to successful management lies in understanding the resident's emotional state and responding with compassion and consistency. This approach not only de-escalates frustrating situations but also strengthens the bond of trust between the caregiver and the resident. For more information on caring for individuals with dementia, the Alzheimer's Association is a great resource.

Understanding and Responding to Dementia-Related Behavior

Frequently Asked Questions

What is perseveration in the context of Alzheimer's disease?

Perseveration is the involuntary and inappropriate repetition of a word, question, or action. It is a common symptom of Alzheimer's disease caused by neurological damage, not a deliberate or intentional behavior.

Why does a resident with Alzheimer's disease perseverate?

Residents with Alzheimer's often perseverate due to anxiety, confusion, or a feeling of being unsafe. The repetition can be a coping mechanism for memory loss and the inability to process new information effectively.

Should a nursing assistant correct a resident who is perseverating?

No, a nursing assistant should never try to correct or reason with a resident who is perseverating. This approach can increase agitation and frustration for the resident and damage the caregiver-resident relationship.

What is a good way to redirect a resident who is perseverating?

Effective redirection involves gently shifting the resident's focus to a positive, simple activity. Examples include offering a favorite snack, engaging them in a simple task like folding clothes, or suggesting they look at a picture book.

How should a nursing assistant respond to a resident who asks the same question over and over?

The best strategy is to answer the question using the exact same simple words each time. This provides a consistent and predictable response that minimizes confusion and agitation.

Can environmental factors influence perseveration?

Yes, a chaotic or noisy environment can increase a resident's anxiety and trigger or worsen perseveration. A calm, predictable routine and a quiet environment are helpful in managing this behavior.

What if redirection doesn't work right away?

Be patient and persistent. If the first attempt at redirection doesn't work, try a different approach or simply continue to respond calmly and consistently to the repeated question. Don't give up or get frustrated.