What to do when dementia patients fixate on things?

According to the Alzheimer's Association, behavioral symptoms like fixation are common in dementia, presenting significant challenges for caregivers. Knowing what to do when dementia patients fixate on things is crucial for maintaining both the patient's well-being and caregiver sanity.

Quick Summary

Effectively managing fixation in dementia involves redirection, understanding the underlying cause, and maintaining a calm, predictable environment. Caregivers can use distraction techniques, validate feelings, and introduce sensory-friendly activities to gently shift a patient's focus.

Key Points

• Distract, Don't Confront: Gently redirect attention to a new activity instead of arguing or correcting the patient's fixation.

• Validate Feelings: Acknowledge the emotion behind the fixation to reduce anxiety, rather than dismissing their concerns.

• Maintain Routine: A predictable daily schedule and a calm, simple environment can minimize triggers for repetitive behaviors.

• Check for Underlying Issues: Always consult a doctor to rule out medical problems like a UTI, which can cause sudden behavioral changes.

• Provide Sensory Engagement: Offer a "fidget basket" or use music and simple tasks to engage the senses and shift focus.

• Use Simple Communication: Speak calmly and use clear, simple phrases, avoiding complex arguments or repeated corrections.

Understanding the Root of Fixation

Why Fixation Occurs

Fixation, or perseveration, is a common behavioral symptom in people with dementia. It can manifest as repeatedly asking the same question, clinging to an object, or performing a task over and over. This behavior often stems from the brain's inability to process new information, memory loss, and a deep-seated need for security and control in a confusing world. Factors contributing to fixation include:

• Anxiety and Fear: The world becomes a less predictable place, and familiar objects or routines offer comfort.
• Memory Loss: The person may not remember that they just asked the same question or completed the task.
• Overstimulation: A noisy or chaotic environment can overwhelm a person with dementia, causing them to retreat into a repetitive, controllable behavior.
• Unmet Needs: The fixation might be a non-verbal way of communicating an unmet need, such as hunger, thirst, or pain.

Ruling Out Underlying Medical Issues

Sudden changes in behavior, including the onset of new or more intense fixation, should always be evaluated by a doctor. Infections, such as a urinary tract infection (UTI), can cause significant behavioral changes in the elderly. Other potential medical issues include medication side effects, dehydration, or pain.

Practical Strategies for Managing Fixation

Effective management techniques focus on patience, redirection, and creating a supportive environment. The goal is not to stop the behavior forcefully, but to gently guide the person toward a different, more positive activity.

Redirection and Distraction

One of the most effective tools is gentle redirection. Instead of arguing or correcting, shift the focus entirely. This isn't about tricking the person, but about providing a new, engaging stimulus.

• Change the Scenery: Suggest a change of location, like moving to a different room or stepping outside for a moment.
• Offer a Favorite Snack or Drink: A simple offer of a favorite treat can break the cycle of fixation.
• Use Visual Cues: Present a photo album, a favorite book, or an object related to a hobby they once enjoyed.
• Involve the Senses: Play soothing music, offer a soft blanket, or suggest a simple, calming activity like kneading dough or sorting objects.

Validation and Emotional Support

Dismissing a person's concerns, even if they are based on a false premise, can increase their anxiety and reinforce the fixation. Validation therapy, which acknowledges and respects their feelings, can be very powerful.

• Acknowledge Their Feeling: If they are worried about a lost item, say, "It sounds like you are very concerned about that. Let's look for it together later." This validates their emotion without necessarily feeding into the delusion.
• Reassure with a Calm Tone: A calm, reassuring voice can do wonders. A gentle touch on the arm can also provide comfort.
• Avoid Arguing: Trying to reason with a person who has dementia is often counterproductive and can lead to heightened agitation. Avoid phrases like "You just asked that" or "I already told you."

Environmental Adjustments

Modifying the environment can help reduce triggers for fixation.

• Maintain Routine: A predictable daily schedule can provide a sense of stability and reduce anxiety.
• Reduce Clutter: A simple, organized space can be less overwhelming.
• Create a "Fidget Basket": Fill a basket with interesting items for the person to hold, sort, or manipulate. Examples include textured fabrics, old wallets with cards, or a soft stress ball.

Comparison of Management Techniques

Technique	How it Works	Best for...	Caveats
Redirection/Distraction	Shifts attention to a new activity.	Breaking a repetitive loop.	May not work for deeply ingrained fixations.
Validation Therapy	Acknowledges feelings to reduce anxiety.	Emotional-driven fixations.	Requires immense patience; can't be rushed.
Environmental Modification	Reduces triggers and provides calm.	Preventing fixation from starting.	Requires ongoing effort and observation.
Sensory Stimulation	Engages senses to shift focus.	Restlessness or anxiety-related behaviors.	Requires knowing what the person finds soothing.

Example Case Study: The "Lost" Purse

Imagine a scenario where a patient fixates on their "lost" purse, repeatedly asking where it is, despite it being safely in a drawer. The caregiver's response is key.

1. Initial Response (Wrong): "I told you, it's in the drawer. Stop asking." This leads to increased anxiety and agitation.
2. Redirecting Response (Better): "It sounds like you are worried about your purse. How about we look at this photo album for a bit?" Then, later, they can revisit the topic with a calmer approach.
3. Validating Response (Best): "You're concerned about your purse, and I understand. It's right here where we put it to keep it safe. Let's have some tea now." This combines validation with gentle reassurance and redirection.

Creating Engaging Activities to Reduce Fixation

Providing purpose-driven activities can help prevent fixation by offering meaningful engagement. For more resources on finding appropriate activities, consult a trusted source like the Alzheimer's Association.

• Household Chores: Simple, repetitive tasks like folding laundry, sorting silverware, or dusting can be comforting.
• Gardening: Planting or watering flowers can be a sensory and calming experience.
• Music Therapy: Playing familiar songs can evoke positive memories and redirect focus.
• Reminiscence Therapy: Discussing old photographs, mementos, or listening to stories from their past can provide comfort and connection.

Conclusion

Managing fixation in dementia requires a blend of strategies, including gentle redirection, compassionate validation, and a supportive environment. By understanding the underlying reasons for the behavior, caregivers can move from a place of frustration to a place of effective, empathetic care. Patience and flexibility are paramount, as what works one day may not work the next. By employing these techniques, caregivers can improve the quality of life for both themselves and their loved ones.

Frequently Asked Questions

Why do dementia patients fixate on things?

Fixation, or perseveration, in dementia is often caused by anxiety, memory loss, and a need for security in a confusing world. It can be a way for the person to cope with cognitive changes and find comfort in repetitive, familiar actions.

How can I redirect a dementia patient's attention?

Use gentle redirection techniques like offering a favorite snack or drink, showing a photo album, or suggesting a simple, calming activity like listening to music. Avoid arguing or forcefully trying to stop the behavior.

Is it okay to lie to a dementia patient during a fixation?

Rather than lying, which can lead to distrust, it is often more effective to use 'therapeutic fibbing' or validation. Acknowledge their concern ("You're worried about your keys") and then gently redirect them to a new activity.

What if the fixation is on something unsafe?

For unsafe fixations, distraction is key. You may also need to remove the dangerous object from the environment. In severe cases, consult a doctor or a memory care specialist for guidance on safety measures.

Can medication help with fixation in dementia?

In some cases, a doctor may prescribe medication to manage behavioral symptoms like severe agitation or anxiety that contribute to fixation. However, non-medical strategies are usually the first line of defense.

How can caregivers cope with the stress of a patient's fixation?

Caregivers can cope by using distraction techniques, seeking support from other caregivers, and taking short breaks when possible. Remember that it's okay to feel frustrated, but focus on the most effective, gentle responses.

What are some good activities for a dementia patient who fixates?

Engaging activities can include sorting objects (coins, photos), folding laundry, simple gardening tasks, or listening to familiar music. The key is to find activities that are both simple and personally meaningful to them.