Dementia Special: Delirium, Alzheimer's, Dementia Care, and Supporting CaregiversPage 39 of 51

13. Don’t Be Judgmental

guideline 12

Don’t be judgmental.

Be kind, for everyone you meet is fighting a battle you know nothing about.


Sometimes when we see things we do not understand or can’t find a reason for, we become judgmental. This is something we all need to think about. There are always circumstances and situations we may not be privy to or understand. To avoid being judgmental about the person with dementia, use the common sense approach:

  • Put yourself in his shoes, and try to understand what he is feeling, seeing, and hearing.
  • Educate yourself about the fact that dementia causes brain damage, and understand that the person with dementia may not have the resources to respond appropriately to all situations.
  • Keep your sense of humor, but never embarrass the person with dementia.
  • Preserve the dignity of the person who is displaying bad behaviors or acting out by removing her to a private area if possible.


Almost a year after I started working primarily with people who had dementia, I met Harriet. I was not prepared for Harriet at all. In retrospect, I’m very glad I met Harriet. I learned more from her than any of the other residents I cared for up to this point.

Harriet was admitted to our facility in 1991. Because many of our residents had early-stage dementia and were still able to watch television, we had a large one installed in our living room. On the day that Harriet was admitted, the activity aide had the television on waiting for a program to begin. The 5 o’clock news was on.

I met Harriet and her family at the door and discovered that she was an attractive, well-mannered woman in her early seventies. We spoke for a few minutes and my first impressions of her were that she would fit very well into our group. However, as we passed through the activity room where the TV was playing I heard her say: “Well, hello! Aren’t you the gorgeous one!” and I realized that Harriet was talking to Tom Brokaw who was reporting the evening news. I had never seen a person with dementia do that before, so I was intrigued.

As time went on, Harriet continued to talk to the TV, and at times became so agitated that we eventually discontinued regular use of the TV. Harriet had what we called mixed dementia. Her doctors suspected that she had Alzheimer’s disease and multi-infarct dementia. Later on I found out that one of her doctors suspected she might also have had untreated bipolar disease, as she exhibited signs of an agitated depression.

Over the next few weeks I realized that Harriet was experiencing disinhibition to a great degree. She had begun trying to touch male residents, and even male visitors, in inappropriate ways. Obviously she needed help with this behavior.

Disinhibition is a process caused by the progression of dementia. It results in an individual’s having a reduced capacity to react normally to a situation. Patients who are disinhibited often blurt out what they are thinking, act impulsively, and behave in socially unacceptable ways. We learn to inhibit our impulses as we grow and mature. Dementia reverses this process.

Actually, most people with dementia become disinhibited to some degree, but depending on a multitude of factors, the frequency and severity of inappropriate behaviors varies. Harriet was experiencing sexual disinhibition to a significant degree.

We asked for a psychiatric consult for Harriet, and a week later a young geriatric psychiatrist came to evaluate her. While the doctor tried his best to administer the mental status exam (MSE), Harriet, in turn, tried her best to get hold of the doctor. He was obviously having a hard time with her and kept gently pushing her away but with little success. Harriet had become so sexually aggressive, he was unable to complete his evaluation and scheduled a return visit for the following Tuesday. On the way out of the facility, he asked the administrator and me to help him complete his exam at that time.

When the psychiatrist made his return visit, we went with him to Harriet’s room and actually stood in front of him so she could not touch him and he could complete his evaluation. He was a good sport about it and took time to explain to us what was going on. He was able to prescribe some medication to help with Harriet’s sexual disinhibition and treat her for agitated depression. However, although the medications helped control her behaviors most of the time, his return visits to see Harriet still required two people to stand between them.

With the psychiatrist’s help, Harriet was eventually able to participate in some meaningful activities, and her quality of life did improve.

Sometimes it’s hard to remember that the symptoms of dementia can be so different from person to person. Caregivers may become judgmental at times because they see behaviors that are bizarre or inexplicable. When this happens, the cause may be related to a mixed dementia or to a specific event in the person’s life that is troubling to them. People who exhibit disinhibition should be protected from embarrassing situations and may need a psychiatric assessment and medication to manage their symptoms.