"The 36-Hour Day," written by Nancy L. Pace and Dr. Peter V. Rabins, was first published in 1981 and includes the six R's of behavioral management.

The book is a comprehensive reference guide for those affected by Alzheimer's disease and includes various topics on the disease journey from an overview, to financial planning and long-term care, to end-of-life issues, to understanding ongoing research.

Essentially, the book details tips and strategies in management of difficult and challenging behaviors associated with the disease by outlining six steps, or the six R's — restrict, reassess, reconsider, rechannel, reassure, review.

RESTRICT: If someone with Alzheimer's is experiencing escalating behavior, such as high anxiety and/or aggression, the first thing a caregiver should do is to attempt to calmly halt the behavior, especially if is potentially harmful to the person or to others. Keep in mind, however, that each person is unique, and trying to restrict or stop the behavior may upset the person more.

REASSESS: In this strategy, the caregiver looks for the root cause of a particular behavior. For instance, aggressive behavior can indicate depression. The caregiver should consider what provoked the negative conduct. Or it could be a medical issue, such as a urinary tract infection, joint or gut pain, or constipation. It could be environmental, or the caregiver's approach could seem threatening. It could be fatigue or a reaction to medication.

RECONSIDER: The old adage of walking a mile in someone else's shoes applies. The caregiver can empathize with what it is like to be confused and disoriented, how upsetting the situation or environment might be. Understanding a person has difficulty performing familiar tasks, like bathing, can ease the stress on both parties.

RECHANNEL: Redirect or steer the person away from negative behaviors to safe, less disruptive activities. Engage them in activities they enjoy and those that are meaningful and provide a purpose.

REASSURE: The caregiver should take time to provide comfort and support when someone is distressed, fearful or angry. Providing that person with confidence and assurance can produce calm and make them feel they will be cared for and loved. Reassure also applies to the caregiver for encouragement and self-reliance.

REVIEW: Once an upsetting behavior has happened and the person has been redirected, it's time for the caregiver to review how the behavior was managed and what worked and what didn't. The caregiver can look at his or her response, the triggers of the particular behavior and how the behavior might have been avoided. The caregiver then can come up with strategies to be used the next time.


Questions about Alzheimer's disease or a related disorder can be sent to Dana Territo, the Memory Whisperer, director of services at Alzheimer's Services of the Capital Area at advice@alzbr.org or visit the organization at 3772 North Blvd., Baton Rouge.