Why can’t staff recognize fear? Because it may not look like fear.

By Susan Saldibar

Have you ever experienced an irrational fear? Something that spooked you or made you feel unsettled and anxious? Of course you have. So have I. We’re human. We all feel nervous and upset occasionally even though we know, cognitively, that we shouldn’t be. So we adjust our thinking, find a way to cope and move on.  

That may not be the case, however, when an individual is impaired cognitively. I spoke recently with Shane Malecha, Clinical Practice Specialist for Aegis Therapies, (a Senior Housing Forum partner).

Why can’t staff recognize fear? Because it may not look like fear.

Shane tells me that, for residents with cognitive difficulties, even a simple cardboard cutout of a Halloween pumpkin pinned on the wall of a senior living community, can be disorienting and trigger fear. What’s interesting, though, is that the resident’s fear may not manifest itself as fear. Instead, it may result in the resident withdrawing or refusing to eat or some other behavioral change that caregivers may not even connect to fear, let alone the source of the fear.

As a clinical practice specialist, Shane is in an ideal position to observe behavior, not only of seniors in assisted living communities but also staff reactions to changes in behavior. What is troubling is how many trained professionals fail to recognize the behavioral changes of residents, when confronted with things in their environment that disturb them. And their fears are triggered by all kinds of things; time changes, shift of activities and even holiday decorations!

Since we’re heading into Fall and the holiday season, Shane thought it would be helpful to share some behavior changes for senior care staff to watch for and shed some light on what may trigger them.

Time Triggers

Residents with cognitive deficits, either through dementia, status post CVA, mental illness, etc. rely on schedule and routine to function. Even small changes can result in anxiety, which in turn can trigger behavioral changes, a need for more assistance, and often lead to falls.  

Examples of time triggers:

  • End of daylight saving time

  • Change in schedules and routine over holidays

  • Holiday activities and family visits, disrupting normal routine

Behavior changes to watch out for:

    • Inconsistent behaviors or issues with a particular caregiver

    • Behaviors such as repeating “help me, help me” or aggression toward others

    • Reduced activity level

    • Changes in mobility patterns – refusing to use walker or asking to use the bathroom more often, seemingly more restless

    • Resistance to care or help with activities of daily living (ADLs)

    • Changes in mood or behaviors following family visits, holiday activities or schedule changes

    • Unwillingness to participate in activities enjoyed in the past

Environmental Triggers

Examples of environmental triggers:

  • Holiday decorations

  • Holiday decorations in rooms and/or apartments. Shane urges staff members to let families know if they have put decorations in a resident’s room. The family can be more aware and help the resident adjust.

  • Changes in décor in dining rooms and tables

  • Rearranging furniture to accommodate decorations, such as Christmas trees, in common areas

Behavior changes to watch for:

    • Loss of orientation; unable to find the activities room, family, dining room, etc. “When you replace hanging artwork with decorations, you are removing their landmarks,” says Shane. “That can result in a resident wandering down an unfamiliar hallway and possibly outside, if there are no safety precautions,” he says.

    • Lingering longer in common areas, even though the extra time results in incontinence or missing out on other activities

    • Refusal to leave the room after activities and meals

    • Resistance to care and caregiver attention. This often occurs when once-familiar room layout is changed

    • Falls or near falls due to disorientation

Awareness is key to keeping residents safe, calm and healthy when seasonal and holiday changes occur. “Know who the individuals are with cognitive decline so you can be more attentive,” Shane suggests. “Look for changes in their behavior patterns. If someone who normally never misses a meal, starts not coming down to dinner, make the extra effort to find out the cause,” he adds.

Oh, and he warns communities not to fall for those cute holiday musical gadgets that can cause total disruption when activated.

So, toss those motion detectors that play Jingle Bells.

For more information on Aegis Therapies, please visit their website by clicking the logo button below:


Download a PDF copy of this article by clicking on the button below: