A person with dementia may act out of character and become aggressive or restless (sometimes known as challenging behaviour). A person’s behaviour can be described as challenging if:
- It puts them or those around them at risk.
- It impacts on their quality of life.
- It impacts on their ability to join in with everyday activities.
Challenging behaviours include:
- Self harm.
Challenging behaviour is most often seen in people with conditions that affect their ability to communicate such as people with learning/developmental disabilities or dementia.
Causes of behavioural changes
- Hunger / Thirst.
- Environment – may to too hot, cold, bright, dark or noisy.
- Fear / Confusion.
- Frustration – often as a result of the inability to communicate an unmet need.
- Tiredness / Fatigue.
- Not feeling in control of decisions that affect their life.
- Feeling invisible.
Actions to help manage behavioural changes
It can be very difficult, stressful and upsetting when managing challenging behaviour and some of the tips below are easier said than done. It is essential that you don’t take the behaviour personally as this will affect your ability to remain calm and may affect the way you interact with them in future.
- Keep a diary to help identify common triggers that cause the behaviour.
- Check the person is comfortable i.e. not hungry, too cold, tired.
- Ask the doctor to carry out an assessment to check for infections.
- Avoid confrontation (either verbal or physical). Remember that logic and reason are unlikely to work.
- Remember they are not being purposely difficult, try and remain calm and respectful.
- Listen to them, acknowledge their feelings and reassure them.
- Don’t force something that can be left until later i.e. is bath time causing the behaviour.
- Try and plan some activities throughout the day to avoid boredom.
- If the situation cannot be resolved, distract the person onto something they enjoy.
Triggers for challenging behaviour with Mum
- Mum had an irrational fear of doctors and hospitals and any visits by a doctor would result in Mum becoming very distressed, agitated and often aggressive. Therefore we tried to avoid any tests / hospital visits wherever possible and stopped the monthly blood tests she had to monitor the affect of her medication.
- Mum had dementia with Lewy bodies and one symptom is stiff and painful joints. As her disease progressed Mum started lashing out when the care home staff were helping with dressing. Pain was identified as a possible cause and regular pain relief was given before dressing, which helped to resolve the issue.
- Mum would often become very embarrassed when helped with bathing and toileting, which led to aggressive behaviour. Suggesting a bath when Mum seemed in a particularly good mood helped. Making sure the environment was right i.e. warm enough, also helped. As did having towels and clothes ready so that Mum didn’t feel too exposed for long.
- Tiredness was another trigger for Mum. Like most people, Mum was irritable when tired, but she couldn’t locate her bedroom to go for a lie down. Often after lunch she would become tired, so we would go to her room for a lie down and she would be asleep before her head hit the pillow!!
People with dementia lose independence over almost all aspects of their life as the illness progresses and are reliant on others for everything. For example they can no longer eat when they are hungry because they are unable to prepare the food themselves and are often unable to communicate what they want. It must be very frustrating and frightening to be in that position.
I believe that the key thing when managing challenging behaviour, is to remember that it is the illness and not the person that is to blame. And remember that there is almost always a reason for the challenging behaviour whether it be hunger, pain, fear, frustration or some other reason. And because they are unable to communicate what’s wrong, then it’s up to us to try and find out.
The Alzheimer’s Society has produced a useful PDF booklet on the behavioural changes that can occur in dementia.