Behaviours have a reason, a cause and a meaning. Challenging behaviour may be:
- An attempt to communicate.
- An expression of unmet need.
- The result of physical/structural changes in the brain caused by dementia.
The actions and words of a person living with dementia are often their way of responding to something in the environment or expressing how they are feeling (anger, fear, frustration). This can include agitation (fiddling, pacing, repeated vocalizations), verbal outbursts (shouting, sweating, or name-calling) and physical aggression (pushing or hitting).
People living with dementia, like all of us, are feeling the effects of the changes to our daily lives. Being at home all day, decreased activity, increased boredom, fear of illness, the effects of “cabin fever,” or even just a sense that things are not as they “should be,” can affect us all emotionally. These changes limit our ability to participate in the activities we would normally do to keep ourselves well, to engage with others for a sense of connectedness, and to get support in a time when most of us are need extra help.
Dementia may also make it harder for the person to identify the emotions that could arise or to have insight into what the triggers might be therefore making these emotions difficult to manage.
When attempting to understand the behaviour of a person living with dementia consider the following:
- What is the person feeling or needing right now? By attempting to understand the reason for an increase in responsive behaviours, you can help to avoid them. Consider:
- Is the person lonely or bored?
- Are they getting enough physical activity?
- Do they need reassurance that you are both safe?
- Are the overwhelmed and confused?
- Impaired judgement and memory may create frustration if the person living with dementia is unable to understand or remember why they cannot participate in their usual activities.
- Give the person living with dementia the opportunity to express their feelings and to talk about their experience. Their feelings and perspective might not make logical sense to you or align with your own reality, but it is their experience.
- Trying to use logic or presenting information that challenges their reality may cause a person living with dementia to feel threatened and become defensive.
- By listening to the person describe their experience, helping to name the emotions you are witnessing, and attempting to identify unmet needs, you may be able to reduce the incidence of responsive behaviours.
- Changing the topic or activity can redirect the person’s focus and allow them to forget about what may have been making them upset or confused.
- For example, if the person is upset at you because they don’t understand why they cannot visit friends, remain calm and apologize, then find a topic of conversation or an object to distract the person.
- Reminiscing with the person about their past can be a positive way of redirecting the person’s focus to more pleasant topics.
- Try not to get upset or take the person’s behaviour personally. They do not mean to upset you and they are doing the best they can.
- Be aware of what your own behavior is telling them. People living with dementia may rely more on how you say things rather than what you say. If possible, walk away while you gain your composure. Try not to show that you feel anxious or angry, as this could cause the responsive behaviour to escalate.
- Recognize that you are doing the best you can in an unexpected and challenging situation. You may not be able to meet all the person’s needs as they were being met before COVID-19 and that is OK.
- Creating a routine that meets the needs of you and the person living with dementia as best you can while we get through this challenging time will help to keep you and the person you are caring for well. Watch our recorded webinar "Activities to do at home" for suggestions for building a routine that provides meaningful activities and promotes well-being.
Additional resources on behaviour are available on the Alzheimer Society of B.C. website:
- The “Dementia Behaviour Changes, Understanding why changes occur” handout provides further information about changes in behaviour and strategies for caregivers.
- The webinar series “Understanding dementia” has more information about managing changing and challenging behaviours.
- The webinar “Managing responsive behaviours in a rapidly changing environment” explores the reasons for reactivity and provides coping strategies.