Managing Challenging Behaviours in Dementia
This comprehensive guide explores challenging behaviours in dementia, offering practical strategies and empathetic advice for families. It covers common behaviours like agitation and sundowning, explains triggers, and provides actionable tips for management. The article also highlights the importance of carer wellbeing and signposts to essential UK support services and professional care options.
Important
Understanding and Managing Challenging Behaviours in Dementia
Caring for a loved one with dementia can be a deeply rewarding experience, but it also presents unique challenges. One of the most difficult aspects for many families is navigating what are often described as 'challenging behaviours'. These behaviours are not intentional acts of defiance; instead, they are often a form of communication, a way for the person living with dementia to express unmet needs, discomfort, or confusion when they can no longer do so with words.
This guide aims to provide families with a compassionate and practical understanding of these behaviours, offering strategies to manage them effectively, reduce distress for both the person with dementia and their carers, and improve overall quality of life. Remember, you are not alone in this journey, and help is available.
What Are 'Challenging Behaviours' in Dementia?
The term 'challenging behaviours' can encompass a wide range of actions or reactions. It's crucial to understand that these behaviours are symptoms of the disease, not personality flaws. They stem from changes in the brain caused by dementia, affecting memory, reasoning, communication, and emotional regulation.
Common Behaviours You Might Encounter:
- Agitation and Restlessness: Pacing, fidgeting, an inability to settle, or expressing anxiety.
- Aggression (Verbal or Physical): Shouting, swearing, hitting, pushing, or resisting care. This is often a sign of extreme distress or fear.
- Repetitive Behaviours: Asking the same questions repeatedly, performing the same actions (e.g., rummaging, packing and unpacking).
- Wandering: Pacing aimlessly, trying to leave the house, or becoming disoriented and lost.
- Sundowning: Increased confusion, agitation, anxiety, and restlessness that occurs in the late afternoon or evening.
- Hallucinations and Delusions: Seeing or hearing things that aren't there (hallucinations) or having strong beliefs that are not based in reality (delusions), such as believing someone is stealing their possessions.
- Inappropriate Sexual Behaviours: Disinhibition, public undressing, or inappropriate touching.
- Resistance to Care: Refusing to bathe, eat, or take medication.
- Hoarding or Hiding Objects: Collecting and concealing items, often due to a feeling of insecurity or a desire to keep things 'safe'.
The 'ABC' Approach: Understanding the Triggers
A helpful way to understand and manage challenging behaviours is to use the 'ABC' approach, which stands for Antecedent, Behaviour, Consequence.
- A - Antecedent: What happened before the behaviour? What was the context? (e.g., a change in routine, a loud noise, hunger, pain, feeling overwhelmed).
- B - Behaviour: What exactly did the person do? (e.g., shouted, paced, refused to eat).
- C - Consequence: What happened after the behaviour? What was your reaction? Did the behaviour achieve something for the person? (e.g., they got attention, the unpleasant task stopped, they were left alone).
By consistently observing and documenting these elements, you can often identify patterns and triggers, leading to more effective strategies. Keeping a simple diary can be invaluable.
Common Triggers for Challenging Behaviours
Many factors can trigger or exacerbate challenging behaviours. Identifying these can be the first step towards prevention and management.
- Physical Discomfort: Pain (often unexpressed), hunger, thirst, needing the toilet, fatigue, illness, constipation, urinary tract infections (UTIs – often cause sudden behavioural changes).
- Environmental Factors: Too much noise or stimulation, unfamiliar surroundings, too little stimulation, changes in routine, poor lighting, feeling too hot or cold.
- Emotional Factors: Fear, anxiety, loneliness, boredom, depression, feeling overwhelmed, loss of control, frustration with communication difficulties.
- Communication Difficulties: Not understanding what is being asked, inability to express needs, feeling misunderstood, misinterpreting verbal or non-verbal cues.
- Medication Side Effects: Some medications can cause confusion, agitation, or other behavioural changes. Always discuss concerns about medication with their GP or pharmacist.
- Sleep Disturbances: Poor sleep quality can significantly impact mood and behaviour during waking hours.
Practical Strategies for Managing Behaviours
Once you've tried to understand the 'why' behind the behaviour, you can explore various strategies. It's often a process of trial and error to find what works best for your loved one.
General Approaches:
- Maintain a Consistent Routine: Familiarity and predictability can reduce anxiety. Try to keep daily activities like meals, bathing, and bedtime at similar times each day.
- Simplify Communication: Use short, clear sentences. Speak slowly and calmly. Use gestures and visual cues. Ask one question at a time. Be patient and allow plenty of time for a response.
- Create a Calming Environment: Reduce noise, clutter, and distractions. Use soft lighting. Ensure the temperature is comfortable. Consider soothing music if they enjoy it.
- Provide Meaningful Activities: Engage them in activities they once enjoyed, adapted to their current abilities. This could be simple chores, looking at old photos, listening to music, or gentle exercise. Boredom can often lead to agitation.
- Ensure Basic Needs Are Met: Regularly check for hunger, thirst, pain, or the need to use the toilet. These are often silent triggers.
- Validate Feelings: Acknowledge their emotions, even if you don't understand the reason. "I can see you're feeling upset," or "It sounds like you're worried." This can help de-escalate situations.
- Offer Choices (Limited): Giving a sense of control can be empowering. Offer two simple choices, e.g., "Would you like tea or water?" rather than open-ended questions.
- Redirection and Distraction: If they are fixed on an upsetting thought or action, try gently redirecting their attention to something else pleasant or engaging. "Let's go look at the garden," or "Can you help me fold these towels?"
Specific Strategies for Common Behaviours:
- Agitation and Restlessness:
- Check for underlying physical discomfort.
- Offer a comforting presence, gentle touch, or a warm drink.
- Engage them in a calming activity like listening to music or looking at a book.
- Ensure they are getting enough gentle physical activity during the day.
- Aggression:
- Step back and ensure your safety.
- Try to identify the trigger immediately (e.g., feeling threatened during personal care).
- Speak calmly and reassuringly.
- Do not argue or restrain.
- If possible, remove the trigger or change the environment.
- Seek professional advice if aggression is frequent or severe.
- Wandering:
- Ensure the home is safe and secure (locks, alarms).
- Consider camouflaging doors with curtains or murals.
- Provide opportunities for safe exercise and walking within a secure environment.
- Use identification bracelets or GPS trackers if appropriate.
- Look for the reason behind the wandering (e.g., looking for something, feeling bored, trying to go 'home').
- Sundowning:
- Maximise natural light exposure during the day.
- Maintain a consistent sleep schedule and bedtime routine.
- Limit naps, caffeine, and sugar in the late afternoon/evening.
- Plan calming activities for the late afternoon.
- Ensure the evening environment is calm, well-lit, and secure.
- Repetitive Questions/Actions:
- Respond patiently and calmly, even if it feels repetitive.
- Try to understand the underlying need (e.g., seeking reassurance, feeling anxious).
- Reassure them gently.
- Distract with a new activity or topic.
- Avoid asking them to remember or 'just stop'.
The Importance of Carer Wellbeing
Caring for someone with dementia can be emotionally and physically exhausting. It's vital to look after your own wellbeing to continue providing the best care possible.
- Seek Support: Connect with other carers, join support groups, or talk to friends and family.
- Take Breaks: Respite care, even for a few hours, can make a huge difference. Care Directory UK can help you find local respite services.
- Educate Yourself: The more you understand dementia, the better equipped you'll be to cope.
- Accept Help: Don't be afraid to ask for practical help from others.
- Be Kind to Yourself: You are doing an incredible job. There will be good days and bad days. It's okay to feel frustrated or sad.
Considering Professional Care and Support
Sometimes, the challenges of managing dementia behaviours become too great for family carers alone. Professional care services can offer invaluable support.
- Home Care Services: Carers can visit your home to assist with personal care, medication, meal preparation, and provide companionship, offering a much-needed break for family members.
- Day Care Centres: These centres offer structured activities and socialisation for people with dementia in a safe environment, giving carers regular respite.
- Respite Care: Short-term stays in a care home can provide a temporary break for carers while ensuring their loved one receives professional care.
- Residential Care Homes: For those whose needs become more complex or whose behaviours require specialised 24-hour support, a care home specialising in dementia care can offer a safe and structured environment with trained staff.
Care Directory UK can help you explore and compare these options in your local area, ensuring you find a service that meets your loved one's specific needs and provides the right level of support for your family.
Need Help and Support?
Frequently Asked Questions
Why does my loved one with dementia suddenly become agitated or aggressive?
Agitation or aggression in dementia is rarely intentional. It's often a sign of unmet needs, pain, discomfort, fear, confusion, or feeling overwhelmed. Common triggers include physical discomfort (e.g., hunger, pain, needing the toilet, infection), environmental factors (e.g., noise, unfamiliar surroundings), or communication difficulties. It's important to try and identify the underlying cause and address it, rather than focusing solely on the behaviour.
What is 'sundowning' and how can I manage it?
Sundowning refers to a state of increased confusion, agitation, anxiety, and restlessness that typically occurs in the late afternoon or early evening in people with dementia. To manage it, try to maintain a consistent daily routine, ensure good light exposure during the day, limit naps, caffeine, and sugar in the afternoon, and plan calming activities for the evening. Creating a peaceful, well-lit environment as evening approaches can also help.
Should I argue or correct my loved one when they are confused or making repetitive statements?
Generally, it's best to avoid arguing or correcting someone with dementia, as this can often lead to increased distress, frustration, and agitation for both of you. Instead, try to validate their feelings, reassure them, and gently redirect their attention. If they are asking repetitive questions, respond patiently with the same answer or try to understand the underlying need for reassurance.
When should I consider professional care for challenging behaviours?
You should consider professional care if the challenging behaviours are becoming unmanageable, causing significant distress or risk to the person with dementia or others, or if you as a carer are feeling overwhelmed and burnt out. This could involve seeking advice from their GP, a dementia specialist, or exploring options like home care, day care, or residential care homes that specialise in dementia support. Professionals can offer tailored strategies and support.
Are there medications that help with challenging behaviours in dementia?
While non-pharmacological approaches are always the first line of defence, in some cases, a GP or dementia specialist might consider medication if behaviours are severe, persistent, and causing significant distress or risk, and other strategies have not been effective. These are typically prescribed with great caution due to potential side effects. Always discuss any concerns about medication with their doctor; never attempt to self-medicate or change prescribed doses.
Need More Help?
Support Organisations
- Age UK:0800 678 1602
- Carers UK:0808 808 7777
- Alzheimer's Society:0333 150 3456
- Parkinson's UK:0808 800 0303