Understanding Behaviors
Challenging behaviors are common in persons with dementia as they may be the only means of communication. As the disease progresses, day-to-day living becomes challenging and frustrating. What was once done independently eventually requires total assistance from a caregiver. A caregiver's assistance may be misinterpreted due to increasing confusion; the person may react verbally or physically as a self-protective response. If you encounter behavioral challenges, think about possible triggers. Identify and address the underlying issue, such as common unmet needs. When basic physical needs are anticipated and met, and caregivers use a soft, slow approach, challenging behaviors can often be prevented. You may also try to pleasurably distract the person by singing a favorite song, reciting a familiar prayer, offering a soft stuffed animal to hold, or providing other comfort measures identified through the About Me form.
Common unmet physical needs include:
- hunger/thirst
- toilet/brief change
- body positioning
- pain
- room temperature
- noise level
Consider the following underlying issues:
Fatigue is one of the biggest enemies of the person with dementia, as the brain tires more easily. Late afternoon or evening can be particularly challenging. Excess fatigue caused by the demands of the day, along with memory difficulties and inability to recognize and effectively communicate basic needs, often results in what is called "sundowning." The person usually displays increased physical and/or verbal agitation. A common theme is the person wanting to "go home."
Boredom may lead to disruptive behaviors as the person searches for something meaningful to do.
Overstimulation also may cause behaviors to occur. The most common causes include exposure to large groups of people, overwhelming or complex tasks, or noisy environments (unnecessary use of television and radio). Avoid these triggers and make sure the person gets enough rest during the day.
Change can be stressful and disruptive for persons with dementia. For example, changing environments, such as a move from home to assisted living, may cause anxiety and fear. Establishing calm, predictable and familiar surroundings is extremely beneficial for persons with dementia.
Emotional needs such as continued or prolonged sadness, crying and/or irritability could mean the person is depressed and may benefit from an antidepressant medication. Consider discussing with the person's healthcare provider.
Communication is frustrating if the person can't express basic needs or concerns and may not understand what is being asked or said. Agitated behavior is a cue that something is wrong. Caregivers should respond to behaviors by considering and anticipating what the person may need.
