If you have a loved one that is living with dementia, you may begin to notice a change in your loved one’s behaviour such as increased irritability, restlessness and physical and non-physical aggression. As dementia progresses, the changes occurring in the brain can result in the emergence of upsetting behaviour.
While the behavioural changes that are caused by dementia may be distressing to the person with dementia and those that care for them, in this article we will provide guidance that will help you manage challenging behaviours associated with dementia. Challenging behaviours are often the result of an unmet need or want, distress, pain or boredom, so discovering the underlying causes can help prevent or reduce such behaviours.
Remember that you do not have to deal with these changes alone. The Good Care Group’s professional carers are trained in how to care for someone living with dementia including a range of best care techniques designed to reassure the person, reduce anxiety and calm challenging behaviours.
Contact our friendly team to learn how live-in dementia care can help you and your loved ones cope with dementia behaviour changes.
How does dementia change a person’s behaviour?
Dementia is a syndrome in which there is a deterioration of cognitive function that is far more accelerated than is normal with biological ageing. As dementia damages the brain and triggers a loss of brain function, it can lead to changes in both a person’s behaviour and their personality.
In the beginning, challenging behaviours may be mild such as hoarding objects or repetitive behaviours. As the disease progresses, individuals may become increasingly agitated and behavioural changes may become more intense and difficult to manage, such as anger, aggression or distress. Psychotic symptoms may also occur such as hallucinations or paranoia. These behaviours often increase in the late-afternoon or evening, which is commonly referred to as “sundowning”.
While behavioural changes most often occur during the mid-to-late stages of dementia, they may also be an early warning sign of certain types of dementia such as dementia with Lewy Bodies (DLB). Visual hallucinations are a common early symptom for DLB. If your loved ones are displaying any unusual or out-of-character behavioural changes, it’s important to discuss these changes with their doctor.
TYPES OF BEHAVIOURS THAT CHALLENGE
Aggression is one of the most common challenging behaviours and it can be frightening for both the person living with dementia and those around them, especially if it’s out of character. Aggression can be either physical or verbal and may result in behaviours such as swearing, yelling, hitting, kicking or biting.
Aggression may be a reaction to the person’s environment rather than an actual symptom of dementia. Sometimes people with dementia can’t communicate the fact that their needs aren’t being met or they don’t even realise it themselves. For instance, they may be hungry but unable to recognize the symptoms of hunger. This frustration may build over time and lead to an aggressive episode.
If you can identify the triggers for your loved one’s irritability or aggressive behaviour, you may be able to prevent and calm such behaviours. For example, those living with dementia may find changes to their environment confusing or frightening and this can lead to aggression. Try and maintain the individual’s home in the manner they are accustomed to so that challenging behaviours may be avoided.
Those living with dementia understandably feel a loss of control over their lives. Help your loved one regain the feeling of control by allowing them to choose the foods they eat or the hour they go to bed. Remember to not take the aggressive behaviour personally but rather use it as a warning sign that the individual may be unable to communicate a frustration, need or want.
People living with dementia often perform repetitive behaviours. These behaviours may be a result of boredom, lack of mental stimulation, memory loss or anxiety.
By carefully analysing the repeated behaviours, you may be able to break the cycle by addressing the underlying need or want of the person living with dementia. Rather than focus on the behaviour, try and understand how the individual might be feeling.
If you believe the underlying cause of the repetitive behaviour is boredom or a lack of mental stimulation, try engaging your loved ones in activities they once enjoyed. A stroll through the garden or listening to some of their favourite music together can do much to relieve the boredom and anxiety that leads to repetitive behaviours.
It’s common for people with care needs, especially those living alone, to feel socially isolated or anxious. If you believe anxiety may be to blame for the repetitive behaviours, try and reassure your loved ones, listen actively to their concerns and simply spend more time with them creating happy memories.
Remember that if the repetitive behaviours are non-threatening, sometimes the best course of action is to simply let the individual be. As long as the behaviour isn’t harmful, try to remain calm and patient and find a way to work with the behaviour.
Hiding, hoarding or losing things
People with dementia often experience memory loss, which can cause them to frequently misplace objects or leave them in unusual places.
Some individuals living with dementia may begin to hide or hoard property. This is an attempt to gain control over the distressing situation of feeling they are constantly losing or having their property taken from them.
To support your loved ones through these behaviours, always keep the individual’s environment the way they are accustomed to it being. For instance, keep items in places that are familiar to the individual. Use visual cues to remind your loved ones of the location of important or frequently used items. Consider making copies of any important keys or documents in case they are misplaced.
Never get angry or upset at your loved one for misplacing or hiding something. Anger does little to resolve the problem and can lead to further anxiety and confusion.
Lastly, don’t immediately dismiss the concerns of your loved ones. If your loved one believes their property is being stolen or misplaced, listen actively to their concerns, reassure them and try to help reach a satisfactory solution.
Trailing, following and checking
People with dementia may develop the habit of following someone closely or continuously asking or checking where that person is. This is caused by the memory loss and anxiety that can accompany dementia. Your loved ones may simply be seeking reassurance that they are not alone.
Always speak with a calm tone of voice and offer physical reassurance. It’s important to remain cheerful and upbeat to provide comfort to the individual. Distracting or redirecting the individual’s attention can help with trailing or following behaviours. Giving your loved one a job such as folding the laundry can make them feel useful and accomplished.
Due to time shifting, the individual living with dementia may ask about the location or whereabouts of someone that is deceased. Avoid reminding them that this person has passed and try to distract their attention with an uplifting conversation or a positive activity instead.
As long as the trailing or following behaviour doesn’t pose a risk to the individual or anyone else, it may be enough to reassure the individual and leave things as they are. Trailing, following or checking behaviours can provide much-needed comfort or assurance to the individual.
Dementia causes people to lose memory of familiar places and faces and this can lead to wandering. Wandering may be circular, pacing back and forth or it may occur if a person becomes confused about their location or lost. Wandering isn’t necessarily harmful if it’s in a safe and controlled environment, but if it occurs at night or without supervision it can be dangerous or even life threatening to the individual.
Improving your loved one’s sleep, health and exercise routine may help them to feel less confined or anxious and promote healthy sleep patterns. If the person is prone to nighttime wandering, it’s especially important to take precautions and render their environment peaceful and safe. Special locks can be purchased for doors to keep the individual safely at home while other tools such as alarms and GPS trackers can be used to alert loved ones when their family member is on the move.
Try and establish if the person has a reason for their wandering such as trying to reach a certain destination or if they are looking for something. Wandering may occur due to an unmet need or want, so try and uncover if all of your loved one’s needs are being met.
Hallucinations and delusions
Many people living with dementia may experience psychotic symptoms such as hallucinations or delusions. Visual hallucinations are also common, especially for those living with Lewy Body dementia. Memory loss and changes in perception can lead to paranoia and accusations such as theft or infidelity.
These types of behavioural changes are often more distressing for carers and family members than they are for the person living with dementia. Before taking any other steps ensure that the individual’s claims are unwarranted.
Sometimes delusions are the result of auditory or visual loss, therefore it is important to have the individual’s hearing and vision tested regularly. Medication or medication misuse may also result in similar symptoms, so ensure proper medication management.
Whenever you encounter such behaviours, remember that although they may not be real they feel very real to your loved one. Listen attentively, reassure the individual, use visual cues as reminders to bring the individual back to reality and distract the person’s attention when possible.
Sleep disturbances are a common symptom of dementia but they are often caused by other dementia symptoms such as depression, anxiety or pain. A person with dementia may struggle to fall asleep or stay asleep and they may exhibit nighttime behaviours such as wandering.
There are many steps that you can take to promote healthy sleeping habits. By establishing a regular bedtime routine and following it daily, you can provide a sense of comfort and familiarity to your loved one. Try and have your loved one avoid consuming caffeine at night as this can be overstimulating. You may also want to limit fluid intake before bed to prevent sleep disturbing bathroom breaks. Make the individual’s bedroom as calm and peaceful as possible and limit outside noise or light.
Lastly, make sure your loved one is getting enough physical activity during the day. Restlessness and anxiety can lead to poor sleep, so engage your loved one in physical activity they enjoy each day such as a walk in the park or garden.
Dementia causes some people to go through social withdrawal where they avoid friends, families and activities they once enjoyed. This can be especially damaging to a person living with dementia since we know that meaningful interactions may slow the onset of memory problems and other dementia symptoms.
To encourage socialisation, don’t rush the individual. Encourage their participation in everyday activities without worrying if the task is actually completed. Remember that people with dementia may find busy social situations over-stimulating. Encourage them to socialise in quiet environments and to take part in activities they still enjoy.
Managing challenging behaviour in dementia
When someone you love with dementia displays challenging behaviours, it can be quite distressing. Try not to take the behaviours personally but rather use them as information about what the individual is trying to express. For instance, some people with dementia are prone to anger when they are hungry while wandering may be triggered by a lack of sufficient exercise.
It can be helpful to keep a diary of challenging behaviour and the situations that triggered them. Events or environments often play a role in triggering challenging behaviours and recognising these triggers early can help family members prevent distressing behaviours before they begin.
Keep in mind that some behavioural changes may have a physical or medical explanation. Always inform the individual’s GP or care team if you notice new behavioural changes or an increase in previous behaviours.
Dementia care from The Good Care Group
Remember, although managing challenging behaviour in dementia can be difficult, you do not have to do it alone. Moving your loved one into a care home may be a solution, but it’s often confusing and distressing for those living with dementia. Live-in care allows your loved ones to receive the dementia care they need while being able to stay in the comfort of their own home.
The Good Care Group has been innovating dementia care for over 10 years. Our qualified carers know how challenging it can be to cope with the behavioural changes brought on by dementia. That’s why each of our carers are highly trained in dementia best practice techniques that focus on the person and their needs.
These techniques are proven to provide reassurance, calm behaviours, and reduce the need for anti-psychotic drugs.
Our blended one-on-one approach to dementia care, led and supported by our own Consultant Admiral Nurse, allows us to provide unrivalled practical and emotional care to people living with dementia. Each of our professional carers is trained in the SPECAL method which allows them to communicate efficiently and reduce distress even during challenging behaviours.