As someone’s ability to remember, reason and speak diminish they have to express themselves in a different way. This new way to communicate is often via new behaviours. Those close to the person with dementia often learn to interpret what a certain behaviour means. For example, they fumble with their belt when they need to go to the toilet, pace when they are anxious, or resist getting dressed because they are in pain.
As care partners and family/whānau come to understand what a behaviour communicates, they can deal with the person’s need rather than focusing on the challenge produced by the specific behaviour. The Spark of Life Programme asks of a new behaviour, “What is the unmet need?”
The physical concerns of people with dementia are many and varied:
- Pain
- Feeling cold/hot
- Hunger
- Tiredness
- Full bowel or bladder
- Shortness of breath etc.
Their environment needs to be considered as well is it
- Noisy
- Under- or over-stimulating
- Stuffy
- Unattractive
- Lacking outdoor access
- Institutional rather than homelike and familiar?
The psychological needs of people with dementia (and all of us) have been summarised by Tom Kitwood as:
- Attachment –needing to be close to someone you trust,
- Comfort – physical and emotional,
- Identity – being recognised for who you are – yourself as a unique individual,
- Occupation –something meaningful to do,
- Inclusion – feeling of part of the group
Central to all this, the person with dementia needs to feel (and be) loved.
Often it requires a lot of imaginative detective work to discover what a certain behaviour means. Knowing what the person with dementia was like before they developed the condition, about their history and interests is essential. For example, an anxious person will become more so if they can’t remember where they are or what they are meant to be doing, someone who was always outdoors in the garden will become agitated if confined to the lounge, a very private person will push away care partners of the opposite sex trying to shower them, a person abused as a child may be terrified when taken to the toilet.
Consider whether there are any particular events that might have triggered this behaviour. The stage and type of dementia may indicate particular issues. For example, the spatial awareness problems in Lewy Body dementia might mean that a person is afraid going into small spaces like a toilet or problems in the visual recognition area (occipital) part of the brain could mean that they misinterpret what they see.
Repeated questions often reflect memory impairment; for the person it is the first time they have asked the question.
The time of day matters to some people in the mid-late stages of dementia who become agitated in the late afternoon, this is called sundowning.
The medical condition of the person also matters a great deal. One third of people with dementia with changed behaviour are in pain, and problems such as constipation, urine infections or heart problems are easily missed in people with dementia.
We all have bad days, when we feel irritable, this is also true for people who live with dementia.
Suggestions for managing challenging behaviours
Challenging behaviours are often complex. There is no ‘one size fits all’ solution. Be mindful of the person with dementia’s non- verbal signs of increasing anxiety/frustration or potential triggers, you may be able to de-escalate situations before behaviours escalate. Try and anticipate their needs and create a calm/unstressed environment.
We communicate a lot with our body language, facial expression and tone of voice. Appear positive, cheerful, calm and offer reassurance. Use simple language, short sentences, and use of steady tone of voice.
- Take a few seconds to think about how you are going to respond to the verbal aggression, breathe/calm the mind and reply with kindness.
- Remove or reduce perceived threats for the person with dementia: ensure they have space, dignity, safety, etc.
- Show the person familiar objects in house (e.g., old photos/videos/TV programs) or garden/shed. Talk with them re home/family and reassure.
- Change the subject, offer a cup of tea, ask for their assistance to do a household task, walk to letter box, etc.
- Offer food/drink, encourage a daytime rest. Give them physical space.
- Try not to contradict what the person says/believes, this could increase their anxiety/frustration.
- Try to keep to the person’s usual daily routine. Include time for familiar, calming, fun activities. (Music, art/crafts, pets, etc)
- Take opportunities to go for regular short walks, sit outside for meals, do some type of regular enjoyable physical exercise.
- Set up regular opportunities for social connections. Phone or have a video call with a relative/friend.
- Set up a box of ‘calming activities’, from items of interest to the person with dementia sourced from items you may have at home. E.g., family photos, balls of wool, buttons, playing cards.
- Home environment: remove clutter, have items of interest to the person with dementia clearly on display/easy to find. Consider having sensor night lights, signs/photos to help locate rooms/everyday items.
If the person with dementia is not in immediate danger, sometimes excusing yourself politely and leaving them alone for a couple of minutes may calm the situation.
Know when to walk away. If the person becomes angry/threatening, take a deep breath and walk away. You can always go back and try again in a few minutes.
Afterwards
- Focus on the person, not the behaviour.
- Do not punish or revisit the incident (they may not recall what happened)
- Make sure you have someone to talk to for support-family, friend, GP, Counsellor, Dementia Waikato.
Finally, Be Kind to Yourself
You are human. None of us are perfect – especially during these times at home.
Take care of yourself, as well as your family member who has dementia.
Feel free to contact us at Dementia Waikato if you need to talk about any issues you are having with the person you are caring for. Dementia Waikato staff are all working from home and can speak with you on the phone 07 929 4042 or via email info@dementiawaikato.org.nz