Dementia and Challenging Behavior

When people think of “dementia,” it is natural to next think “memory loss.” What we may not be prepared for is how other behaviors can change and even become difficult to manage. In fact, it is these challenging behaviors that families report as more troublesome than memory loss. 

What is challenging dementia behavior?

Challenging behavior includes actions that are unsafe, destructive, highly upsetting or dangerous to self or others. Challenging behavior does not include behavior that seems unusual or bothersome, such as asking the same question repeatedly or preferring particular foods, clothing or routines.

Some common challenging behaviors that occur with dementia include:

• Refusing care
• Wandering
• Rummaging
• Refusing to change clothing
• Suspiciousness
• Agitation and pacing

What causes challenging behavior?

If you look closely, you will find underlying reasons for the challenging  behaviors. For instance, wandering or rummaging may provide your loved one with a sense of purpose or lessen feelings of boredom. Refusal of care may be a way to maintain control over a situation that seems frightening or overwhelming. Agitation can communicate an unspoken, unmet need, such as fatigue or the need to toilet.

For example, Elsie has Alzheimer’s disease. Several afternoons a week, she would get highly upset and start pacing and crying. A few minutes into these episodes, she would have a toileting accident. The family thought she was so upset that she became incontinent. However, they could not figure out the reason. Inevitably, these incidents would make the family argue in front of Elsie. She would remain upset for hours.

It turns out that Elsie would get upset because her bladder was full, but she could not figure out what to do about it – that is, to use the toilet. She also could not figure out how to get from where she was to the bathroom. Once she was consistently walked to the toilet two hours after she ate lunch, these episodes of afternoon upset entirely stopped.

Without meaning to, Elsie’s family would unknowingly set her up for these afternoon episodes. They did not realize Elsie would become more distressed when they argued in front of her. Elsie was also upset because she was embarrassed by her toileting accidents. Her family had failed to notice how Elsie would fidget in her seat before she started her agitated pacing, thereby missing the early signs of an uncomfortably full bladder. They learned how to interpret her behavior, which helped them meet her needs and prevent her distress.

How can I prevent or reduce challenging behavior?

By reading this blog, you are learning some practical approaches to excellent dementia care, based on best practices taught in DementiaWise®, our proprietary dementia care program. This information can help you provide better care to your loved one with dementia. It is up to us as caregivers to change our attitudes, habits and behavior to prevent or reduce challenging behavior. Start with these important tips:

1. Pay attention to your nonverbal communication. Be aware of your facial expressions, posture and tone of voice. People with dementia will mirror your nonverbal communication. Make sure the nonverbal communication you bring into the room matches what you want to see in them.
2. Model positive emotions. Put aside strong feelings that may distract or trouble you before beginning a care task. People with dementia generally understand your emotions.
3. Keep it simple. Provide clear instructions and ask yes/no questions. Limit options to two choices.
4. Observe their body language. It will provide cues about your loved one’s emotional state and needs. Respond before difficult behavior begins, and there will no longer be difficult behavior.
5. Understand that difficult behavior is a form of communication. Difficult behavior may communicate boredom, fear or an unmet physical need. It is up to you to look for its meaning.
6. Avoid arguing. Adding conflict into the situation just makes things worse. Do not argue, correct or try to convince using facts and logic.
7. Intervene only when necessary. Focus your efforts on those behaviors that can become unsafe, destructive or dangerous. We cannot change every behavior that bothers us in another person.

Caring for someone with dementia can be stressful. Getting extra help that provides excellent dementia care can help reduce or prevent challenging behavior while also providing a much-needed break for the caregiver.

ComForCare/At Your Side Home Care offers in-home care to help you live your best life possible. Our DementiaWise-trained caregivers can assist with bathing, dressing, meals, transportation and errands. Count on us for help when you need it.

Editor’s note: This article was originally published March 1, 2016. It has been revamped and updated for accuracy and comprehensiveness.

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