Dementia and Behaviours

People living with dementia can sometimes behave in ways that seem out of character, for example, they may over react to a situation in a way that seems problematic or difficult to deal with. The first steps to responding skilfully to ‘difficult behaviours’ involves both an understanding of how dementia may affect a person and an ability to look for the need the person is trying to meet through their behaviour.

Information Sheet

Ways in which dementia may cause changed behaviours

Difficulty with problem solving
Dementia affects a person’s problem solving abilities meaning that even seemingly simple difficulties may become overwhelming and problematic for a person, for example, an uncomfortable item of clothing may cause irritation and eventually agitation for a person who is unable to identify and remove it.

Difficulty with motivation
For most people with dementia it is common at some point to develop difficulty with motivation, or apathy. When people lose the ability to self-motivate due to changes in the brain it becomes important for other people to assist with motivation, this can be exhausting for those supporting the person and can be a catalyst for accessing support services to assist.

Difficulty with powerful emotions like frustration and anger
Living with dementia is challenging as daily living tasks that were once simple and automatic become more difficult to achieve. It is not surprising then that some people with dementia can experience feelings of failure leading to frustration or anger. These emotions are natural reactions to the changes and loss associated with dementia and may indicate that other needs (see below) are not being met. For example, is the person feeling a lack of control?

Changes in mood and anxiety
People with dementia may experience low mood and increased anxiety as a response to the changes brought on by dementia which may make a person’s world feel less secure, stable and hopeful. Memory loss can lead to feelings of anxiety expressed through repetition of actions or questions. To reduce anxiety a calm and reassuring response is needed. It can be difficult to tease apart the difference between apathy and depression – this may require the help of a medical professional.

This term is used to describe a commonly experienced pattern of agitation and/or increased confusion occurring in the late afternoon or early evening. This may be due to unmet emotional needs (and/or others, see below) as well as disturbances of the 24 hour body clock. Changes in routine, for example, if a person is no longer involved in food preparation for dinner may lead them to feel unneeded and no longer useful.

Understanding the need behind the behaviour

Behaviour is another form of communication. Generally speaking our behaviour is intended to meet a need, for example, I open the fridge when I’m hungry, ring a friend when I’m lonely, turn on the TV when I’m bored, have a nap when I’m tired etc.

The basic needs of people living with dementia do not change but their ability to meet their own needs can reduce as language skills, problem solving and cognitive abilities decline. By understanding the need (why) behind a behaviour we can feel more confident to respond skilfully – in many ways this requires us to develop the skills of thinking like a detective. The ‘detective approach’ therefore cautions against seeing challenging behaviours as deliberative, manipulative or simply ‘symptoms of dementia’, an approach which is unlikely to promote understanding and or positive solutions to the behaviour.

As many factors influence a person’s behaviour in any one moment all of these factors may need to be considered in understanding what need/s the behaviour is expressing. The person’s personality, life experience, relationships, health status and the environment as well as changes brought on by dementia may all be affecting a person’s behaviour.

The following list provides some guidance as to possible needs a person may be seeking to meet through their behaviour:

Physical needs
Many physical factors can impact on behaviour, for example, could the person’s behaviour be a result of an illness, infection or pain (dental pain, joint pain etc). Does the person need food or drink? Do they need the toilet or are they constipated? Are they too hot or cold? Are they tired or uncomfortable? Has their hearing or eyesight deteriorate? Have they had adequate exercise?

Emotional needs
Is the person’s behaviour a response to feeling a lack of control or autonomy? Are they feeling frustrated, insecure or anxious? Are they feeling rushed, excluded or side-lined? Do they feel things are being ‘done to’ rather than ‘done with’ them? Are they able to engage in enjoyable conversations/activities that promote a sense of being useful and valued? Do tasks/activities match a person’s abilities and interests?

Social needs
Is the person feeling a sense of connection with others or feeling isolated and alone? Are they provided with the opportunity of both giving and receiving to those around/important to them? Are they able to participate in their local community and environment?

Environmental needs
Is the environment too busy, loud or over stimulating? Is the environment too dull so that the person feels bored and under stimulated? Is there sun or glare that might be distressing? Is the environment poorly lit causing more confusion or leading a person to misidentify objects or to experience falls?

Spiritual needs
Is the person able to find a sense of meaning and purpose in life? Are there opportunities in the day for experiencing joy? Is the person able to express values or beliefs that are important to them, for example, generosity, spending time in nature, listening to music?

Self care for the care partner

It is extremely difficult to meet another person’s needs if your own needs are not being met. For many people the demands of supporting a person with dementia can come at a cost to their own wellbeing. Self-care is therefore an essential part of caring for someone with dementia. Consider whether your own needs are being met and what steps you can take to support your own physical and emotional health. Friends, support groups and professionals can all provide invaluable help. Accepting offers of practical support and assistance doesn’t mean that you are not coping but is a strategy that will likely benefit both you and the person with dementia. To live well with a person with dementia involves being open to learning more and seeking support from others who understand the changes you and the person with dementia you are supporting are going through.