Challenging Behaviour In Dementia: How to Manage it

Dementia and challenging behaviour sometimes go hand in hand on a daily basis if you work in a dementia care home. This could be mentally or physically from the person such as pushing you away or verbally shouting at you. Working in health and social care can be challenging at times and in this article, we will provide you with some tips for dealing with challenging behaviour in dementia clients.

We emphasise that proactive practices can help move away from reactive crisis management. The aim of this article is to outline behaviours that can be proactively identified, with strategies developed to enhance the lives of those living with Dementia.

What is challenging behaviour?

There are many forms of challenging behaviour, but as Leanne Cunliffe from Care for Me Training points out; not all of these behaviours are aggressive.

Here are some examples of aggressive behaviours that challenge:

• Physical aggression – pushing, pulling or punching
• Verbal aggression – shouting, swearing or screaming
• Inappropriate sexual behaviour – exposure, touching
• Acts of self-harm
• Throwing objects

Examples of behaviours that challenge which are non-aggressive forms are:

• Repetitive noises or questioning
• Eating or drinking excessively
• Following others/trailing
• Dismantling objects, hoarding things
• Falling intentionally, non-compliance
• Urinating in inappropriate places

As dementia develops, it can cause behaviour changes that can be confusing, irritating or difficult for others to deal with, leaving carers, partners and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise.

What is the cause of the behaviour?

Depending on the progression of dementia, then the levels of challenging behaviour will vary and the individual’s background may also explain their frustration. Imagine being in their position if they cannot verbally communicate or you do not understand them, how else would you communicate with someone?

Peter Gathercole from Endeavour Care Training adds:

Often we look at behaviour as a challenge rather than look at the cause of the distress, establishing why someone is distressed will help us formulate the correct response in reducing the distress the person may have. Like any good detective, you are gathering the facts, assessing the information, evaluating the evidence and planning your response. You can ask some key questions to ascertain the cause of the behaviour.

Suggested questions you could ask as the detective are.

• Is this a new behaviour?
• Does the behaviour pose danger for the resident or others?
• Whom is it really a problem for? (Resident? Staff? Family?)
• Look at each behaviour as a separate challenge.
• When did the behaviour start?
• Is the behaviour an expression of other illness?

Nicola Le Prevost, Clinical Lecturer Pilgrims Hospice Kent adds:

“Does the person have other conditions which are not stable, or are they developing an illness such as urinary tract infection or chest infection, for instance, which can produce changes in behaviour or exacerbate confusion? Management involves recognition and measures to manage the problem in addition to the behaviour. Care staff can be unaware or forget to look at early signs of illness affecting behaviour before the person is showing more physical signs of the problem.”

How can you assist those living with dementia?

• Always stay calm and do not confront or challenge the individual and this could make them feel more distressed
• Communicate clearly – speak slowly and repeat yourself if you feel the need to do so
• Listening skills are crucial to identifying what the problem is at hand
• Stay positive in the situation, the individual will feel negativity and get more frustrated otherwise
• Identify and rectify problems in the environment – is the environment noisy? is it comfortable?
• Remember the goods – try to help the individual recall something good from their past such as the music they listened to when they were younger or memorable historic events
• Use ABC charts to try to identify possible triggers for any behaviours that challenge
• Try alternative therapies such as aromatherapy, music, dance, doll therapy etc
• Try to assess if the person with dementia is in any pain, as this may be the cause of some behaviours that challenge due to the inability to express this. A tool such as the Abbey pain tool can be used to help identify possible signs of pain in an individual unable to communicate this
• Use distractions techniques or life storybooks to take the individual away from the situation that is causing them distress, and change the experience to a more positive one
• Use a person-centred approach by completing “This is me” document, which helps to identify things unique to the individual

Jane Chatterjee, lecturer in palliative care at St Gemma’s hospice adds further:

It is important to consider the potential of physical illness and pain particularly in an older population likely living with co-morbid conditions. Behavioural pain assessment tools such as the Abbey pain tool detect the wider concept of distress and it is important to rule out other causes of distress before assuming the pain is the cause unless there are obvious physical signs.

One distress is detected using such a tool then ABC charts can help determine the potential cause of the distress which may be physical pain/discomfort, psychosocial or emotional or a combination of these. Sometimes it is difficult to identify distress if it is more subtle and that is where behavioural assessment tools are useful as well as information from those who know them well.

What should the aims of any intervention try to avoid or reduce?

Any intervention should aim to help avoid people with dementia feeling undervalued, vulnerable, their rights infringed, loss of dignity, a sense of shame or hopelessness. It should also reduce the likelihood of living in an environment that is poor, chaotic, hostile with little opportunities for positive interaction or positive routines.

Are your workers trained sufficiently?

Ensuring workers have the confidence, skills and knowledge to deal with challenging behaviour in dementia clients is essential. Explore Skills for Health eLearning courses to support your employees.