How to handle challenging behaviours in dementia care 

Dementia has physical, psychological, social and economic impacts, not only for people living with dementia, but also for their carers, families and society at large, and can often result in the person showing disruptive or difficult behaviours as they move through the stages of dementia.  

In this blog we’ll discuss the types of challenging behaviours that can be proactively identified, suggesting strategies to practice when delivering care for those living with dementia.  

What is challenging behaviour? 

Dementia can deeply impact a person’s life. They may worry about losing their memory and ability to think clearly, but also about losing their sense of identity. It can be confusing and unsettling for them when they struggle to understand what’s happening or feel a lack of control over their surroundings. These challenges can influence how they behave. 

There are a variety of negative behavioural changes that can happen which you may experience when caring for your patients. 

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

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 other changes are there in behaviour? 

Not all changes will be negative or challenging, and at the start of dementia, people exhibit behaviours of:  

• Repetition – asking the same questions over again, or carrying out the same activity repetitively.
• Restlessness – pacing up and down, struggling to sit still, fidgeting and wandering around.
• Sleeplessness – people suffering from dementia can have difficulty sleeping and may be more prone to sleepwalking.  
• Loss of self – this can lower a person’s confidence, self-esteem and in turn, their self-identity of who they are, and what they like.  

What is the cause of the behaviour? 

Depending on the progression of dementia and what stage the persons is at, the levels of challenging behaviour will vary. Try to put yourself in their shoes and imagine being in their position – if they can’t verbally communicate or you do not understand them, what other behaviours may they take to try and communicate? 

Suggested questions you could are: 

• Is this a new behaviour? 
• Does the behaviour pose danger for the resident or others? 
• Who is it really a problem for? (Resident? Staff? Family?) 
• When did the behaviour start? 
• Is the behaviour an expression of other illness? 

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 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 good times – 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. 

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.