Managing Dementia-Related Behaviors

One of the most requested training topics that I provide in senior care facilities is managing behaviors of residents diagnosed with some type of dementia. Between 50% – 80% of residents in long-term care have dementia and over 60% have others psychological disorders including depression and anxiety. Many of these residents will exhibit various behaviors that are labeled “difficult” or “challenging”. While effectively dealing with dementia-related behaviors can be a challenge to the caregiver (and others), it is important to understand what behaviors really are before attempting to intervene.

What are Behaviors?

When I ask caregivers sitting in my training sessions “What are behaviors?” I get a mixed bag of answers including aggression, yelling and wandering. These are common responses that most caregivers would provide to such a question. I then explain that their examples are more like “symptoms” of a deeper problem and that there are reasons for their expression. People in the session start to nod on agreement. They get it.

Behaviors are means of expressing something inside the demented mind that is too difficult to express coherently. They are attempts to tell us about basic and unmet needs that can no longer be verbally communicated. In other words, behaviors are forms of communication. And, perhaps most importantly, there are meanings behind all behaviors. It is up to the care staff to figure out what the resident means when behaviors are expressed.

3 Steps to Understanding Behaviors

Step One – Examine the Behavior. I know caregiving is a demanding job and there are many people to care for. But, if you want to get a handle on behaviors and be more effective managing them, you first need to stop and examine what is happening. What exactly is the behavior? Is it harmful to the resident or others? Was there a trigger before the behavior that set things in motion? Find out if the resident is hungry, thirsty, in pain or needs to go to the bathroom. Many behaviors are expression of very basic needs, so rule out the simple reasons. Is the behavior a reaction to newly prescribed medication? This may be more difficult to assess, but it can still be a reason for the behavior. Might there be another psychological reason for the behavior, like loneliness or boredom?

Step Two – Explore Potential Solutions. Are the resident’s basic needs being met? Did the resident skip a meal and is now looking for food? Does the resident have a UTI causing delirium and agitation? Sometime the environment itself can cause or trigger many behaviors. Is the resident in an area that is too stimulating? Would he or she do better in a calmer and more soothing environment? And finally, are you being effective in assessing what the resident needs? If one approach doesn’t work, try others.

Step Three – Try Different Responses. We used to believe in Reality Orientation. Remember that? It involved bringing the confused resident back into reality and we thought this may be the best approach to behaviors. That approach was replaced by Validation which focuses less on the behavior and more on the feelings and emotions behind the behavior. I find this to be the better approach. If one way doesn’t work, try another.

Final Words

Successfully handling dementia-related behaviors can be challenging but in order to be most effective, try to understand what the behavior represents. Understand that there is a reason to each behavior and that it is a cry out to fulfill some basic or unmet need that can no longer be easily expressed. Caregivers must be detectives looking for clues behind behaviors. It is up to the caregiver to find out what the resident needs that will calm them and bring quality back into their life.

More About Alzheimer’s and Dementia

• Elopement in Senior Care
• Alzheimer’s and Depression
• Ethics in Dementia Care
• Alzheimer’s and Communication
• Alzheimer’s and Nutrition