Challenging Behaviour in Dementia

What is Considered Behaviour of Concern in Dementia?

According to local dementia statistics from the Alzheimer’s Society, there are currently 900,000 people living with dementia in the United Kingdom. The number is expected to rise to 1.6 million by 2040.

The behaviour of concern in dementia refers to actions, reactions, or conduct displayed by individuals that may pose challenges for the individual and people around them. These challenging behaviours can manifest in various forms, such as aggressive behaviour, agitation, delusions and hallucinations, wandering, sundowning or repetitive behaviours. Understanding the triggers behind the challenging behaviour provides a more empathetic approach to managing and addressing them effectively.

The behaviours are a form of communication where individuals with dementia may express their needs, discomfort, or emotions when they struggle to convey their thoughts verbally. At Leaf Complex Care, our care teams of support workers adopt a person-centred approach and Positive Behaviour Support (PBS), focusing on understanding the individual’s perspective, preferences, and history. This approach helps develop personalised care plans that consider the unique needs and background of each person with dementia. By emphasising empathy and individualised care, our support workers foster a more compassionate and effective response to behaviours that ultimately improve the overall quality of life for individuals living with dementia.

Families, caregivers, and healthcare professionals need access to resources that provide information about dementia, its progression, and practical strategies that can manage challenging behaviour. These are just a few of the many reasons why our clinicians have free access to training programs that emphasise communication skills, stress reduction techniques, and person-centred care, which can empower caregivers to navigate the challenges associated with challenging behaviour.

Common Characteristics of Challenging Behaviour in Dementia

Dementia manifests itself in various challenging behaviours that can significantly impact quality of life. The challenging behaviours often arise due to cognitive decline, changes in brain structure, and communication difficulties. From agitation and aggression to wandering and sundowning, each behaviour presents unique challenges that necessitate compassionate and tailored approaches in their own homes.

Aggression and Agitation

Aggression and agitation are common behavioural symptoms perceived as challenging behaviour in dementia. The challenging behaviour often stems from the underlying cognitive decline and changes in the brain. Aggressive behaviours can manifest in various forms, including verbal outbursts such as swearing, screaming, shouting, or making threats. Physical aggression may involve hitting, pinching, scratching, hair-pulling, biting, or throwing objects.

Music therapy, sensory stimulation, and structured routines have been shown to reduce aggression and agitation. However, pharmacological interventions may be necessary in some cases, and their use should be carefully monitored due to potential side effects. Regular communication and collaboration among healthcare providers, caregivers, and support services are essential to developing comprehensive and individualised strategies for managing aggression and agitation in people living with dementia.

Wandering

Wandering is a challenging aspect of a person’s behaviour, particularly in the advanced stages of severe dementia. As dementia progresses, individuals may tend to wander, often without clear awareness of their surroundings or purpose. This behaviour can cause distress among family members and caregivers as they witness their loved one walk into unfamiliar environments, which is a safety risk. Proactive support is vital in ensuring the well-being of individuals with dementia.

Sundowning

In people with advanced dementia, you might notice changes in their behaviour, especially in the late afternoon or evening. This behaviour is called “sundowning,” although it’s not strictly related to the sun setting and can happen at any time of the day. During this time, individuals may experience heightened distress and agitation, confusion and even hallucinations or delusions, making it challenging for them to sleep well at night. Sundowning can occur at any stage of dementia but is more common in the middle and later stages of the condition.

Repetitive Behaviours

Living with dementia can lead to repetitive talking and behaviour changes, where a person may keep doing or saying the same things due to memory loss. For instance, they might repeatedly check their belongings or fridge without realising it. This repetition may be a way of expressing confusion or anxiety. When someone asks the same question repeatedly, they may not be aware of it, so providing comfort, security, and reassurance is crucial in responding to repetitive actions or questions. For example, if a person with dementia repeatedly asks which day of the week it is, they may need reassurance rather than just knowing the day of the week.

Understanding repetitive behaviours and responding with emotional support can be challenging, but it helps the person feel included and comforted during episodes of sundowning or confusion.

Delusions and Hallucinations

Delusions and hallucinations are common manifestations in individuals with dementia, particularly among people with Lewy body dementia. The behaviour can significantly impact a person’s well-being, often causing distress and anxiety. When a person with dementia experiences delusions, those around them must stay calm and create a supportive environment. Caregivers should communicate effectively with the individual, acknowledging their feelings and expressing empathy. Identifying potential triggers in the environment and addressing other causes contributing to the delusions can help manage the risk of exacerbating distress. Overall, fostering a compassionate and understanding approach is essential for promoting mental health in individuals living with dementia-related delusions and hallucinations.

We understand the challenges that might arise and that everyone deserves the right support in place. Therefore, you can read about Leaf Complex Care’s Dementia 24-hour care at home and what are the benefits of live-in care for Dementia.

Triggers and Causes

A combination of internal and external factors often triggers challenging behaviours in dementia. Common triggers include confusion, frustration, pain, environmental changes, or unmet needs. Internally, factors such as cognitive decline, confusion, and difficulties in communicating effectively can lead to frustration and agitation. Individuals with dementia may struggle to express their needs or understand their surroundings, leading to a sense of helplessness. External triggers, such as changes in environment, routine, or caregiver interactions, can also contribute to challenging behaviours. For instance, a sudden change in surroundings or a lack of familiarity may cause disorientation and distress. Additionally, unmet physical or emotional needs, such as hunger, pain, or loneliness, can amplify challenging behaviours as individuals with dementia may struggle to articulate their discomfort.

Biological factors, including neurodegeneration and changes in brain structure, have a significant role in developing challenging behaviours. Moreover, pre-existing mental health conditions, such as depression or anxiety, can heighten behavioural issues in individuals living with dementia. Social factors, such as a lack of social engagement or meaningful activities, can contribute to boredom and frustration.

Identifying and addressing these triggers can help caregivers and healthcare professionals develop tailored strategies to mitigate the behaviours of concern, creating a more supportive and comfortable environment. Understanding triggers is crucial for effective management, as they can be provoked by factors such as pain, discomfort, unmet needs, or environmental stressors. Caregivers must employ person-centred approaches, tailoring interventions to the individual’s preferences and history.

Effective Strategies for Managing Challenging Behaviour in Dementia

To positively impact individuals living with dementia and increase their strengths, caregivers increasingly turn to Positive Behaviour Support (PBS) and a person-centred approach as pillars of caregiving. This proactive and individualised approach not only seeks to address the challenging behaviours individuals with dementia face but also aims to enhance their overall well-being by recognising and honouring their unique needs, preferences, and personal histories.

In this context, effective strategies go beyond mere behaviour management, as they strive to create environments that foster dignity, respect, and a sense of belonging, thereby promoting a higher quality of life.

Positive Behaviour Support (PBS)

Positive Behaviour Support is an effective and person-centred strategy for managing challenging behaviours in individuals living with dementia and complex care needs. PBS seeks to understand and address the underlying causes of challenging behaviours through a positive and proactive framework. The care team at Leaf Complex Care understands individual needs and preferences, and PBS aims to create an environment that minimises triggers for challenging behaviours and promotes well-being.

One key aspect of Positive Behaviour Support is the emphasis on individualised interventions. Rather than employing generic strategies, PBS tailors interventions to the unique characteristics and needs of each person living with dementia. This personalised approach considers factors such as the person’s life history, communication style, and environmental preferences. PBS fosters a more supportive and healing environment by identifying and addressing the specific triggers and unmet needs contributing to challenging behaviours. Moreover, when we involve family members in the collaborative development of strategies, our PBS practitioners promote a team approach that enhances the overall quality of care for individuals living with dementia, ultimately leading to improved outcomes and a higher quality of life.

Want to know more about the benefits of the right care provided by support workers? Read our latest blog about all the positive experiences and new possibilities when having people who truly care.

Person-Centred Approach

The person-centred approach has emerged as a highly effective strategy for managing challenging behaviours in individuals living with dementia. This approach, pioneered by psychologist Carl Rogers, revolves around recognising and respecting each person’s unique needs, preferences, and experiences. In dementia care, our care team tailors interventions to align with the individual’s background, interests, and personal history. By prioritising the person’s autonomy and dignity, caregivers can establish a supportive environment that minimises stress and promotes well-being. For example, understanding a person’s life story, preferences, and past experiences can inform the creation of personalised activities that engage and stimulate them, reducing the likelihood of challenging behaviours triggered by frustration.

Furthermore, a person-centred approach promotes a shift from a one-size-fits-all model of care to a more individualised and empathetic approach. Understanding the person’s perspective becomes crucial in understanding challenging behaviours, such as aggression or agitation. By acknowledging the emotional needs behind these behaviours, caregivers can respond with empathy and compassion, de-escalating situations more effectively. This approach values the person’s humanity and encourages teamwork between the caregiver and the individual living with dementia. It recognises that behaviours are often a form of communication, and by attuning to the individual’s needs, caregivers can implement strategies that prevent or alleviate challenging behaviours. Ultimately, Leaf Complex Care’s person-centred approach empowers individuals living with dementia to enhance their sense of self and allow for a more dignified and compassionate approach to care.

Support with Behaviours That Challenge with Leaf Complex Care

Leaf Complex Care is a compassionate and dedicated healthcare provider that supports individuals living with dementia and complex care needs. We understand that challenging behaviours often stem from unmet needs or distress and that understanding each person’s unique needs is crucial in providing support. We prioritise person-centred care and tailor our support to help individuals live life on their own terms and gain greater independence. Our team adopts PBS strategies, fostering a calm, supportive environment that minimises triggers for challenging behaviours.

Choosing Leaf Complex Care means opting for a provider that will be your helping hand even in the most challenging times. With locations in Bristol, Slough, Somerset, and Birmingham, we extend our services across the UK, ensuring privacy and respect for families seeking expert support. To take the first step towards a more compassionate and tailored approach to dementia care, contact us today through our website or visit one of our offices.