Managing challenging behaviour in dementia sufferers

(picture credit: Alamy, posed by model)

Two practitioners,  Walter Brennan and Alison Kingston Miles, advise on how social care professionals can handle challenging behaviour among people with dementia

Walter Brennan is a training consultant specialising in personal safety and conflict

Not all people with dementia display challenging behaviour. But more than 80% of families who care for a relative with dementia will seek professional help and guidance, usually when the person’s behaviour becomes challenging and difficult to manage.

There are several definitions of challenging behaviour but I tend to define it as intense behaviour that can be physically or psychologically damaging towards self or others and results in personal isolation, necessitating specialist interventions.

Examples include wandering, non-stop shouting, violence, exposure, self-injury, sleep disturbances and incontinence.

Carers often find their own coping abilities are stretched and can’t understand why the person may be behaving in such a way.

Without support and guidance (and training) the person with dementia may well find themselves restricted in the amount of activities they can do. Or, as is often the case, they will be moved away from the security and familiarity of their own home into a residential setting, probably exacerbating the original problem.

Sadly this can then lead to the person becoming isolated and even viewed negatively by others who may not understand the behaviour.

So, as part of any carers assessment, professionals should ask:

● What function does this behaviour serve for this person in this context?

● Why is this outcome important for this person?

● What other alternatives are available for this person to achieve these ends?

So, for example, the answers may be:

● Wandering allows John to maintain his previous enjoyment of walking and exploring. It may allow him to avoid people he doesn’t particularly like.

● The outcome matters because it helps to maintain John’s autonomy and sense of control of his environment. It may help John to gain some understanding of where he is and improve his orientation.

● Alternatives are that we provide a safe walking area for John, so he doesn’t interfere with other people. This would keep him active during the day so he starts to feel tired, improving his sleeping, and take him out to explore new environments.

Challenging behaviour of course taxes resources, but by trying to understand and empathise, staff can eventually find positive solutions for these most vulnerable people.

Alison Kingston Miles is services manager at Flagship’s Old Maltings very sheltered housing scheme in Norfolk

It is widely recognised that most challenging behaviour in people with dementia is their way of communicating an unmet need. They may be in pain or discomfort, missing a loved one or grieving for a parent, angry at something unseen by others or frightened by a strange environment.

People who have dementia feel pain but are often unable to communicate it. This can then lead to frustration and fear – two of the main causes of challenging behaviour.

The need for occupation and stimulation is important – allowing someone with dementia to sleep all day or to do nothing leads to boredom. Being under-stimulated can lead to wandering and aggressive challenging behaviour.

Placing labels and post-it notes on familiar things that people will recognise can reduce the risk of wandering. Placing a photo of loved ones nearby is helpful to those at a high risk of wandering as it reduces the anxiety and confusion caused by not knowing where they are. Locking doors to prevent wandering will result in frustration.

Aggression is often a defensive reaction to a person feeling that their personal space has been invaded.

Reassurance is key when confronting aggressive behaviour. Soothing people in a calm and even tone often helps diffuse the situation. Staff who raise their voice can make an aggressive confrontation worse.

Sudden movements and fixed and forceful stares also inflame hostile confrontations. Always approach the person slowly, from the front, speaking in a calm manner and maintaining a running commentary. This will make the person aware of what is happening.

In some instances it may be necessary to withdraw from the situation. Make sure that they are not putting themselves or others at risk and return to them 10-15 minutes later when they have calmed down.

Remember that reassurance and comfort should always be provided after challenging their behaviour because the person will still be distressed when they have calmed down.

Related stories

More advice on dementia from the Social Care Institute for Excellence 

Judith’s story

Gerry Robinson on dementia care homes

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