Dementia and challenging behaviour guidance for home care staff

Our behaviour – good, bad or indifferent – is a clear expression of our feelings and needs. It is a form of communication and is demonstrated in a myriad ways. Memory, concentration, communication and the ability to reason things out or make sense of what is happening are often impaired in people with dementia.

There are many forms of behaviour that can challenge you when caring for a person with dementia. They may repeat things, push you away, or become irritable, agitated or aggressive while you are trying to provide care or support. You may feel uncomfortable if their mood changes and they start shouting or swearing at you or appear to have no interest in themselves or their care. They may pace around or wander off. Some people with dementia experience hallucinations. This can be difficult behaviour to understand, especially if time with a person with dementia is limited.

What might be the cause of the challenging behaviour?

To understand or make sense of challenging behaviour, it is important that you try to see things from the perspective of the person with dementia, who may be frustrated, fearful or stressed; feel lonely or suffering from pain and discomfort; misunderstand what is happening; feel ignored, overlooked and not in control of their life; or feel disorientated.
 
How can you help?

● Stay calm and don’t take challenging behaviour personally – it is rarely aimed at you as an individual;
● Show that you recognise and understand the person’s feelings;
● Use reassuring words and speak in a calm, respectful manner;
● Avoid making the situation worse (perhaps stop the activity you are doing and try something else);
● Focus on what they are able to do well rather than on things they find challenging.

What do you do if a challenging situation occurs?

Think about what happened just before the behaviour changed. Who was there? Did something you say trigger an angry response? Did you speak too quickly, ask too many questions or ignore or talk over them? Did anything in the person’s surroundings change?

Could difficult behaviour be down to something you did (for example, approaching the person from behind, perhaps startling them, or touching or moving a part of their body that may be painful)? Could the behaviour be related to the person’s history or personal preferences? Perhaps you are trying to put them to bed when their favourite programme is on TV, or maybe you are talking when they are trying to listen to the news.

Record what you see

It is important to observe the behaviour you are seeing and record it. Be specific, using descriptions rather than one word. It is not enough to say a person was angry as that can be interpreted differently by different care workers. You need to describe how they expressed their anger. By describing what you saw it will make it easier for another care worker to recognise the signs more easily.

Care workers often work alone so it is important to record how any situation involving challenging behaviour has been resolved. Make sure you describe what actions were taken and how the person responded. Their personal care plan can then be adapted to meet their needs and reduce the number of situations where challenging behaviour may occur – a more satisfactory outcome for all concerned.

Understanding the person behind the dementia

The more you know about the person with dementia you are caring for, the more likely you are to understand the reason for their behaviour. So it is important that you see and understand the person behind the dementia (that is, what makes them tick, what they have done in their lives, personal likes and dislikes and important relationships). For example, if someone has been a teacher they may prefer to stand up and walk around as they did in class. You can make sense of this behaviour if you know their background and by working with and around it you can reduce the risk of it becoming challenging.

Sometimes you may experience challenging behaviour because of a change in roles: so a wife who has cared for her husband and children all her life may find receiving care difficult.

Sometimes challenging behaviour is as a result of a memory being triggered that produces a reaction; on other occasions it may be related to surroundings. For example, if a person with dementia does not recognise their reflection in a mirror they may become anxious that another person is in the room.

Read the full article, and a companion piece with tips for care workers, on the United Kindom Homecare Association’s (UKHCA) website.

Jennifer Roberts is dementia lead and consultant at the UKHCA

Related articles

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Managing challenging behaviour in dementia sufferers