Managing challenging behaviour in dementia


The brain damage of dementia can cause behaviour changes, which can be upsetting for the individual affected and for those that care for them. hometouch carers have the knowledge and experience to manage the symptoms sensitively, so that the person lives safely and with dignity.

The hallucinations, delusions, and wandering of advanced dementia can be challenging for the person with dementia and for the professionals that care for them. In their confusion and distress, the individual can become aggressive and agitated. Attempts to control or quieten them can increase their fear and stress, escalating the situation. However, a careful approach, centred around the needs of the person affected can de-escalate a crisis and reduce the need for medication or containment.

Challenging behaviour in dementia

The brain damage of dementia can affect both behaviour and personality. This is more common as the disease progresses, however it can be an early sign in some types of dementia including Parkinson’s, frontotemporal dementia and dementia with Lewy bodies. The British Medical Journal described challenging behaviours:

‘Challenging behaviour is a catch-all term that, in the context of dementia, includes one or combinations of shouting, wandering, biting, throwing objects, repetitive talking, destroying personal possessions and other objects, agitation and general anger, physical attacks on others, and waking others at night.’

The confusion of dementia can cause disorientation and the individual may wander away from the home. Restlessness and distress can cause shouting, rocking, hand-wringing or acting out, this agitation often increases in the late afternoon and early evening, which is known as ‘sundowning'. People may experience hallucinations or develop delusions that can make them suspicious, aggressive or inappropriate.

Behaviour that is antisocial or could potentially be dangerous to the individual, the family or those that care for them is usually described as ‘challenging’.

Care and challenging behaviours

Caring for people exhibiting challenging behaviour can be difficult and frustrating for family and inexperienced carers. Historically an approach of control and containment was used, with anti-psychotic medication administered to manage aggression. However this is increasingly being questioned on both ethical and evidence-based grounds. The Alzheimer’s Society says:

‘Drugs can have severe side effects and a significant impact on a person’s quality of life. Therefore, it is vital to first consider other options that do not involve medication when deciding how best to help someone who is behaving aggressively.’

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Making the home safe to reduce danger remains important and medication may be necessary for some individuals, however it is also essential to consider why the person is showing distress and address any issues.

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Understanding challenging behaviour

Dementia can directly cause challenging behaviour. However confusion, delusions and hallucinations are not the only causes of distress. Pain, boredom or an uncomfortable sitting position can all cause agitation, especially in people who are unable to communicate their discomfort. It’s important to manage the underlying cause of the problem, rather than simply dealing with the response.

hometouch provides person-centred care tailored to an individual’s interests, abilities and needs. Too often care can be about survival and safety, leaving people frustrated and under-stimulated. By effectively caring for the individual, we can reduce boredom, frustration and challenging behaviours.

Understanding care

Physically preventing someone putting themselves in danger can increase distress, no matter how well-meaning the intervention may be. When an individual is confused and vulnerable, being restrained or restricted can be threatening, being held or controlled can feel like an attack.

Professional carers know to calmly take control without being confrontational. Using their hands, voice and body, they can make the individual feel at ease. By being reassuring but not patronising, their dignity and self-respect are maintained.

Positive communication

Caring is about working together with the individual, not battling against their challenging behaviours. This approach helps the person with dementia know that the carer is on their side, so they are more likely to trust them and accept their support and guidance.

Consistency of care can help in establishing trust as well as understanding and responding to an individual’s needs. Communication with someone with dementia is about more than just words. Non-verbal communication is key. Body language, positioning, facial expression and tone of voice are all very important:

  • Looming over an individual can be intimidating. It’s better to get down to their level, by crouching or kneeling.
  • Keep the voice calm, slow and low. Repeating reassuring comments can be soothing.
  • Maintain eye contact and think carefully about gestures and facial expressions. People with Alzheimer’s may pick up on tension or stress, even if it is apparently unexpressed.
  • Try not to make sudden movements. These can shock and cause distress.
  • Acknowledge their feelings of anger and frustration and give them time and space to recover.
  • Disturbance of the sleep cycle

    With time, dementia starts to affect the body’s natural cycle of sleeping and waking. This leads to restlessness and agitation in the night-time. Waking care overnight can maintain safety and reduce the burden on family members.

    Dealing with hallucinations and delusions

    Hallucinations can be a particular challenge. Questioning or contradicting can increase confusion and anxiety. Professional carers can help to redirect their attention without belittling or patronising the individual.

    Delusions and paranoia can also be a problem. People affected by dementia can forget where they have placed important items, which can make carers vulnerable to accusations of theft. hometouch professional caregivers have had criminal record and careful reference checks. They will work sensitively with the family and the individual with dementia, and will always recommend that valuables are safely locked away, to reduce the risk of any mix-ups.

    Dementia is a distressing and difficult condition for people affected and for carers. hometouch’s professional caregivers understand this and will always focus on the person and their needs, not the behaviour. Using a sensitive, supportive approach they can manage challenging behaviour and, by providing consistent, caring assistance, may help prevent escalation and crises.

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