There are many possible causes for a sudden change in behaviour in your loved ones. Dementia, which affects almost 1 million people in the UK, often causes behavioural changes but there are other physical, mental and personal causes. Sometimes, a person’s behaviour simply changes as a result of natural ageing as their values, beliefs or habits change over their lifetime.
Whether your loved one is experiencing ongoing behaviour changes due to a health condition like dementia or these behaviours are new and sudden, this guide provides useful information and actionable tips on how to deal with challenging behaviour. You’ll learn what challenging behaviours are and how most of them can be managed by responding to the person’s needs.
What Makes Behaviour Challenging?
It is important to recognise that not all behavioural changes should be perceived as negative or problematic. As we age, people often undergo natural physical, emotional, and cognitive transformations that can manifest as behavioural changes. Before trying to change or prevent any behaviours, you need to differentiate between normal changes associated with ageing and behaviours that genuinely pose challenges to the individual and those around them.
Challenging behaviour can be described as actions, reactions, or conduct that present difficulties to the individual, their caregivers, or their environment. These behaviours can be verbal or physical. They often disrupt daily routines, social interactions, and overall quality of life.
What sets challenging behaviour apart from regular behaviour is its persistence and intensity. While occasional changes in mood, forgetfulness, or moments of confusion are common throughout life but especially as we get older, challenging behaviour tends to be more consistent and pronounced. The intensity of these behaviours can make it difficult for individuals to adapt to daily routines or activities.
Challenging behaviours also have the potential to jeopardise the safety and well-being of the individual and those around them. Behaviours like aggression, wandering, or refusing to cooperate with essential care routines can lead to dangerous accidents, injuries, or emotional distress.
Examples of Challenging Behaviour
Behaviour does not have to be verbally or physically aggressive to be challenging. For instance, a person with dementia may seek comfort and support by asking repetitive questions, but this can become stressful to a caregiver over time.
Challenging behaviours are simply behaviours that can be distressing to the individual or those around them. Examples include:
- Verbal aggression, shouting, or using offensive language
- Physical aggression, hitting, kicking, or throwing objects
- Wandering or attempting to leave a safe environment unsupervised
- Refusing to cooperate with essential care, such as bathing or taking medications
- Sundowning; a state of increased confusion and agitation in the late afternoon or evening
- Hoarding objects or displaying obsessive behaviours
- Repetitive questioning or actions
- Social withdrawal and refusal to engage in previously enjoyed activities
- Pacing or restlessness
- Delusions or hallucinations
- Self-harming behaviours or self-neglect
Managing Sudden Changes in Behaviour
If your loved one is displaying new and sudden behaviours that are out of character, it’s important to rule out any underlying medical causes.
Sudden changes in behaviour among older adults are frequently linked to underlying physical health issues such as constipation, pain, or urinary tract infections, which may lead to increased agitation, confusion, or distress.
When you observe any sudden changes in behaviour, it’s always a good idea to arrange a home visit from a person’s GP. They can conduct a thorough assessment to identify any potential physical problems. Remember to discuss any medications the person is taking, including non-prescription drugs, to ensure they are not contributing to the changes.
If physical health issues are ruled out by the GP, the individual may be referred to a mental health team. Mental health conditions like anxiety and depression could also play a role in behavioural changes.
Steps for Supporting Challenging Behaviour
When your loved one is experiencing behaviours that challenge, it can be helpful to view the problem through these steps.
1. Look for a problem
Many challenging behaviours are the result of someone being unable to express or communicate an unmet need or want. These unmet needs could include pain, physical discomfort, changes in the environment, or emotional distress. Observing and documenting patterns of behaviour can help you in understanding the triggers and possible reasons behind a person’s behaviour.
It can be helpful to ask yourself these questions:
- Could they be trying to communicate a need, such as hunger or thirst?
- Is the person’s environment comfortable?
- Is the behaviour the problem or is the person reacting to their environment or those around them?
2. Keep a diary
If you start to record and keep a log of instances of challenging behaviours, you will likely see some patterns develop. For example, if someone is understimulated throughout the day or doesn’t get enough exercise during the daylight hours, you may notice they become prone to wandering during the evening.
By recognising the triggers for certain behaviours, you can change how you react to certain them and improve the situation. You may learn that certain subjects trigger unpleasant memories or emotions in your loved one, so you can learn to avoid discussing those subjects. Or you may discover that being unable to enjoy an activity as they once did is emotionally distressing for your loved one, so you can try and find new and stimulating activities for them to enjoy.
When keeping your record, think about the following questions:
- When and where does the behaviour happen?
- Is the location always the same or different?
- Are the circumstances for the behaviour similar?
- Are the same people often involved? For example, visitors or family members?
- Are there patterns to the behaviour? For example, common themes, people, places or questions?
3. Respond to the emotion, not the behaviour
It can be helpful to try and look past the behaviour and instead focus on the emotions the person may be experiencing. Are they bored, tired or confused? Could they feel embarrassed, annoyed or patronised?
Approaching the situation with empathy and understanding can help to de-escalate the situation and address the root cause. Acknowledging the person’s emotions and validating their feelings can create a sense of trust and reassurance. This is why it is so important to remain calm and composed to avoid escalating the situation further.
When someone you love displays challenging behaviours, it can be quite distressing. Try not to take the behaviours personally but rather use them as valuable insight into what the individual is feeling or trying to express. For instance, someone may become prone to anger when they are hungry or ask repetitive questions why they feel confused.
4. Develop a strategy
Creating a well-thought-out strategy is essential in supporting challenging behaviour. Start by engaging in open communication with the person experiencing the behaviour, if possible, and those who spend time with them, such as family members, caregivers, or close friends. Collaboratively come up with a plan that takes into account the individual’s preferences, needs, and unique personality traits.
Experiment with various approaches and make gradual changes to identify what works best for the person. Simply changing the way you communicate during sensitive situations such as personal care routines can make a significant difference. Consider modifying the environment to create a more supportive and comfortable setting for the individual.
Focus on the person’s best interests and tailor the strategy to suit their specific requirements. What works for one person may not be effective for another, so be patient and adaptable in finding the most suitable solutions.
Consistency is key. Ensure that all caregivers and support staff involved follow the same strategy. This consistent approach will help the person feel secure and reduce confusion or anxiety.
Regularly review and adjust the strategy as needed based on the person’s responses and progress. Remember that each individual is unique, and by continually refining the approach, you can provide the best possible support and care to your loved one.
Support for Dementia Carers and Family Members
At Prestige Nursing & Care, we believe that people living with dementia should be able to live a fulfilling and healthy life at home. With the right dementia care and support in place, tailored to their individual needs.
If your loved one is living with dementia and experiencing challenging behaviours, we can help. For over 75 years, Prestige Nursing & Care, has supported people living with dementia in their own homes and communities and helped them enjoy a greater quality of life. We are trusted by families up and down the country to provide care for all of life, evolving the level and type of care we provide to meet changing needs.
We are here to take your call and will provide impartial support and guidance. Do not hesitate to contact our friendly care experts today to discuss your dementia care needs.