-A change in environment (e.g., going to visit a place they haven't been before or making changes to their assisted living apartment or suite). -Being hungry or thirsty or in need of a bathroom. Having someone approach too quickly or from the side where their peripheral vision might be impaired.
Behavioral disturbances in dementia are often globally described as “agitation” including verbal and physical aggression, wandering, and hoarding. These symptoms create patient and caregiver distress, and lead to nursing home placement.
This is known as sundowning and these behaviour changes can become worse after a move or a change in routine. The person with dementia may become more demanding, restless, upset, suspicious, disoriented and even see, hear or believe things that aren't real, especially at night.
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.
When looking at individual symptoms in dementia patients, the most prevalent BPSD are apathy, depression, irritability, agitation and anxiety, while the rarest are euphoria, hallucinations, and disinhibition. The most clinically significant symptoms are depression, apathy, and anxiety.
Challenging behaviour can include tantrums, hitting or kicking other people, throwing things or self-harming. Behaviour is challenging if it is harmful to the person and others around them, and if it stops the person achieving things in their daily life, such as making friends or concentrating at school.
“Behaviours of concern” are behaviours of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviours which are likely to seriously limit or deny access to the use of ordinary community facilities.
Three fundamental types of behaviour can be distinguished: the purely practical, the theoretical-practical, and the purely theoretical.
Pain. Pain is a significant trigger of behavioral disturbance in dementia patients, but is often overlooked or ignored.
Behavioural triggers
For example, if a teacher wants students to listen, he or she will generally call for their attention (sometimes using a signal) and wait for them to be quiet, thereby triggering the desired attentive behaviour.
During the course of the disease, up to 90% of patients will exhibit behavioral and psychological symptoms of dementia (BPSD), which can include depression, apathy, disinhibition, delusions, hallucinations, aggression, irritability, agitation, anxiety, wandering, and sleep or appetite changes.
Identifying Behaviours of Concern
Behaviours of concern can include: aggression toward others ● self-injurious behaviour ● inappropriate social and sexual behaviour ● self-stimulating behaviour such as excessive rocking ● extreme withdrawal or noncompliance.
Examples include tantrums, unfounded fears and overly anxious behaviour, aggressive behaviour such as hitting or biting, disruptive behaviour and defiance.
Having an awareness can help you decide when to intervene during challenging behaviour. The de-escalation cycle is defined in seven phases: Calm, Trigger, Agitation, Acceleration, Peak, De-Escalation and Recovery. There are specific features at each phase allow some predictability in planning for intervention.
I'm going to discuss five of the most basic ones here: 1) Don't tell them they are wrong about something, 2) Don't argue with them, 3) Don't ask if they remember something, 4) Don't remind them that their spouse, parent or other loved one is dead, and 5) Don't bring up topics that may upset them.
Keep well-loved objects and photographs around the house to help the person feel more secure. Try gentle touching, soothing music, reading, or walks. Reduce noise, clutter, or the number of people in the room. Try to distract the person with a favorite snack, object, or activity.
Administration: The examiner reads a list of 5 words at a rate of one per second, giving the following instructions: “This is a memory test. I am going to read a list of words that you will have to remember now and later on. Listen carefully. When I am through, tell me as many words as you can remember.
While most adults know that teasing or bullying can trigger a behavior issue, many are not aware that some children also respond negatively to unwanted praise. Other common behavior triggers include overstimulation (bright lights, loud noises, etc.), transitions and having to interact with someone they don't like.
Causes of distressed behaviour
fear or embarrassment. frustration with a situation. depression. no other way to express themselves.
People with dementia sometimes develop delusions or false beliefs, and hallucinations or they sense things that are not actually there. Delusions in dementia may be paranoid; for example, the person might believe someone is stealing from them, their spouse is cheating on them, or someone is out to get them.