Understanding and Managing Behaviours in Dementia: A Caregiver's Guide

According to the World Health Organization, more than 55 million people live with dementia worldwide, and this number is rising.

For caregivers, navigating the resulting behavioural changes can be one of the most challenging aspects of care. Our authoritative guide offers compassionate and practical insights into how to manage behaviours in dementia, promoting a more peaceful and understanding environment for everyone involved.

Quick Summary

Managing dementia behaviours requires patience, routine, and understanding the root cause rather than reacting to the symptom. Effective strategies involve compassionate communication, environmental adjustments, meaningful activities, and proactive self-care for the caregiver, focusing on de-escalation rather than confrontation.

Key Points

• Identify Triggers: Understand that behaviours often result from unmet needs, pain, or environmental stress, not deliberate action.

• Use Compassionate Communication: Speak calmly, use simple language, and validate feelings rather than correcting inaccurate statements.

• Create Structure and Routine: Establish a predictable daily schedule and a calm, familiar environment to reduce confusion and anxiety.

• Employ Redirection and Distraction: Gently shift focus from a challenging behaviour to a positive or engaging activity to de-escalate tension.

• Prioritise Caregiver Self-Care: Caregiver well-being is crucial. Seek support, take breaks, and manage your own stress to provide the best care possible.

• Tailor Your Approach: Be flexible and patient, as strategies may need to be adapted based on the individual and the progression of their dementia.

• Focus on Safety: Implement environmental safety measures and tracking devices for specific behaviours like wandering to ensure your loved one's well-being.

Decoding the 'Why' Behind Dementia Behaviours

Before you can effectively respond to a challenging behaviour, it's crucial to understand that it is not a deliberate action. A person with dementia is acting out of confusion, fear, pain, or an unmet need they can no longer communicate effectively. By becoming a detective and observing patterns, you can often uncover the trigger and prevent the behaviour from occurring.

Common Triggers and Root Causes

• Physical Needs: Is the person hungry, thirsty, too hot or cold, in pain, or needing to use the bathroom? A sudden increase in agitation could be a sign of a urinary tract infection (UTI) or other physical discomfort.
• Environment: Is the room too noisy, cluttered, or dark? Changes in routine or unfamiliar surroundings can be disorienting and cause distress.
• Communication: Difficulty expressing a need or understanding what is being said can lead to frustration. Speaking too quickly or using complex language can be confusing.
• Boredom or Overstimulation: A person can become restless due to a lack of meaningful activity or anxious and agitated when faced with too much noise and activity, known as 'sundowning'.

Practical Strategies for Compassionate Communication

How you communicate is more important than what you say. A person with dementia relies heavily on non-verbal cues, tone of voice, and body language.

• Stay Calm and Gentle: Your tone of voice and facial expressions can quickly de-escalate or heighten a situation. Always approach calmly and speak in a soothing, reassuring tone.
• Keep It Simple: Use short, direct sentences and ask simple, yes-or-no questions. Avoid long explanations or complex choices that can cause confusion.
• Redirect and Distract: If a person is fixated on a topic or behaviour, redirect their attention gently to something else. For example, if they insist on leaving, say, "It's almost time for our walk, but first, can you help me fold these towels?"
• Validate Feelings, Not Facts: When a person is distressed by a false memory or belief, acknowledge the feeling behind their words. Instead of correcting them, respond to their emotion. For example, "I can see you're worried. I'm here with you and you are safe."

Creating a Calming and Structured Environment

Consistency and a soothing environment can significantly reduce confusion and anxiety. Small changes can make a big difference.

• Establish a Predictable Routine: A consistent daily schedule for meals, bathing, and activities provides a sense of stability. Try to perform tasks at the same time each day to build familiarity.
• Reduce Clutter and Noise: A simple, organised living space is less overwhelming. Minimise background noise from the television or radio, especially during meals or one-on-one interactions.
• Utilise Familiar Objects: Surround the person with familiar objects, photos, and furniture. This can provide comfort and trigger positive memories.
• Enhance Safety Measures: Install door alarms, motion sensors, or GPS trackers for wandering. Lock up dangerous items like cleaning supplies, car keys, and tools.

Dealing with Specific Challenging Behaviours

Different behaviours require different, tailored approaches. Here are some strategies for common situations.

Wandering:

1. Rule out unmet needs (hunger, pain, bathroom).
2. Provide safe opportunities for movement, like supervised walks.
3. Ensure the environment is secure with locks or alarms.
4. Consider a GPS tracking device for peace of mind.
5. Hide items like coats or purses that signal going out.

Aggression:

• Stay calm and use a gentle, reassuring tone.
• Do not argue or challenge the person.
• Back away and give them space if the situation feels unsafe.
• Wait until the person is calm before re-engaging.
• Look for patterns in aggression—is it triggered by a certain time or task?

Repetitive Actions:

• Acknowledge the action or question briefly to show you've heard.
• Try to find the underlying need (e.g., anxiety or boredom).
• Redirect with a simple, engaging activity like folding laundry or looking at a photo album.
• Avoid reminding them they just said or did something. This only causes frustration.

Responsive vs. Reactionary Approaches to Care

One of the most valuable shifts in caregiving is moving from a reactionary mindset to a responsive one. This table highlights the key differences.

Aspect	Reactionary Approach	Responsive Approach
Focus	The immediate behaviour	The underlying need or emotion
Communication	Arguments, corrections, commands	Calm reassurance, simple language
Environment	Ignores external triggers	Adjusts surroundings to reduce stress
Caregiver Stress	High, fuelled by confrontation	Reduced, based on understanding
Result	Increased agitation, frustration	Improved mood, reduced tension

The Crucial Role of Caregiver Self-Care

Caregiver burnout is a real and serious issue. The emotional and physical demands of caring for someone with dementia can be overwhelming. Prioritising your own well-being is not selfish; it is essential for providing effective, compassionate care.

• Seek Support: Connect with a dementia support group to share experiences and learn from others facing similar challenges. Organisations like the Alzheimer's Association provide invaluable resources.
• Take Respite: Use respite care services to take planned breaks. This can be for a few hours, a full day, or a weekend. Time away to rest and recharge is vital.
• Manage Your Stress: Engage in stress-reducing activities, such as exercise, meditation, or spending time in nature. Remember that the disease is the cause of the behaviour, not your loved one.
• Educate Yourself: The more you understand dementia, the better equipped you will be to handle the challenges. Educate family members and friends so they can also communicate effectively.

A Final Word

Learning how to manage behaviours in dementia is a continuous process of adaptation and discovery. Each person's experience with dementia is unique, and what works one day may not work the next. By approaching each situation with patience, empathy, and a detective's curiosity, you can build a deeper connection with your loved one and create a more peaceful existence for everyone. Remember, your kindness and support are what truly matter.

Frequently Asked Questions

What is 'sundowning' in dementia and how should I manage it?

Sundowning is increased confusion, anxiety, and agitation that occurs in the late afternoon or early evening. To manage it, keep the environment brightly lit during the evening, maintain a regular sleep schedule, limit daytime naps, and plan for calming activities during these hours. A light, early dinner and avoiding caffeine and alcohol can also help.

How do I handle a person with dementia who is constantly repeating questions?

Instead of getting frustrated, try to understand that this is due to short-term memory loss. Provide a simple, clear answer each time without reminding them they've asked before. You can also use distraction by suggesting a new activity or looking at photos. Some caregivers find it helpful to place visual cues, like a clock, in plain sight to provide reassurance.

What should I do if my loved one becomes verbally aggressive?

Stay calm and do not argue. Your body language and tone of voice are key. Acknowledge their feelings with a reassuring phrase like, 'I can see you're upset.' If you feel unsafe, give them space by leaving the room temporarily. Once calm, you can return and try to redirect them to a different, pleasant activity.

How can I prevent wandering in a person with dementia?

Wandering is often a sign of restlessness or boredom. Ensure basic needs like hunger and a full bladder are addressed. Provide regular, safe physical activity like walks. You can also install safety devices like alarms on doors or use a GPS tracker. In some cases, covering doorknobs or placing a dark-coloured mat can deter someone from leaving a specific area.

How important is a daily routine for managing dementia behaviours?

A daily routine is extremely important. It provides a sense of security and predictability, which helps to reduce confusion and anxiety. Maintaining a consistent schedule for meals, naps, and activities helps regulate their internal clock and makes daily tasks more manageable.

Is it ever a good idea to remind a person with dementia about things they have forgotten?

It is generally not a good idea. Correcting a person's memory can cause embarrassment, frustration, and distress. It is more effective to respond to the feeling behind their words and then redirect their attention. Living in their reality rather than trying to pull them back to yours can prevent confrontation and keep the mood positive.