What is a behaviour in aged care? Understanding challenging and changed behaviours

According to Dementia Support Australia, changed behaviours often indicate that a resident is experiencing stress, has an unmet need, or is trying to communicate something. Understanding what is a behaviour in aged care goes beyond simple actions; it involves deciphering these underlying messages to provide compassionate, person-centred care.

Quick Summary

A behaviour in aged care refers to actions or responses, often called 'changed' or 'challenging behaviours', displayed by residents that can signal unmet needs, distress, or environmental factors. It is essential for caregivers to look beyond the action itself to understand the root cause and respond with empathy and appropriate support strategies to ensure the resident's well-being and safety.

Key Points

• Behaviour as Communication: A resident's actions in aged care are often a form of non-verbal communication, especially when they can no longer express themselves verbally.

• Underlying Needs: Challenging behaviours frequently signal an unmet need, such as pain, hunger, boredom, or confusion.

• Person-Centred Approach: The best practice is to move beyond managing the behaviour itself to understanding and addressing its root cause, focusing on the individual's history and preferences.

• Behaviour Support Plans: Formal plans are essential for consistently managing and responding to specific changed behaviours in a non-restrictive and empathetic manner.

• De-escalation Techniques: Staying calm, using redirection, and validating feelings are key strategies for managing difficult situations and preventing escalation.

• Environmental Impact: Factors like noise, a disrupted routine, and overstimulation can trigger changed behaviours, highlighting the importance of a predictable and calm environment.

Deciphering behaviour in aged care

In aged care, the term 'behaviour' takes on a deeper meaning than in everyday life. It is not simply about whether a resident is compliant or disobedient. Instead, it encompasses a wide range of actions and reactions that can be a form of communication, especially for those with cognitive decline or other health conditions that affect verbal expression. Rather than seeing a resident's actions as a problem to be solved, expert carers view them as a signal, a clue to an underlying issue that needs to be addressed.

Common types of changed behaviours

Changed behaviours can manifest in many forms, each with its own potential triggers and meanings. Identifying and understanding these patterns is the first step toward effective and compassionate care. Some common examples include:

• Physical Aggression: This can include hitting, pushing, or kicking. It is often a reaction to feeling threatened, overwhelmed, or in pain. An individual may lash out because they feel unable to communicate their distress in any other way.
• Verbal Disruption: Shouting, yelling, or making repeated demands can be disruptive to others but is often a cry for attention, an expression of frustration, or a symptom of anxiety or confusion.
• Wandering or Intrusiveness: A resident who wanders may be looking for something or someone, or simply feel restless and disoriented. Intrusive behaviour, such as entering other residents' rooms, can stem from a loss of social inhibition.
• Refusal of Care: When a resident resists help with tasks like bathing, dressing, or eating, it can be a sign of discomfort, fear, or a desire to maintain independence and control.
• Repetitive Actions or Questions: Individuals with cognitive impairments may repeat phrases, questions, or actions due to short-term memory loss or a need for reassurance. This is often a coping mechanism.

Uncovering the root causes of behaviour

Effective behaviour management in aged care is not about suppressing the action but about addressing the cause. Caregivers must become detectives, using their knowledge of the resident to investigate what might be triggering a particular behaviour. Potential triggers include:

• Pain or Discomfort: An undetected urinary tract infection, constipation, or the side effects of medication can cause agitation or confusion. Since seniors may not be able to articulate their pain clearly, their behaviour becomes a primary indicator.
• Environmental Factors: Noise, a change in routine, or an unfamiliar environment can cause stress and anxiety. For some, the overwhelming social demands of a group setting can be a trigger.
• Psychological Needs: Loneliness, boredom, and a lack of purpose can lead to changed behaviours. Residents need meaningful engagement and social connection to feel fulfilled.
• Cognitive Decline: Conditions like dementia directly affect a person's ability to process information, remember, and communicate. This can lead to frustration and unpredictable behaviours.
• Communication Breakdown: In many cases, the individual is trying to communicate a need but cannot find the right words. Their behaviour is a form of non-verbal communication.

The importance of behaviour support plans

For residents with consistent changed behaviours, a formal Behaviour Support Plan (BSP) is often implemented. These plans are person-centred and designed to identify triggers, outline appropriate responses, and ensure consistency in care. A good BSP is created through a collaborative process involving caregivers, family members, and the resident (if possible) and is reviewed regularly.

Comparison: Traditional vs. Person-centred approaches to behaviour

Aspect	Traditional Approach	Person-Centred Approach
Focus	Managing the behaviour as a problem.	Understanding the behaviour as communication.
Goal	Stop or control the action.	Address the underlying unmet need.
Role of Carer	Authority figure, enforcing rules.	Partner, detective, and empathic listener.
Interventions	Restrictive practices, sedatives, punishment.	Diversion, reassurance, environmental changes.
Outcome	Temporary cessation of behaviour, increased distress.	Improved quality of life, reduced distress.

Strategies for effectively managing aged care behaviours

Managing challenging behaviours requires patience, empathy, and a strategic approach. Here are some key strategies caregivers can use:

1. Stay Calm and Reassuring: A person who is agitated often feeds off the emotions of those around them. Maintaining a calm and steady demeanor can de-escalate a tense situation. Use a gentle tone of voice and simple, clear language.
2. Use Redirection and Diversion: Instead of confronting the behaviour directly, try to redirect the person's attention to a different activity or topic. Offering a favourite snack, a familiar object, or a walk can be effective.
3. Validate Their Feelings: Acknowledge the person's emotions. Saying something like, “I can see you're upset,” can help them feel heard and understood, even if the reason for their distress isn't clear.
4. Simplify the Environment: Overstimulation from noise, too many people, or a busy schedule can be overwhelming. Creating a quiet, calm space can help reduce agitation.
5. Maintain a Routine: A predictable daily routine can provide a sense of security and stability, especially for those with memory loss. Unpredictable changes can trigger confusion and distress.
6. Assess the Situation: Before acting, take a moment to consider potential triggers. Are they hungry, in pain, bored, or in need of the toilet? Addressing the physical need may resolve the behavioural issue immediately.

Ethical considerations and legal requirements

In many regions, including Australia, the aged care industry is governed by regulations that prioritize the use of non-restrictive practices. The Aged Care Quality and Safety Commission provides guidance on Behaviour Support Plans and the appropriate use of restrictive practices only as a last resort, with proper authorisation and clear documentation. This shift in focus ensures that the dignity and human rights of older people are protected.

Conclusion

Understanding what is a behaviour in aged care is fundamental to providing high-quality, compassionate support. It's a nuanced process that involves seeing beyond the immediate action to the person's underlying needs and emotions. By embracing a person-centred approach, caregivers can transform a challenging situation into an opportunity for communication and connection, ultimately enhancing the resident's quality of life and ensuring their dignity is always respected. This proactive, empathetic strategy is not just best practice—it is the cornerstone of truly excellent aged care.

Dementia Support Australia provides extensive resources on behaviour support for aged care.

Frequently Asked Questions

What is meant by 'changed behaviour' in aged care?

Changed behaviour refers to any action or response by a senior that differs from their usual behaviour, often indicating an underlying issue such as pain, confusion, or emotional distress. It is a key way residents with cognitive decline communicate their needs.

How do you identify the cause of a behaviour in aged care?

Identifying the cause involves careful observation, a review of the resident's health history, and considering potential triggers. This could include checking for physical discomfort (like pain or hunger), assessing environmental factors (noise, routine changes), and evaluating their emotional state (loneliness, boredom).

What is a Behaviour Support Plan (BSP)?

A Behaviour Support Plan is a personalised document for an aged care resident that identifies triggers for challenging behaviours and outlines proactive, non-restrictive strategies for care staff to follow. It ensures a consistent and compassionate approach to support.

What are some common triggers for challenging behaviours?

Common triggers include physical pain or illness, changes to routine, overstimulation, unmet needs (like hunger or thirst), medication side effects, cognitive impairment, and psychological factors such as fear or anxiety.

Is it ethical to use restrictive practices for behaviour management?

No, it is not. Ethical and regulatory standards, such as those from the Aged Care Quality and Safety Commission, mandate that restrictive practices should only be used as a last resort, with proper authorisation, and always after less restrictive options have failed.

How can caregivers effectively manage verbal aggression?

Caregivers can manage verbal aggression by remaining calm, using a gentle and reassuring tone, not arguing or confronting the person, and using distraction or redirection techniques. It's also important to validate the person's feelings and try to understand the source of their frustration.

What role does empathy play in managing behaviours?

Empathy is crucial because it allows caregivers to see the person beyond their actions. By putting themselves in the resident's shoes, they can better understand the distress, fear, or confusion behind the behaviour and respond with compassion rather than focusing only on the problem behaviour itself.