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Dementia and behaviour
As dementia progresses you may notice changes in behaviour that can be upsetting, especially if someone who is usually calm and loving starts behaving aggressively. If this is the case remember that they’re not deliberately trying to upset you. These changes could even be occurring as a result of changes to the environment, their health or medication.
Often you can solve the problem by understanding why the behaviour is taking place, tracking when the problem occurs and what emotions are involved. Sometimes it’s a case of frustration. Other times it’s due to impaired vision or hearing, illness, dehydration or fatigue. Sometimes there’s been too much stimulation in the environment, routines have been changed or the person with dementia has been asked to do a task that’s either too difficult or unfamiliar.
In fact, dementia affects different people in so many different ways that it’s quite possible the person you’re caring for demonstrates none of the behaviours described below.
- Depression
- Wandering
- Anxious or agitated behaviours
- Aggressive behaviours
- Hallucinations and false ideas
- Disinhibited behaviours
Depression
Depression may accompany dementia. It may be caused by problems with medication, physical illness, social isolation and environmental factors. Signs of depression include a loss of interest in activities, less energy and sleeplessness as well as decreased feelings of self worth. When caring for someone with depression you may wish to avoid large groups, establish regular routines, restrict the amount of noise and activity, be realistic in your expectations and offer constant praise. It’s also worth knowing that depression can be treated although medication can have side effects, which you will need to discuss with your doctor.Read more: About depression and anxiety
Wandering
If the person you care for starts to wander it’s often because they’ve set off to go somewhere and forgotten where it was they were going. Either that or they’re using up excess energy, searching for some place from their past, confused, agitated or believe that they have a job to go to. Sometimes this happens at a regular time, for example in the evenings when you may need to be more alert and reassuring. If wandering becomes a problem you may wish to encourage them to wear an identity bracelet or Medic Alert bracelet with contact details. You may also wish to relocate door locks, install buzzers on external doors and inform neighbours and shopkeepers about the problem. If the person you’re caring for has disappeared, stay calm, notify neighbours and police and search out their favourite places. Once you’ve located them try not to be angry, provide reassurance and go back to your familiar routine as swiftly as possible. You may also wish to consider a medical check-up to exclude illness, pain or the side-effects of medicine, which may also have contributed to the behaviour.Anxious or agitated behaviours
Anxious or agitated behaviour may include pacing, fiddling or repeating words. Once again these behaviours may be triggered by discomfort or illness such as depression, so it’s important to keep a close observation on when and how they occur and seek medical advice. It’s also possible that feelings of anxiety are brought on by unfamiliar environments, fear, misunderstanding, bewilderment or as a result of grief or failure to cope with everyday demands. Be aware of early warning signs and seek help from the National Dementia Helpline on 1800 100 500 on strategies that could stop these behaviours from developing. For example, you may try reducing the demands you make and ensuring that the person you care for gets adequate exercise.Aggressive behaviours
This sort of behaviour can include physical and verbal abuse and violence towards others and property. Again, it’s important to try and understand why the behaviour is taking place. Is the person being asked to do something too complex? Are they feeling humiliated, fearful or bewildered, or simply trying to let you know that they’re bored or ill? Is there a possibility that they are experiencing side-effects from medication or frustrated by impaired vision or hearing? Whatever the reason, discuss the problem with your doctor, reduce stress in the environment, be conscious of early warning signs, make sure the person you care for is comfortable and well exercised. You may also try distracting them. If you feel threatened it’s important that you find a safe place away from the person you care for, and for your own wellbeing take regular breaks.Hallucinations and false ideas
Dementia can cause inaccurate interpretation of information, which may take the form of hallucinations – sensory experiences that cannot be verified by anybody else, suspicions, paranoia, misidentification and delusions. As above, a visit to the doctor is recommended to eliminate the possibility of any medical problems such as poor eyesight or hearing problems, psychiatric problems and illnesses such as fevers, malnutrition and dehydration. You may also wish to avoid unfamiliar environments and carers, poor lighting, sensory overload or the disruption of familiar routines – and once more, make sure you don’t take anything personally.Disinhibited behaviours
Occasionally it may seem as if a person with dementia has lost all social awareness, demonstrating behaviour that is sometimes rude, tactless or even offensive. This behaviour may take place for a number of reasons. For example, if someone is taking their clothes off it may be because they want to go to the toilet or they believe they’re in the bedroom. Other times they may simply have forgotten the appropriate behaviour required. If this is the case a gentle reminder may be necessary.Alzheimer’s Australia produces help sheets on behaviours that may be of concern. You can also contact the National Dementia Helpline on 1800 100 500 for more information, education and counselling on this subject.
The Dementia Behaviour Management Advisory Service (DBMAS)
This service offers people with dementia and their carers support in managing behavioural and psychological symtoms of dementia, such as wondering and aggression. DBMAS also provides clinical supervision and mentoring for carers and care staff, support with care planning, short-term case management, crisis management and referrals to other relevant services. DBMAS services can be accessed by staff of government subsidised aged care services, including aged care homes, Community Aged Care Packages, Extended Aged Care at Home (EACH and EACH Dementia programs), respite services, Day Therapy Centres, other dementia specific services, and Aged Care Assessment Teams/Services.
For more information contact 1800 699 791 (24 hours a day).
