PRACTICAL SUGGESTIONS FOR UNDERSTANDING DIFFICULT BEHAVIOUR

POSSIBLE CAUSES:
 
PHYSIOLOGICAL OR MEDICAL CAUSES:

• Fatigue at time of request, activity or event.
• Disruption of sleep pattern (day and night reversal) causing sleep deprivation.
• Physical discomfort, such as pain, fever, illness, constipation, fecal impaction,

expressed as anger.

• Loss of control over behaviours due to physical changes in the brain.
• Adverse side effects of medication such as phychotropics, sedatives or tranquilizers.
• Impaired vision or hearing causing person to misinterpret sights and sounds.
• Hallucinations.

 
ENVIRONMENTAL CAUSES:

• Sensory overload – too much noise, activity, or clutter, or too many people in

environment.

• Unfamiliar people, place, or sounds.
• Sudden movements, startling noises.
• Feeling lost, insecure, forgotten. When familiar person is out of sight, impaired

person may feel abandoned.

• Difficulty adjusting to darkness from well-lighted area and vice versa.

 
OTHER CAUSES:

• Being asked to respond to several questions or statements at once.
• Responding to arguments between other people
• Response to caregiver’s impatience, stress, irritability.
• Person scolded, confronted, contradicted.
• Surprised by unexpected physical contact.
• Inability to perform what was once a simple task, e.g., buttoning clothes.
• Instructions unclear or too complicated.
• Change in schedule or routine.
• Attention span too short for task.
• Task not broken down into manageable steps.
• Activity perceived as too childlike, insulting.

 
COPING STRATEGIES
 
Begin with medical evaluation to rule out physical and/or medication problems.
 
Discuss possible adverse side effects of current medications with physician.
 
Have vision and hearing checked.
 
Alternate quiet times with more active periods.
 
Plan outings, activities when person is rested.
 
Make sure person is comfortable – clothes are not tight, person is not too hot or too cold.
 
Simplify environment by reducing noise, number of people, and clutter.
 
Keep daily routine as consistent as possible.  Avoid changes and surprises.  For some people
with dementia, the slightest change may lead to confusion and disorientation.  Try scheduling
meals, bathing, and walks, for example, at the same time everyday.
 
Determine an appropriate amount of time to accept change in routine when rescheduling is
necessary. For example, if a new caregiver is to be introduced, or day care is being tried, 
accustom the person to the new place or caregiver as gradually as possible.
 
Keep furniture and objects in the same place at all times.
 
Orient person to time by using calendars and large numeral clocks, as the person may lose a
sense of time because of the disease.
 
Make sure the person is protected from hurting him/herself.  Remove sharp utensils, tools, 
and objects from environment.
 
Remove the person from stressful situation, person(s), or place.  Gently guide the person 
from environment while speaking in a calm and reassuring voice.
 
Distract the person with a favourite food or activity. This may reduce agitated feeling.
Distraction and avoidance are often the most useful approaches to handling agitated or angry
behaviours.
 
Exercise regularly to help in reducing stress.  Try walking or dancing.
 
Try music, massage, quiet reading as way to calm person.
 
Use gentle physical touch to calm person.  Holding hands and hugging may be comforting
for some persons living with dementia, but perceived as restraining by others.