Reducing and managing behaviour that challenges

Read about how to manage situations where a person’s behaviour changes.

1. How does dementia change a person's behaviour?
2. What causes changes in behaviour in people with dementia?
3. You are here: Reducing and managing behaviour that challenges
4. Repetitive behaviour and dementia
5. Trailing, following, checking and dementia
6. Dementia and hiding, hoarding or losing things
7. Loss of inhibitions and dementia
8. Restlessness and agitation in dementia
9. Social withdrawal and dementia
10. Behaviour that challenges - looking after yourself
11. Changes in behaviour - useful organisations

There are many possible reasons for behaviour that challenges. Sometimes, the behaviour happens in phases and stops over time. It can often be managed by recognising and responding to the person’s needs. However, there may be times when changes in behaviour happen very suddenly, and you may need support from professionals.

Managing sudden changes in behaviour

Sudden changes in behaviour are often caused by a physical health problem such as constipation, pain or urinary tract infection – especially when the person seems to be more agitated, confused or distressed.

If you notice a sudden change, it’s always a good idea to ask the person’s GP to visit. They can check for any physical problems, and arrange any necessary tests such as blood or urine tests. Ask the doctor to review all medication the person is taking, including any non-prescription drugs.

If the GP rules out health problems as a cause, they may refer the person to a mental health team. Mental health conditions such as depression may also contribute to changes in behaviour. These can often be managed with medication or with non-drug approaches.

Think of the person’s point of view

• Always try to see things from the person’s perspective.
• People with dementia can sometimes find it hard to understand what’s going on around them. This can be confusing and frightening for them. You might not understand their behaviour, and this can be frustrating for you. But the behaviour will often have meaning for the person with dementia.
• Think about what you know about the person and their life. For example, if you know someone used to work night shifts, it might explain why they want to stay awake or go out at night.
• It’s likely that they’re trying to stop feeling distressed and to feel well again. The behaviour may be the best way for them to communicate what they want or to help themselves feel better.
• Be aware of the person’s beliefs and thoughts and try not to argue with them. For example, if they believe they need to go and collect their children from school, don’t tell them they’re wrong. Instead ask them to tell you more about their children, or move their focus onto an activity.

Managing wellbeing

Always think about what you know about the person and what works best for them. The person is likely to respond to your behaviour and communication, so if you’re frustrated or angry it may make things worse.

For example, if they are repeating questions, try to be patient and sensitive towards them. They may not know that they have repeated themselves and may notice if you seem impatient, which might distress them.

If the person behaves rudely, don’t attempt to argue or correct the behaviour. Offer them gentle reassurance, or try to distract their attention.

Other tips for managing the person’s wellbeing include:

• Spend time with the person. This could be having a cup of tea and a chat with them. You could do an activity like playing a game or preparing food together, or keep close to them when you have tasks to carry out. For example, you could be ironing while the person listens to the radio. Being with the person can help them feel reassured and comforted.
• If you’re unable to meet, then phone or video calls can be a good way to spend time with the person too.
• Think about how the person has coped with situations in the past. This may affect how they deal with things now. For example, a person who has always been anxious may become more anxious about things now that they have dementia.
• Think about how they are feeling, what they are trying to express, and how you can support them emotionally. Even though a person with dementia may have problems with their memory, they still feel and respond to emotions.
• If they forget an event that happened earlier in the day, they may still feel the emotions of it later. It can help to respond directly to how the person is feeling (for example, by saying ‘I can see that this is difficult for you’).

Antipsychotic drugs

Antipsychotic drugs often used to be prescribed to people with dementia if they showed behaviour that challenges. However, most of these drugs have limited or no benefits for people with dementia, may not treat the cause of changes in behaviour and carry serious risks and side effects.

Antipsychotic drugs should only be prescribed by a doctor as a last resort if other treatments have been tried and didn’t work. They should only be used if the person’s behaviour is persistently causing them severe distress or putting them or others at risk of physical harm. Even then, they should be used alongside non-drug approaches based on the person’s needs.

If antipsychotics are used, the doctor should monitor how they’re affecting the person. Treatments should be reviewed after six or 12 weeks, or both.

Steps for managing behaviour that challenges

It may be helpful to manage behaviours by looking at them in steps. A professional (such as a dementia specialist nurse or a dementia support worker) can help you to follow the steps below.