Problem solving

There are a number of behaviour changes that sometimes accompany dementia.

These behaviours can include resistance, wandering, agitation, anxiety and aggression.

What causes these behaviours?

There are many reasons why behaviours change. Every person with dementia is an individual who will react to circumstances in their own way.

Sometimes the behaviour may be related to changes taking place in the brain. In other instances, there may be events or factors in the environment triggering the behaviour.

In some situations, a task such as taking a bath, may be too complex. Or they may not be feeling well.

Understanding the behaviours

It is important to try to understand why a person with dementia is behaving in a particular way. If family members and carers can determine what may be triggering the behaviour, it may be easier to figure out ways to prevent the behaviour happening again.

When you are faced with a difficult behaviour or situation, try to understand why it is occurring. What are some of the factors triggering the behaviour that you may be able to change? Try to recognise elements in the environment, the medical situation or problems of communicating that may be contributing to the problem.

When does the problem occur? It can be helpful to keep a daily log or record describing the problem. Think about and record what was going on right before the behaviour occurred? Who was involved? Who was affected by the behaviour? What emotion was expressed – anger, frustration or perhaps fear? What was the response? Did this work? The log can be helpful in identifying a pattern in terms of the time of day or triggering event. There are four categories of possible causes for changed behaviours – health, the environment, the task itself and communication.

The person’s health

Some common problems to be alert for are:

  • Effects of medication - People with dementia are vulnerable to over medication, to reactions from combinations of drugs and to their side effects. Drugs can cause confusion as well as sudden changes in a person’s functioning. 
  • Impaired vision and hearing - Both of these problems can affect a person’s ability to understand what is being said or happening.
  • Acute illness - It is not always easy to recognise acute illness in people with dementia, as they may not be able to tell you about their symptoms. Illnesses such as urinary tract infections, pneumonia, gastrointestinal infection or fever may lead to increased confusion.
  • Chronic illness - Chronic illnesses can affect a person’s mood and level of functioning. Illnesses can include angina, heart problems, diabetes or the pain associated with arthritis, ulcers or headaches.
  • Dehydration - Many people with dementia do not get enough fluid because they no longer recognise the sensation of thirst or they may forget to drink. Symptoms of dehydration may include confusion, dizziness, skin that appears dry, flushing and fever and rapid pulse.
  • Constipation - This can be very uncomfortable and can lead to painful bowel problems and sometimes an increased level of confusion.
  • Depression - Many of the symptoms of depression, such as impaired concentration, memory loss, apathy and sleep disturbances resemble those of dementia. It is often difficult to tell which are caused by depression or by a combination of them both. Diagnosis of depression is possible through a thorough medical assessment.
  • Fatigue - Disrupted sleep patterns can cause angry or agitated behaviour.
  • Physical discomfort - The person may be hungry or bloated or need to go to the toilet, be too cold or too warm.

The environment

  • Environment too large - Sometimes the physical space in which a person with dementia is living is overwhelming.
  • Too much clutter - Sometimes there is too much in the environment for the person to absorb, and they may become overwhelmed.
  • Excessive stimulation - When there is too much going on in the environment, such as music or television in the background during conversation or there are too many people around, the behaviour of someone with dementia may change.
  • Confusing sensory environments - Lighting, visual contrasts between floors and walls, the use of colours can all affect a person’s behaviour and level of functioning. Inadequate levels of light may affect their ability to concentrate while eating. Patterned floor tiles can look like steps, causing the person to trip or become uncertain. Glare from direct sunlight or a highly polished floor can affect a person’s ability to see. Shadows can contribute to hallucinations.
  • Changing routines - People with dementia need a certain amount of routine and daily structure on which they can depend. This consistency is important in helping to minimise the amount of stress they may be experiencing.
  • Unfamiliar environment - An environment that is new or unfamiliar is more likely to be confusing for a person with dementia because they experience problems with new learning, memory and perception. 

The task

  • Task too complicated - Sometimes people with dementia are asked to do tasks that are too difficult, even though they may have been able to do them previously.
  • Task unfamiliar - People with dementia gradually lose their ability to learn new tasks or skills. Expecting that they will learn may place an unrealistic demand on them.

Causes related to communication

  • Unable to understand - People with dementia may become angry or agitated because they do not understand what is expected of them.
  • Unable to communicate - They may also feel frustrated with their inability to make themselves understood.

Problem solving

Make a plan and try it. Develop a list of alternative strategies for responding to the behaviour or situation. Be creative. Have someone else look at the situation and give suggestions. Think about the strategies you have identified. Decide on the one you are going to try first.

Review the strategy. Problem solving is a process of trial and error. There are no simple solutions. If the new strategies you tried did not reduce the changed behaviour as you had planned, try other strategies.