Managing Challenging Behaviors

A person who has dementia may exhibit challenging behaviors for many reasons. Being sensitive to the emotion behind the behavior can help to manage stress and frustration.

Potential Causes of Problem Behaviors

Reaction to Loss: We all rely on input from our environment to guide us in activities and relationships. An individual with dementia has lost both the benefit of such input and the ability to inform us of their internal world. This may cause fear, insecurity and frustration.

Inability to Meet Basic Needs: Hunger, dehydration, elimination problems and fatigue can produce behavioral changes. They may show their discomfort through agitated and aggressive behavior.

Medical Problems: Pain and discomfort from a medical problem or medication side effects can go unnoticed because of the individual’s inability to report it.

Psychiatric Disorders: Individuals who are diagnosed with a psychiatric disorder are likely to exhibit more behavioral problems if they develop dementia.

Environmental Factors:

  • Excessive noise
  • Poor or glaring lighting
  • Cold temperature
  • Change in the environment/routines
  • Boredom and conflicts

Sensory Impairment: Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel more frightened and frustrated.

Factors Related to the Caregiver: A caregiver’s attitude and knowledge of dementia affect the care of individuals with the disease. The more one knows about dementia, the more likely they will be to understand behavioral problems.

Coping with Wandering

  • Do not leave a person with dementia home alone even just for a few minutes.
  • Monitor and record wandering patterns.
  • Consult with a physician to see if medications can help.
  • Provide recreational activities—music therapy, physical exercise or movies, for example—to reduce boredom.
  • Ensure that the individual is well fed, well hydrated and using the bathroom since individuals may wander to fulfill basic needs.
  • Reduce environmental stimuli like loud music, screaming or overcrowding.
  • Outfit the individual with an identification bracelet, and put some form of identification in every jacket or pocketbook.
  • Have a current photo readily available and find out about leaving one on file at the police department.
  • Secure doors so they are difficult to open.
  • Add electronic chimes or doorbells so a caregiver is alerted if the individual is leaving.
  • Identify rooms with colorful signs.
  • Post a large sign that says “stop” or “do not enter” on exits.
  • Mask exit doors with a curtain.
  • Place a large black mat or paint a black space by an exit, which may look like an impassable hole.

  • Put away essential items, such as coats, shoes, or pocketbooks.

  • Tell neighbors about wandering behavior and make sure they have your phone number.

Coping with Agitation and Aggression

  • Seek a doctor’s advice to determine if there is a medical cause or if medications are causing adverse side effects.
  • Limit outside noise, clutter or the number of persons in a room.
  • Keep to the same routines.
  • Reduce caffeine intake.
  • Do not move objects and furniture.
  • Dot the environment with familiar objects that promote pleasant memories.
  • Try gentle touch, soothing music, reading or walks.
  • Speak in a reassuring voice.
  • Distract the person with a snack or activity.
  • Learn to recognize behaviors – an agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.
  • Do not try to restrain the person during an agitated reaction.
  • Keep dangerous objects out of reach.
  • If agitation increases at night, a nightlight may reduce confusion.
  • Acknowledge the person’s feelings.

Coping with Paranoia

  • Discuss paranoid behaviors with the individual’s doctor. Medications may need to be adjusted.
  • Explain to family members and caregivers that suspicious accusations are a part of the illness.
  • Respond to the feeling behind the accusation.
  • Try non-verbal reassurances like a gentle touch or hug.
  • If the individual suspects money is “missing” allow them to keep small amounts of money in a pocket or pocketbook.
  • Help to look for a missing object. Try to learn where their favorite hiding places are for storing objects that are “lost.”
  • Avoid arguing.

Coping with Sundowning

Sundowning is a dementia-related symptom that refers to increased agitation, confusion and hyperactivity that begins in the late afternoon and builds throughout the evening.

  • Plan activities or outings in the morning.
  • Do only simple, calming activities in the afternoon.
  • Keep individuals awake during the day.
  • Increase indoor lighting before dusk.
  • Ensure that the individual is not suffering from hunger, thirst, pain or fear.
  • Remove excess stimuli and clutter.
  • Consult your doctor to see if medications may help.

For more information about Managing Challenging Behaviors, please call our Helpline at 888-280-6055