Coping with Stressed and Distressed Behaviour
All behaviour is a form of Communication. Sometimes it is useful to try to take a step back and look at what could be causing the behaviours. It can be helpful to talk things through with the other people involved in the care and support of the person you care for. Remember the person with dementia may be in pain due to an underlying medical condition, but may be unable to express this. They may be bored, upset about something or lacking the opportunity for Physical Exercise. Apathy and/or depression can also be experienced by people with dementia.
Sudden Changes in Behaviour
Distressed behaviour could be caused by Delirium. Delirium is typified by a rapid change of cognition and is characterised by hallucinations, clouding of consciousness and mis-interpretation of events, as well as sleep disturbance. The sooner delirium is detected the better the outcome, it is a medical emergency and help should be sought from the person’s GP immediately. See Depression, Delirium and Dementia for more information.
Behavioural and Psychological Symptoms in Dementia
Behavioural and Psychological Symptoms in Dementia (BPSD) can affect people as their dementia progresses. Towards end stage dementia, BPSD difficulties may settle, though ongoing management of them is often required. Drugs may have low effectiveness and cause adverse effects, and unfortunately no one treatment is effective for all causes of BPSD.
Behaviours family carers find challenging:
- Refusal to accept support with personal care
- Behaviours that can seem paranoid, suspicious, or accusatory
- Aggression and anger
- Restlessness/anxiety/Walking – Formally Wandering
- Repetitive actions or questions
- Eating issues
- Continence or other toileting issues
- Actions which could put the person with dementia at risk
- Inability to recognise home or current surroundings (disorientation to place)
- Sleep disturbance, sometimes turning night into day
- Hallucinations and delusions
- Unable to recognise family members or friends
- Depression/frequent upset/agitation
- Refusal to take medication
- Constantly seeking reassurance
- Disinhibition eg. acting inappropriately
Carers report a high level of burnout and stress, so it is important to seek help and support from family and friends and health and social care professionals. Professionals can work with you to devise approaches that may help manage these behaviours. They can help you to identify triggers and develop coping strategies. These behaviours can be very challenging and it is important for carers to get the right support for their individual circumstances. Carers Link provides advice, information and support to carers in East Dunbartonshire including courses on Understanding Dementia.
The Alzheimer Society has useful fact sheets on Behaviour Changes and Alzheimer Scotland has one on Behaviour that Challenges – Understanding and Coping.