Challenging. Behaviour
- 1. CHALLENGING BEHAVIOUR BY C SPAIN
- 2. CHALLENGING BEHAVIOUR By the end of this session you will---- Be able to identify different types of behaviours. Be able to understand why these behaviours happen Be able to react correctly towards these behaviours in a safe a calm way.
- 3. Dealing with aggressive behaviour If you are caring for someone with dementia, you may find that at times they behave aggressively. This can be very distressing. By understanding what causes this type of behaviour and learning some ways to deal with it, you can make sure it happens less often, and feel better able to manage when it does.
- 4. What do we mean by 'aggressive behaviour' in people with dementia? People with dementia can behave aggressively in one or more of the following ways: being verbally abusive or threatening being physically threatening, such as kicking or pinching lashing out violently at people or property. This may take the form of overreacting to a situation or becoming very agitated as a result of what seems to be a very minor setback or criticism.
- 5. What causes aggressive behaviour? There are many reasons why a person with dementia may act aggressively, including: if they feel frightened or humiliated if they feel frustrated because they are unable to understand others or make themselves understood if the dementia has eroded their judgment and self-control if they are no longer restrained by inhibitions learned in early childhood, and have forgotten how to behave appropriately.
- 6. BUT REMEMBER. Dealing with aggressive behaviour is not easy, and there are no simple answers. You can help to make it less of a problem through a gradual process of identifying what triggers the aggression and finding some effective ways to deal with it.
- 7. Step 1: Try not to take it personally Any form of aggression can be upsetting, but it's important to remember that the person is not being aggressive deliberately. Their behaviour may appear to be targeted at you, but that is probably just because you are there. Although the emotion at the root of their aggressive behaviour - such as frustration - may persist, they will probably forget any individual incidents much more quickly than you do.
- 8. Try to remember that for many people aggression is simply a normal part of the way that dementia progresses in many people. The fact that the person you are caring for is aggressive towards you doesn't mean that their feelings towards you have changed - just that their reactions have become different as the structure of their brain has changed.
- 9. Step 2: Find ways to react to aggressive situations In the long term, prevention is the best solution for aggressive behaviour (see Steps 3 and 4), both for you and for the person with dementia. If an aggressive situation does arise, don't blame yourself. Instead, concentrate on handling the situation as calmly and effectively as possible, using the following tips: At the time…
- 10. Before you react, take a deep breath and count to ten. Try to stay calm, and don't enter into an argument. A heated response will probably make the situation worse. Reassure the person and try to distract their attention. Try not to show any anxiety, as this may increase the person's agitation - although if you feel threatened, this is easier said than done. You might be able to plan some strategies in advance that you could use in such situations.
- 11. If the person is physically violent, give them plenty of space. Unless it is absolutely necessary, closing in on them or trying to restrain them can make matters worse. You may need to leave the room until you have both calmed down. If you need to, call for help.
- 12. After the incident... Resist any temptation to punish the person by, for example, withdrawing a treat or ignoring them. The person may no longer be able to learn from experience, and could forget the incident very quickly. However, they may feel a general sense of unease for some time. Try to behave normally and be as reassuring as possible.
- 13. If aggressive incidents are frequent or worrying, discuss them with a professional such as a psychiatrist specialising in older people, or a community psychiatric nurse. They may be able to offer support and suggest other ways of handling the situation.
- 14. Try to avoid treating aggressive behaviour with drugs, as these can suppress the behaviour without addressing its cause and may add to the person's confusion. However, if there seems to be no other option, the doctor should prescribe the minimum dose and review the treatment very regularly.
- 15. Step 3: Work out what triggers the aggressive behaviour Think back to times when the person has become aggressive and to what events have led to their outbursts. Can you identify any common triggers? These could give you a clue as to what is troubling them. You won't be able to do this until the situation has been and gone, but once the heat of the moment has passed you may be able to think about what happened, and why. Use the list below to give you some ideas.
- 16. People with dementia may become aggressive: if they feel frustrated, under pressure or humiliated because they are no longer able to cope with the everyday demands of life. It can take longer for someone with dementia to process information and respond to situations, and this can be very distressing for them
- 17. People with dementia may become aggressive: if they feel that their independence or privacy are threatened. Being forced to accept help with intimate functions such as washing, dressing or going to the toilet can be understandably stressful. Most of us have had privacy in these areas of life since childhood
- 18. People with dementia may become aggressive: if they feel that they are being judged or criticised because they have forgotten something or have made a mistake in completing an everyday task if they feel bewildered or anxious because there is too much noise, too many people around, or a change in a familiar routine
- 19. People with dementia may become aggressive: if they feel anxious or threatened because they don't recognise certain places or people. They may be convinced that they are in the wrong place, or that a relative is a stranger who has broken into their home
- 20. People with dementia may become aggressive: if they feel frightened because of a sudden noise, sharp voices, abrupt movements or a person approaching them without warning from behind if they are in physical discomfort or pain, or if they are bored or thirsty.
- 21. Step 4: Tackle the triggers Using what you have learned in Step 3, try to find ways to avoid or minimise the situations that trigger the person's aggressive behaviour. Some of the solutions may be straightforward - for example, making sure the person always has plenty to drink. Others may require rather more thought. Some carers have found the following useful,
- 22. Tackle the triggers If the person with dementia does not seem to be coping well, reduce any demands on them and make sure they have an unrushed and stress-free routine. Wherever possible, explain things calmly and in simple sentences, allowing more time for them to respond than they would have needed before the dementia.
- 23. Tackle the triggers Find tactful ways to offer help without seeming to take over. Guide or prompt the person, and break tasks down into easily manageable steps, so that they can do as much as possible for themselves. Try not to criticise, and do your best to hide any irritation that you feel. Avoid situations where the person is set up to fail. Praise any achievements, and focus on the things that the person can still do, rather than on those that are no longer possible.
- 24. Tackle the triggers Watch out for warning signs, such as anxious or agitated behaviour or restlessness, and take action immediately to help them feel more calm and reassured. Find activities to stimulate the person's interest, and make sure that they take enough physical exercise.
- 25. Tackle the triggers Make sure that the person has regular health checks, and consult the GP immediately if they seem to be ill or in discomfort. If there seems to be no pattern to their behaviour and you are finding it very difficult to manage, don't suffer in silence - seek professional advice.
- 26. Step 5: Take time to deal with your own feelings Even if you manage not to take it personally, an incident of aggressive behaviour may well leave you feeling quite shaky, and over time this kind of behaviour can leave you feeling exhausted and distressed. Find ways to help yourself recover, both immediately after an incident and in the longer term, and tap into sources of support. Try not to bottle up your feelings or resentments - find ways to talk things through.
- 27. Time to deal with your own feelings If you do lose your temper, don't feel guilty - remember, you are under great stress - but do discuss things with a friend, a professional or another carer who may be able to suggest ways of handling such situations more calmly. Some carers find the following solutions help.
- 28. Chat things through or just have a cup of tea with a friend, relative or neighbour. Take some time to unwind on your own. Talk to the GP, community psychiatric nurse or other professionals. Join a carers' group to share experiences and offer mutual support.
- 29. BEHAVIOURS Now we will look at some unusual behaviours that we may come across whilst we are working with our client group.