Unusual Behaviour
- 1. Unusual behaviour If you are caring for a person with dementia, you may sometimes find their behaviour confusing, irritating or difficult to deal with, leaving you feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, you will find it easier to stay calm and deal effectively with the challenges that arise.
- 2. What do we mean by 'unusual behaviour'? Certain types of behaviour are particularly common in people with dementia. These include: Repetitive questioning, actions or movements Trailing the carer around the house Hiding and losing things Shouting and screaming
- 3. Why do some people with dementia behave like this? People often behave in certain ways in order to communicate what they want or how they are feeling. If the person you are caring for has difficulty expressing themselves in words, their behaviour may become more extreme. You will find it easier to deal with the challenge if you understand what the person is trying to tell you. This information sheet outlines some of the most typical sorts of unusual behaviour in people with dementia and explains some common causes.
- 4. Unusual behaviour Certain forms of behaviour are particularly common in people with dementia. By working out what each behaviour means, and finding ways to overcome the problem, the situation can become more manageable.
- 5. Repetitive behaviour People with dementia often carry out the same activity, make the same gesture or ask the same question repeatedly. Medical professionals sometimes call this 'perseveration'. This can be because they don't remember having done it previously, but it can also be for other reasons, such as boredom. If the behaviour is becoming very repetitive, try to distract the person with an activity. If you can't contain your irritation, make an excuse to leave the room for a while
- 6. Asking the same question over and over again As well as memory loss, this can be due to the person's feelings of insecurity or anxiety about their ability to cope. Try to be tactful and patient, and encourage them to find the answer for themselves - for example, if they keep asking the time suggest that they look at the clock themselves. People with dementia may become anxious about future events such as a visitor arriving, which can lead to repeated questioning. It may help if you don't mention the event until just before it takes place.
- 7. Repetitive phrases or movements This can be due to noisy or stressful surroundings, or boredom. Encourage the person to do something active, such as going for a walk. It can also be a sign of discomfort, so check that the person isn't too hot or cold, hungry, thirsty or constipated. Contact the GP if there is any possibility that they are ill or in pain, or if medication is affecting them.
- 8. Repetitive actions Actions such as repeatedly packing and unpacking a bag, or rearranging the chairs in a room, may relate to a former activity such as travelling or entertaining friends. If so, it may serve as a basis for conversation. Alternatively, it could signify boredom or a need for more contact with people.
- 9. Repeatedly asking to go home This can take place in residential care, or when the person is already at home. It can be a sign of anxiety, insecurity, fear or depression. The concept of 'home' might evoke memories of a time or place where they felt comfortable or safe, or of a home, family and friends that no longer exist
- 10. Repeatedly asking to go home . If the person doesn't recognise where they are now as home, then it isn't home for them. Try to understand and acknowledge the person's feelings and reassure them that they are safe and loved.
- 11. Restlessness Some people with dementia suffer from general restlessness. This can be a sign of hunger, thirst, constipation or pain, or they may be ill or suffering from the side-effects of medication. Other possibilities are boredom, anger, distress or anxiety, stress due to noisy or busy surroundings, or because they need more exercise
- 12. Restlessness . It may also be due to changes that have taken place in the brain. If they seem upset, try to find the reason and reassure them, and try to distract them with an interesting activity or by involving them in some form of exercise.
- 13. Pacing up and down Pacing may indicate that the person wants to use the toilet but is unable to tell you. Try asking them whether they need to use the toilet or leading them towards the toilet.
- 14. Pacing up and down If they are adamant that they want to pace, try to find somewhere they can walk safely, help them choose comfortable clothes and shoes, offer drinks and snacks, check their feet regularly for redness, swellings or blisters, and try to persuade them to rest from time to time.
- 15. Fidgeting People with dementia may fidget constantly. As with pacing, try to distract their attention and offer reassurance. Try giving them something to occupy their hands, such as a soft toy or worry beads, or provide a 'rummage' box containing interesting objects.
- 16. Other types of unusual behaviour There are a number of other types of behaviour that are particularly common in people with dementia. In general, try to distract the person and offer plenty of reassurance
- 17. Shouting and screaming The person may continually call out for someone or shout the same word or scream or wail over and over again. The person could be in pain or ill, experiencing hallucinations, or their behaviour could be a result of brain damage. In these cases, talk to the GP.
- 18. Shouting and screaming They could be lonely or distressed, anxious about their failing memory, bored, or stressed by too much noise and bustle. If they shout out at night, a nightlight in the bedroom may be reassuring. If they are calling for someone from their past, try talking to them about their past
- 19. Lack of inhibition The person may behave in a way that other people find embarrassing because of their failing memory and general confusion. In a few cases, this may be due to specific damage to the brain. Try to react calmly. If they undress or appear naked in public, they may have forgotten when and where it is appropriate to remove their clothes. Take them somewhere private, and check whether they are too hot or are uncomfortable or whether they want to use the toilet.
- 20. Lack of inhibition Lifting a skirt or fiddling with flies may be a sign that the person wants to use the toilet. If they start to stroke their genitals in public, discourage them tactfully and try to distract their attention. If such behaviour is frequent or persistent, consult the GP. .
- 21. Lack of inhibition If they behave rudely - for example, by insulting people or swearing or spitting - don't attempt to argue or correct them. Just try to distract their attention, and explain to other people later that their behaviour is due to dementia and is not directed at them personally.
- 22. Night-time waking Many people with dementia are restless at night and find it difficult to sleep. Older people often need less sleep than younger people in any case. Dementia can affect people's body clocks so that they may get up in the night, get dressed or even go outside. This can be very worrying - and exhausting - for carers. Make sure the person has enough exercise during the day and that they use the toilet before bed. Try a walk before bedtime, a warm milky drink and soothing company before they fall asleep. If they wake up, gently remind them that it is night-time.
- 23. Trailing and checking Living with dementia makes many people feel extremely insecure and anxious, which can result in constantly following the carer round, or calling out to check where they are. A few moments may seem like hours to a person with dementia, and they may only feel safe if you are nearby.
- 24. Trailing and checking This behaviour can be very difficult to cope with, but try not to speak sharply. If you are busy, give them something absorbing to do - perhaps a pet or toy to play with, or you can hum or sing, or put the radio on. Make sure you also find some time for yourself
- 25. Hiding and losing things People with dementia sometimes hide things and then forget where they are - or that they have hidden them at all. The wish to hide things may be due to feelings of insecurity and a desire to hold on to the little that they still have. However impatient you feel, try to be reassuring.
- 26. Hiding and losing things Don't leave important documents lying around, and make sure you have a spare set of keys. Try and find out the person's hiding places so that you can tactfully help them to find 'missing' items. If they hide food, check hiding places regularly, and discreetly dispose of any perishable items.
- 27. Suspicion Some people with dementia can become suspicious. If they mislay an object, they may accuse someone of stealing from them, or they may imagine that a friendly neighbour is plotting against them. These ideas may be due to failing memory, an inability to recognise people, and the need to make sense of what is happening around them
- 28. Suspicion . If this happens, state calmly what you know to be true, if appropriate, and then reassure and distract the person. Explain to others that they shouldn't take unfounded accusations seriously. However, don't automatically dismiss the person's suspicions if there is any possibility that they may be true.
- 29. How to cope with unusual behaviour Try to remember that the person you are caring for is not being deliberately difficult. Ask yourself whether their behaviour is really a problem. Try to put yourself in the person's situation. Imagine how they might be feeling and what they might be trying to express.
- 30. How to cope with unusual behaviour Offer as much reassurance as you can, by touching and holding. Distract them with calming activities such as a hand massage, stroking a pet, a drive in the country or by playing their favourite music. Try to make sure that you have support for yourself and breaks when you need them.
- 31. How to cope with unusual behaviour If you find the person's behaviour really difficult to deal with, ask for advice from professionals or other carers before you become too stressed. Medication may sometimes be used for these behaviours. The person with dementia's GP must monitor and review such medication very carefully. Ask about the side-effects of any drugs so that if they appear you do not automatically assume that the dementia has become worse.
- 32. UNUSUAL BEHAVIOURS Thank you for your time. Mr C Spain