Behavioural challenges when supporting a person with dementia
Supporting a person with dementia can be very rewarding. But situations can arise that are difficult for the person with dementia or those supporting them – or both parties.
Explore the links below to find out more about some of the most common difficult situations that can arise when supporting a person with dementia.
It is very difficult to be faced with aggressive behaviour from a person with dementia we are caring for. We need to try to see things from the person's point of view. Usually, aggressive behaviour communicates an important message. When we understand the message, we can meet the person's needs and prevent the situation from happening again.
A different reality
A person with dementia may believe that things from the past are happening now or may see things that aren’t there: this is their reality. The person's 'reality' will often be just as real to them as our 'reality' is to us. Both telling the truth and lying can cause distress. It's better to respond to the person’s feelings and try to address their needs.
Problems related to using the toilet
People with dementia may experience difficulties with their continence for a number of reasons. These problems can often produce strong feelings in the person, such as embarrassment and anxiety. Using the toilet is a complex activity, and specific problems can often be addressed through understanding the nature of the difficulties faced by an individual.
Memory problems in dementia often cause people to repeat themselves. This may test our patience, but there are various things we can do to help. Memories that are shared frequently are often very significant for the person.
People with dementia might walk for a variety of reasons. Once we understand the reason, we know whether there's anything we need to do. If we are concerned that the person is at risk, we need to give full consideration to the person's abilities and difficulties to come up with a plan that meets their needs.
There are many reasons why a person with dementia may not be prepared to do exactly what we would like them to do. A person with dementia should not be expected to follow our wishes or conform to our standards, in fact, we should be doing our best to cooperate with them. We need to consider our approach and to gain as much knowledge as we can about the person, their standards and preferences.
It is perfectly natural and normal for people with dementia to have sexual needs. 'Inappropriate sexual behaviour' may be labelled as such because of other people's prejudices or preconceptions. Staff can give sensitive support to help people to express their sexuality appropriately. Behaviour that seems sexual may actually be prompted by other needs. Having dementia does not automatically mean that a person lacks capacity to consent to sex. We need to uphold people's rights to privacy.
People with dementia do not inevitably become withdrawn. Often, becoming withdrawn is a response to isolation, boredom or low self-esteem and indicates unmet physical or psychological needs. People with advanced dementia may not be able to interact much, but they may still be very alert to what is going on around them. When a person is withdrawn, never treat them as if they're not there. It is important to try to find ways of making contact with people who are withdrawn.
Antipsychotic medication and dementia
If the behaviours of the person with dementia cause significant distress, or involve risks to the person or others, the person may be prescribed antipsychotic medication. This medication can have unpleasant and dangerous side effects for people with dementia, making daily life much more difficult for them. Research indicates that people with dementia have been prescribed antipsychotic medication too readily, and best practice guidelines now recommend a considerable reduction in their use.
Alternatives to antipsychotic medication
Antipsychotic medication has been used too often in the care of people with dementia. They help some people with dementia, but cause unnecessary problems for most people who take them. Antipsychotic medication should be a last resort in helping people with dementia who are behaving in ways that challenge others. If people with dementia are behaving in ways that challenge others, it's important to try non-medical ways of meeting their needs first.
All SCIE resources are free to download, however to access the following download you will need a free MySCIE account:
- What the research says: Difficult situations
Useful links Open
Alternatives to antipsychotic medication: psychological approaches in managing psychological and behavioural distress in people with dementia
This 2013 British Psychological Society briefing paper sets out guidance for practitioners on how to respond to distress in people with dementia by following a ‘staged approach’: a series of steps involving identifying, understanding and implementing individualised interventions.
The Alzheimer’s Society produces over 80 factsheets on all sorts of topics related to dementia, including many that relate to difficult situations in supporting a person living with dementia: Dementia and aggressive behaviour (509), Sight, perceptions and hallucinations in dementia (520), Managing toilet problems and incontinence (502), Walking about (501), and Sex and intimate relationships (514).
Dementia: Supporting people with dementia and their carers in health and social care
This 2006 guideline jointly published by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) offers comprehensive best-practice advice on the care of people with dementia and on support for carers.
Positive and proactive care: reducing the need for restrictive interventions
The Department of Health’s 2014 guidance on restraint is aimed at all health and social care staff working with adults in England.