Behaviours that challenge when supporting a person with dementia

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.

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People with dementia do not inevitably become withdrawn. Often, becoming withdrawn is a response to isolation, boredom or low self-esteem and indicates unmet physical or psychological needs.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.

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.

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.