Behavioural Changes

• Most, but not all, behaviour changes seen in persons with dementia are thought to be a response to a cue or trigger they experience.
• ‘Responsive behaviours’ are being recognized as a form of communication and the persons’ best attempt to respond to their current situation and communicate their unmet needs.
• Some of these behaviours are disruptive and can be a great burden for family caregivers.
• There are numerous strategies that can be tried to avoid or reduce disruptive behaviours.
• Successful management of disruptive behaviours requires a team approach with health care providers and caregivers to understand a loved one needs that may be behind these dementia related behaviours.

• Sudden changes in behaviour are important to recognize as these are often the only clue that an older person is sick, getting worse in their dementia, becoming depressed, and/or having a side effect from a new medication.
• Attention to your family member's behavioural and psychological symptoms are key to improving and maintaining their quality of life.

Types of Disruptive Behaviours

Behaviours that cause the greatest burden on caregivers include the following:

• sleep disturbance
• increased agitation in the late afternoon or evening (sundowning)
• repeating sounds words or phrases
• physical aggression
• arguing
• wandering
• showing signs of depression
• resisting help with activities like dressing, washing, toileting, eating
• suspiciousness
• accusations (e.g., theft, infidelity)
• delusions
• hallucinations
• paranoia about having clothing, jewelry or money stolen

Over time, these behaviours place a growing burden on caregivers. Successful management means making adjustments in the understanding of what can influence or trigger behaviours and implementing approaches to care tailored to the individual with an emphasis on their remaining abilities and strengths.

Ways to Avoid or Reduce Disruptive Behaviours

Ways to avoid or reduce these behaviours include:

• set up daily routines
• avoid big changes in the environment as this may trigger agitation
• provide a calm and safe environment (e.g. avoid moving furniture, avoid throw rugs and trip hazards, reduce loud and unexpected noises)
• encourage physical activity during the day, such as exercises or walks, to help work off anxiety and excessive energy
• respond to your family member's emotions, provide reassurance, touch, and hugs
• avoid arguing as this may increase agitation; instead change the subject and engage the patients’ long term memory such as asking about a spouse, children or a favorite sport
• be empathetic to your family member's problems
• maintain a consistent approach among all caregivers in managing the behaviour
• consider whether a day program may be helpful, as program staff are usually familiar in dealing with behavioural issues and it will provide a break for you, the caregiver

If you notice a change in your family member's behaviour, here are some suggestions about what to do.

• Write down what the changes are, how long they have been going on, and what makes them better or worse. This information will help the health care provider decide what the problem might be, how it started, and how to treat it.
• Never change medications or add new ones – this is the responsibility of the health care provider.
• Ask others who have contact with your family member to see if they have noticed any changes in behaviour.

When Medical Help is Required

• If you notice a negative change in your family member's behaviour, talk to the health care provider directly about the problem. Make an appointment as soon as possible, and watch for any signs that the behaviours are getting worse or changing in some way.
• Some behaviours are due to structural changes in the brain, caused by the disease and may require medications.
• Some newer anti-psychotic and antidepressant medications, as well as the use of cognitive-enhancing drugs, have been shown to be helpful.
• Often it is a case of trial-and-error to figure out which drugs (or combination of drugs) have the best effect in improving behaviours.
• If behaviours become overwhelming, a referral to a specialist or inpatient behavioural unit may be necessary.
• A team approach is the best way of providing care to an older person with

While the content of each Caregiver College Topic may be linked to a variety of other Topic areas, the following have been identified as a Key Linkage which you may be interested in also reviewing

• Delirium
• Dementia
• Depression

Helpful Resources

Active Seniors' Options

• This website provides the user with information on older people and identifies other important sites with direct links to them.

Depression in Seniors

• This website explores the various components of depression and behavioural changes. It includes a wide array of further readings and online resources on depression and depression in dementia.

HereToHelp - Confusing Behaviours

• This website, developed by BC Partners for Mental Health and Addictions Information, provides easy-to-read information including fact sheets, toolkits and workbooks.

American Geriatrics Society – Foundation for Health In Aging

• Understanding Behavior Disorders Related to Dementia examines changes in behaviour and resulting strategies.

Alzheimer Society of Canada

• This Society has developed a list of 10 warning signs to help you know what to look for. It is important to see a doctor when you first notice any of the warning signs as they may be due to depression, drug interactions, infections or Alzheimer's disease.