Dementia behaviour changes and challenges

Key Points:

• Dementia isn’t a disease, but an umbrella term for neurological diseases that affects a person’s functioning
• There are many different types of behaviours that can develop because of dementia that may seem like a complete character change for an individual with dementia
• Carers and aged care staff should notice behaviours and what may have triggered a behaviour to help manage any unexpected outbursts

At first, the changes could be subtle, not causing too much effect on the family or the person with dementia.

It’s when the behaviour becomes more obvious, for example, a person with a usually gentle temperament suddenly having aggressive outbursts, that families can become distressed and upset.

Changes in behaviour can be very confronting and unpredictable. It all comes down to how a cognitive decline in a person with dementia affects their moods and emotions and this will be different for everyone with the condition.

For family members, it can be difficult to watch their loved one slowly become someone they don’t know.

It is equally difficult for the individual with dementia who may suddenly lose the ability to do things they have always loved, as well as feeling more and more confused by what is happening around them.

How is this happening?

Dementia is an umbrella term for a number of different neurological diseases or conditions affecting the brain. The most common ones include Alzheimer’s disease, Vascular dementia, Lewy body disease, Frontotemporal dementia and Huntington’s disease.

The changes occurring in the brain can affect the memory, mood and behaviour of someone to a large or small degree.

Behaviour changes could be caused by brain-related issues or due to changes to someone’s environment, health or medication.

For instance, frontotemporal dementia involves damage to the frontal lobes of the brain, which leads to deterioration in behaviour and other important body functions.

However, a change in environment, for example like a move into a new aged care facility, could result in a person with dementia suddenly getting scared and aggressive because they are in unfamiliar surroundings.

Finding the root cause of someone’s behaviour can help you find a way to alleviate the stress and emotions felt by the person with dementia.

​Types of behavioural changes

Increased repetitive behaviour, hoarding and becoming physically or verbally aggressive are all examples of behavioural changes.

It’s important to note the mood or reactive behavioural change of an individual with dementia and to figure out what may have triggered the reaction.

Some changes in behaviour or mood you may notice can include:

• Aggression

Whether it is physical or verbal, this emotive behaviour normally stems from anger, fear or frustration.

Some people may act irritated by a locked door, which prevents them from walking or makes them feel trapped.

Exercising regularly can help with aggressive behaviour and clear communication of a carer or nurses actions can lessen the likelihood of an individual with dementia responding aggressively out of fear.

Find the reasons behind why someone with dementia is showing aggression to fix the problem and minimise challenging behaviour.

• Catastrophic reaction

A small problem that is usually easily fixed can generate an overreaction from a person with dementia.

This could include screaming and shouting, making unreasonable accusations, agitation, stubbornness, crying or laughing uncontrollably.

An overreaction is called a ‘catastrophic reaction’, and can also be an indicator of dementia before diagnosis.

A catastrophic reaction can be quite scary to family and carers who haven’t seen this before from their family member, especially when it comes out of nowhere.

• Hoarding

While hoarding can affect many people from all walks of life, dementia can be one cause of an elderly person to hoard.

There are a few different reasons why people begin hoarding, including isolation, old memories, loss and fear.

A person with dementia might feel they have lost something and attempt to search for it continuously, resulting in items being hoarded. For example, going to the shops and buying sugar, however, already having packets of sugar accumulating at home.

Some people with dementia may even start taking things they don’t own or start accusing people of stealing from them.

This can lead to a person not trusting their caregiver or aged care facility, and they might even resist care out of fear.

• Repetitive behaviour

Repeating tasks continuously or asking the same thing over and over is common for a person with dementia.

A person with dementia can be sidetracked from repetitive behaviour by encouraging them to focus on other activities.

• Anxious behaviour

People with dementia can feel quite anxious due to changes around them for a multitude of reasons, including grief, failure and loss.

Signs of anxiety in people with dementia include restlessness, pacing or fidgeting.

A common side effect is an individual with dementia becoming “clingy”.

Being trailed by a person with dementia might be due to the person feeling lost or uncertain.

• Wandering

Wandering is when a person with dementia walks around at home, in their neighbourhood or around their aged care facility.

The person’s memory may be failing, so they can’t always tell you why they were wandering or where they were heading too.

Family or nursing homes can be quite concerned over the health and safety of the individuals when they begin to wander.

A person wandering could be due to a change in environment, loss of memory, too much energy, searching for their past, expressing boredom, confusion between night and day, agitation, seeking a job to perform, and more.

Wandering can also come in the form of ‘Sundowning’, when a person with dementia becomes confused, restless or insecure during the afternoon or early evening.

• Disinhibited behaviour

Sometimes a person with dementia may present actions that are otherwise considered rude, inappropriate or offensive.

What is considered appropriate under social rules on what to do and what not to do, can be lost due to dementia.

This behavioural change can be very challenging to confront by family members, especially when their family member has never acted in such a way before.

Disinhibited behaviour can include rude remarks, like comments about someone’s appearance; bold and inappropriate behaviour, including flirting or sexually charged comments; exposure through clothing removal at inappropriate times; or fondling of themselves in public.

Some of the reasons a person with dementia may be exhibiting this behaviour can be due to confusion, discomfort, forgetting, loss of judgement skills, or disorientation.

​What carers can do

One way carers can figure out where a challenging behaviour has stemmed from is to keep a log or diary of their behaviours and see what patterns may be developing to identify the cause of these reactions.

When a trigger is found, find ways to avoid or reduce the contact of the trigger with the person with dementia.

Always discuss aggressive behaviour problems with a doctor, who can check out whether there is a physical illness or discomfort issue causing the behaviour.

Ensure to keep up a regular routine to prevent unexpected outbursts and try to keep their surrounding environment consistent and familiar where possible. If moving into a nursing home, slowly introduce the person to their new living arrangement.

If someone with dementia is in an episode of difficult or aggressive behaviour, make sure to keep calm and stay out of reach if they are becoming violent.

Suggest things to distract the person, including asking them if they want to go get a drink with you or go for a walk outside in the garden.

Carers can access support from a number of support organisations specialising in dementia, such as Dementia Australia or Dementia Support Australia, that provide ways to access the help you need when it comes to challenging behaviours, as well as advice on handling changes in your loved ones with dementia.

If your family member with dementia is in a nursing home, talk with your aged care facility about strategies to implement to minimise challenging behaviour and to keep your older loved one with dementia safe.

Support for behavioural changes

There are a number of support options available to help you look after a loved one with challenging behaviours.

Contact a dementia phone support line, such as the National Dementia Helpline on 1800 100 500, if you need to talk or get advice, and a number of dementia support organisations offer workshops and support groups to help you or connect you with others in a similar situation.

Dementia Behaviour Management Advisory Service (DBMAS) is a support system for people with dementia when changing behaviour is having an impact on your care or becoming challenging.

DBMAS can assess someone with cognitive decline, provide clinical support, information and advice, and assist with care planning and short-term case management.

Call the DBMAS 24-hour telephone helpline on 1800 699 799.

If a loved one can no longer live at home, look for an aged care facility offering dementia-specific care, with trained staff to look after challenging behaviours.

Some nursing homes have dedicated wards for elderly people with dementia who exhibit challenging behaviours.

Use the AgedCareGuide.com.au directory to find residential aged care facilities in your area that cater for challenging behaviours.

Do you have any tips for managing triggers of people with dementia? Let us know down below.

Related Content:

What is dementia?
Specialised support for managing severe dementia behaviours
Accessing the right dementia support
Tips for dementia awareness and inclusivity