For families and friends who have a loved one living with dementia, the arrival of out-of-character behaviours can be difficult to deal with, especially when they take an aggressive turn, either verbally or physically.
These are often called ‘challenging behaviours’ or ‘aggressive behaviours’ in dementia, but at Care UK, we call them ‘distressed behaviours’ because they are, more often than not, caused by the actions of those around the person living with dementia, their environment or a need that is going unmet.
It’s important to remember that these behaviours can be just as challenging for the person living with dementia as they are for their loved ones who are supporting them.
Distressed behaviour is not a natural symptom of dementia. A person who is living with dementia might struggle to communicate when they are confused, in pain or have other unmet needs. As a result, they may develop distressed behaviours that challenge us, such as swearing, shouting, or becoming physically aggressive.
To understand the cause of the new behaviour, it’s important to put yourself in the shoes of the person living with dementia. Triggers of these behaviours can include:
Signs of anger and frustration can take the form of verbal aggression, such as swearing, shouting, or threatening, or physical aggression, such as striking out, scratching, biting, or throwing objects. These behaviours can arise from unmet needs, an attempt to communicate a need to others or the effects of dementia.
For example, a less common symptom of dementia known as sundowning, where towards the early evening a person believes they need to attend to the daily routines from another stage in their life, such as collecting their children from school or preparing dinner. If they are told to sit down, they may react with anger.
Changes in behaviour can also be caused or exacerbated by an infection, resulting in delusions or hallucinations, a loss of inhibitions, depression, or misunderstandings. They can also occur when a person living with dementia is bored, feels isolated or feels they are not being involved in decision making.
Understanding the reason behind a person’s behaviour is the first step towards addressing their unmet needs. Think about the situation or environment from their point of view. Is there a lot of noise? Are there too many people around that they don’t recognise? Are they wearing something uncomfortable?
Having a good understanding of the person as an individual – their unique preferences, routines, personality and life history – is an important part of this, which is why Care UK’s teams are dedicated to person-centred care. Behaviours that challenge us can link to a career, habit, or routine from another stage in a person’s life.
There are several things you can do when a person living with dementia has complex behaviours – and there are things that you should avoid doing, too.
When someone who is living with dementia is angry, they may struggle to communicate this and instead show aggressive behaviour, such as shouting, swearing or throwing objects. It’s important to try to see the situation from their point of view to understand why they are reacting in this way.
Triggers of anger for people living with dementia can include:
At Care UK, we call ‘challenging behaviours’ ‘distressed behaviours’ because they are not normal or natural symptoms of dementia. These complex behaviours can include:
Everyone experiences dementia differently, but anger is not a natural symptom of dementia. Instead, it can occur because of other symptoms of dementia, such as confusion or memory loss, or as a result of an unmet need that the individual is struggling to communicate. Read more about the different types of dementia.