What causes changes in behaviour in people with dementia?

As human beings, we all have the same basic needs. These include physical, psychological and social needs. We do things consciously and unconsciously to meet these needs.

The symptoms of dementia can make it more difficult for someone to do this. They may also find it more difficult to communicate their needs or wishes. Changes in their behaviour may be:

• caused by them having needs that aren’t being met (for example, if they are hungry or thirsty they may seem more tired or less alert than usual)
• their attempt to meet a need (for example, if they feel too hot, they may remove clothing at inappropriate times)
• their attempt to communicate a specific need to others (for example, if they need to use the toilet they may shout out).

Below are examples of how different types of needs may affect someone’s behaviour.

Physical needs

• The person may be in pain or discomfort. For example, they may be thirsty, need the toilet, or generally feel unwell. They may have an infection or constipation. Or they may have been in one position for too long, or find the chair they are sitting in uncomfortable.
• The person may experience side effects from medication, such as drowsiness or confusion. This can also make it harder for them to communicate how they’re feeling or what they need.
• The environment may not be comfortable for the person. For example, it could be too hot or too noisy, or they may not like the music or TV programme that is on. Make changes to the person’s surroundings if necessary. For example, this could mean reducing or changing the sounds around them, improving the lighting or adjusting the temperature. It may also help to keep familiar or comforting items close to the person, such as photographs or a favourite jumper.
• The person may have a condition such as sight loss or hearing loss. This can mean that they mistake something they see, hear, smell or touch for something else. The person should have their eyesight and hearing tested. Help make sure they wear glasses and a hearing aid that are clean and working properly, if they need them.
• The person may be sexually frustrated.

Psychological needs

• The person may be frustrated by their situation – for example, not being able to do the things they used to. They may also be frustrated if other people assume they can’t do things for themselves and take over.
• The person may feel depressed, anxious, or have a mental health condition.
• The person may be having delusions (strongly believing things that aren’t true), or hallucinations (seeing things that aren’t there). These can be confusing and frightening, and may affect how the person reacts to a situation.
• The person may feel confused or unsettled by an environment that doesn’t seem familiar to them. They may think they are in the wrong place.
• The person may seem to experience reality differently to you. For example, they may believe they have to go to work even though they’re no longer working.
• The person may misunderstand the intentions of those caring for them. For example, they may see personal care as threatening or an invasion of their personal space.

Often psychological needs can be met in simple ways, such as listening to and talking with the person, or changing the subject or moving their focus onto an activity they enjoy. However, some people may benefit from specialist support. Consider whether the person may benefit from psychological therapies with professionals, such as cognitive stimulation therapy or reminiscence therapy. 

Social needs

• The person may be feeling lonely or isolated. They might not spend much time with others, or they may not feel included.
• The person may be bored or not have much to stimulate their senses.
• If the person has different visitors such as care workers, they may all have their own approaches and routines. This can be confusing for the person.
• The person may be trying to hide their condition from others or may not be aware of the difficulties they’re having.

Help the person to have a daily routine and support them to be independent and do as much as they can for themselves. The behaviour may be the person’s response to feeling they’re not able to contribute or are not valued by others. It may be helpful to encourage the person to find the answer for themselves. For example, if the person keeps asking the time, consider buying a clock that is easy to read, and keep it where they can see it.

Staying connected can help someone feel comforted and stimulated. Help the person to stay in touch with other people. For example, you could help to arrange visits, or phone or video calls.

Support the person and make adaptations if necessary, to continue their interests or things they enjoy or find useful, for example making music or exercising. They may also enjoy activities that engage their senses. These may include aromatherapy, art (such as colouring or crafts) or doll therapy.