Challenging behaviour in dementia

As the dementia progresses, many people develop behaviours that can be challenging. This includes restlessness and aggression.

Aggression is not just about physical acts but can be shown in other ways, including verbal aggression. These behaviours can be distressing, both for the person and the carer.

If a person with dementia becomes aggressive, it is important to remember that they are not ‘behaving badly’ and are not to blame. Their behaviour may be a direct result of changes in their brain, or be caused by a general health problem, such as pain from an infection. These behaviours can also reflect problems related to the care the person is receiving, or their general environment or social interactions. In this case, the behaviour is best viewed as an attempt to communicate an unmet need, rather than as a direct symptom of dementia. If a person is being aggressive, they should be assessed by their GP in the first instance to identify any possible underlying causes.Healthcare professionals may look at prescribing certain medications, often antipsychotic drugs, as a way of improving someone’s behaviour. However, these drugs can have severe side effects and a significant impact on a person’s quality of life. Therefore, it is vital to first consider other options that do not involve medication when deciding how best to help someone who is behaving aggressively.

Alternatives to drug treatments for aggression

Think about whether there are any specific triggers or circumstances which cause the person to become aggressive. Keeping a diary can help with this. For example, does the person become aggressive at a specific time of day or when carrying out a certain task? Aggression can often be an expression of how someone is feeling, such as frustration at not being able to do something or not being understood. It might be that the person is bored, frightened or even humiliated by the situation.

If any possible underlying causes have been addressed and the person is still behaving aggressively, there are a number of simple non-drug treatments that may help. These include life story work and reminiscence therapy, social interaction, aromatherapy, talking therapies, animal therapy, music and dance therapy and massage. 

It they do not help the person and their symptoms are severe or distressing, then medication may be necessary as a last resort. Medication treatment should be reviewed regularly (after six and/or 12 weeks). If antipsychotics are prescribed, their use should be monitored by a health professional, such as the GP, and stopped after 12 weeks, except in extreme circumstances.

Things for carers to think about around challenging behaviour:

  • Does the person’s behaviour pose a direct or immediate threat to themselves or other people?
  • Has the person been assessed by their GP to check whether they have an infection or are in pain?
  • Is the person comfortable and well cared for?
  • Is the person helped to lead an active life, with interesting and stimulating daily activities?
  • When the person is aggressive, how do you and others react?
  • What non-drug approaches have been tried?
  • If drugs are being prescribed, have the risks, side effects and benefits been discussed with you and the person with dementia? When will treatment be reviewed?
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