Understanding changed behaviours
Many people with dementia experience changes in behaviour. Understanding the causes of changes can help you respond and care well for them.
Common changes
Here are some of the most common behaviour changes for people living with dementia can experience – and some useful tips to help you respond to them appropriately. Remember, we’re here to help so Live Chat with us or call us anytime for more personalised support. Click on the behaviour below to learn more.
Agitation
There are many reasons why the person you care for may become aggressive or agitated. They might be frustrated by changes around them. They might find everyday tasks more difficult or may be in pain but can’t communicate this clearly. Not feeling in control can also make a person feel threatened or angry. And if behaviour changes suddenly, it could be caused by infections that are easily treatable.
For more information, download the Understanding agitation helpsheet.
Tips:
- Try to remain calm and avoid arguing or reasoning. Acknowledge how the person is feeling and reassure them.
- Ask or look for signs of pain and discomfort, such as wincing, grimacing, clenching teeth, groaning or frowning.
- Offer a drink or snack.
- Take them for a short walk for a change of scenery. Being outdoors can help improve a person’s mood.
- Figure out if they need comfort and reassurance or some space. Avoid bringing up the incident again and move on to something new.
- Ask the person’s GP to check for infections if you notice a sudden change in behaviour.
Aggression
Aggression is a term used to describe verbal or physical abuse or violence directed towards a person or an object, including pushing out at others, throwing belongings around the room or yelling out and making threats. This action often masks underlying causes and, most importantly, what the person themselves are experiencing such as pain or discomfort. It is important to consider the reasons or message that a person living with dementia is trying to express through these behaviours.
For more information, download the Understanding aggression helpsheet.
Tips:
- Consider what happened before you noticed the aggression to understand if there have been recent changes for the person or other potential reasons (e.g. pain, confusion) that might contribute to this change.
- Understand how often the behaviour occurs and try to describe events in detail as this can provide a comprehensive picture for identifying any patterns and potential causes.
- Give the person space to vent or express themselves safely and self-sooth.
- Ensure safety in situations of high risk – for example, leave and re-approach the person when they have calmed down and are willing to engage. Alternatively try to encourage the person into a safe environment with low stimulation and as few people around as possible.
- Remember undiagnosed or under-treated pain can also lead to behaviours that may present as aggressive.
Anxiety
When someone doesn’t feel familiar in their surroundings, they can often feel scared, confused, frustrated or sad. This may make the person seem nervous, tense or unable to relax – or they may become upset when you’re not there. They may show physical symptoms too, such as shaking, palpitations or sweating.
For more information, download the Understand anxiety helpsheet.
Tips:
- Think about routine: has there been any change to the person’s usual activities or environment? Can they be with people who are important to them and do meaningful activities?
- Encourage them to do activities they find relaxing, such as walking, gardening, reading or listening to music.
- Offer new information as you go, rather than giving a full list of the daily plan.
- Encourage them to talk about their feelings and take the time to listen.
- Encourage the person to take 10 gentle, slow breaths with you.
Apathy
Watching the person you care for lose interest in the world around them can be disheartening. They may no longer take a role in the household and sit quietly. They might not start conversations and show little interest in friends or family members. This may be because they have forgotten how to do an activity.
For more information, download the Understanding apathy helpsheet.
Tips:
- Try to maintain a daily routine and keep this visible using a calendar or chalkboard.
- Use things you know the person enjoyed before to help get them started with activities.
- Start doing activities with the person until they continue by themselves – show rather than tell.
- Try positive phrases like “It’s time to go on our morning walk,” rather than asking the person if they would like to go.
- Try different strategies to see what works best for them. Some may work better than others.
Disinhibition
It can be confusing and confronting when the person you care for says or does things that are out of character or rude. These behaviours may occur due to changes in the brain, triggers in the environment, or through illness. The person may be responding to a situation that they have misread or misunderstood. Disinhibited behaviours are common and may include making tactless or offensive comments, taking clothes off in an unexpected setting/situation, talking to strangers as if they know them, or losing sexual inhibition.
For more information, download the Understanding disinhibition helpsheet.
Tips:
- Remember, the person is not deliberately trying to offend or embarrass you.
- Remain calm and try not to react in a negative way. A quiet response will be helpful, even though you may find the situation embarrassing or distressing.
- Redirect the person’s focus onto something else and, if necessary, move to a different environment.
- Consider the potential causes. A quick mental checklist may help to identify the cause and support you to respond.
Hallucinations
Seeing or hearing things that are not there can be confusing and frightening for the person you care for and you. Hallucinations in dementia are most commonly visual but can involve other senses like hearing and touch. They may be a result of sensory or physical changes, or a response to medication.
For more information, download the Understanding hallucinations helpsheet.
Tips:
- Remember that what the person is experiencing is real to them and may make them angry or feel frightened.
- Validate their feelings: let the person know that you understand what they are feeling and believing.
- Speak to their GP about possible physical causes, such as delirium, dehydration, infections, or reactions to medication.
- Get the person’s eye health and vision checked. Hallucinations may be related to some eye conditions that can cause vision loss.
Personal care
Many things can lead to changes in personal care routine. The person you care for might be in pain, feel cold or confused, or can no longer recognise objects, like a toilet or shower. They might feel embarrassed or scared of someone else being there.
For more information, download the Understanding distress during personal care helpsheet.
Tips:
- Consider their personal preferences: do they prefer a warm bath before bed, or have they always taken a morning shower?
- Ask or look for signs of pain and discomfort, e.g. wincing, grimacing, clenching teeth, groaning or frowning. Address any pain before helping with personal care.
- Consider the bathroom environment: is it warm enough and well lit?
- Encourage the person to do as much as they can for themselves, such as undressing or using a face cloth.
- Use music to reduce anxiety for everyone. Try playing the person’s favourite music as they get ready for a shower or bath.
- If the person becomes agitated, take a step back and stand quietly until they are ready for you to help again.
- Be realistic and flexible: showering a couple of times a week is perfectly acceptable. Take the wins, making a note of what worked and what did not.
Sleep changes
The person you care for may be restless at night or wake very early in the morning. They may not be able to tell the difference between night and day. There are many reasons why a person’s sleep might change, including their environment (like feeling too hot or cold), new medications or other causes.
For more information, download the Understanding sleep changes helpsheet.
Tips:
- Speak to a GP to make sure it isn’t triggered by physical or medical causes.
- Check the bedroom: is it too hot or cold? Is it quiet and dark enough?
- Keep the environment consistent: did they sleep with a hot water bottle in winter?
- Cut down caffeine and alcohol. If they like a cup of tea or coffee in the afternoon, switch to decaf.
- Keep active: schedule activities during the day and avoid sleeping in the afternoon.
- Aim for at least 30-60 minutes of daylight exposure every day to help reset the ‘body clock’ and regulate sleep patterns.
Wanting to leave
When a person with dementia doesn’t recognise their surroundings or the people around them, they may want to leave. They may ask to go home, go to work or to pick up their children from school. Often what they’re looking for is somewhere familiar or more comfortable, but they may also be unwell or experiencing pain, unable to express this. They can also become agitated and upset if you try to stop them.
For more information, download the Understanding wanting to leave helpsheet.
Tips:
- Store items such as keys, coats, handbags, and suitcases out of sight.
- Ask the person where and why they want to go. Give them time to talk and reassure them about their wishes and concerns.
- Try to redirect the person’s attention to something that they enjoy.
- Think about the environment the person is in: Has it changed recently? Are there ways to make it feel more familiar, e.g. family photos, familiar objects or their favourite music.
Walking or pacing
The term ‘wandering’ is often used to describe the movement of people with dementia and is best avoided as it implies the walking is not purposeful or meaningful. In fact, there is often a reason or a purpose from the person’s perspective.
Walking, in itself, is not an issue if the environment is safe. However, repetitive walking which results in distress or discomfort for the person living with dementia needs further evaluation.
For more information, download the Understanding walking or pacing helpsheet.
Tips:
- Consider the person’s social, cultural and occupational history and their preferences for physical activity – e.g. have they always been an avid walker, did they previously lead an active lifestyle?
- Consider pain as a potential contributing factor – look out for signs of pain or discomfort from the person’s facial expressions, other changes in behaviour, any vocalisations and abnormal rubbing, leaning or limping. It is common for person with dementia to stand, walk more or avoid sitting due to pain.
- Consider wayfinding difficulties or environmental triggers – e.g. the person might be looking for their room, an exit, or wanting to get access to the outdoors.
- Supportive strategies for addressing repetitive walking and pacing need to be tailored to the person and their needs – e.g. engagement in activities appropriate to the person’s interest and ability to concentrate, or providing access to outdoors.
Agitation
There are many reasons why the person you care for may become aggressive or agitated. They might be frustrated by changes around them. They might find everyday tasks more difficult or may be in pain but can’t communicate this clearly. Not feeling in control can also make a person feel threatened or angry. And if behaviour changes suddenly, it could be caused by infections that are easily treatable.
For more information, download the Understanding agitation helpsheet.
Tips:
- Try to remain calm and avoid arguing or reasoning. Acknowledge how the person is feeling and reassure them.
- Ask or look for signs of pain and discomfort, such as wincing, grimacing, clenching teeth, groaning or frowning.
- Offer a drink or snack.
- Take them for a short walk for a change of scenery. Being outdoors can help improve a person’s mood.
- Figure out if they need comfort and reassurance or some space. Avoid bringing up the incident again and move on to something new.
- Ask the person’s GP to check for infections if you notice a sudden change in behaviour.
Aggression
Aggression is a term used to describe verbal or physical abuse or violence directed towards a person or an object, including pushing out at others, throwing belongings around the room or yelling out and making threats. This action often masks underlying causes and, most importantly, what the person themselves are experiencing such as pain or discomfort. It is important to consider the reasons or message that a person living with dementia is trying to express through these behaviours.
For more information, download the Understanding aggression helpsheet.
Tips:
- Consider what happened before you noticed the aggression to understand if there have been recent changes for the person or other potential reasons (e.g. pain, confusion) that might contribute to this change.
- Understand how often the behaviour occurs and try to describe events in detail as this can provide a comprehensive picture for identifying any patterns and potential causes.
- Give the person space to vent or express themselves safely and self-sooth.
- Ensure safety in situations of high risk – for example, leave and re-approach the person when they have calmed down and are willing to engage. Alternatively try to encourage the person into a safe environment with low stimulation and as few people around as possible.
- Remember undiagnosed or under-treated pain can also lead to behaviours that may present as aggressive.
Anxiety
When someone doesn’t feel familiar in their surroundings, they can often feel scared, confused, frustrated or sad. This may make the person seem nervous, tense or unable to relax – or they may become upset when you’re not there. They may show physical symptoms too, such as shaking, palpitations or sweating.
For more information, download the Understand anxiety helpsheet.
Tips:
- Think about routine: has there been any change to the person’s usual activities or environment? Can they be with people who are important to them and do meaningful activities?
- Encourage them to do activities they find relaxing, such as walking, gardening, reading or listening to music.
- Offer new information as you go, rather than giving a full list of the daily plan.
- Encourage them to talk about their feelings and take the time to listen.
- Encourage the person to take 10 gentle, slow breaths with you.
Apathy
Watching the person you care for lose interest in the world around them can be disheartening. They may no longer take a role in the household and sit quietly. They might not start conversations and show little interest in friends or family members. This may be because they have forgotten how to do an activity.
For more information, download the Understanding apathy helpsheet.
Tips:
- Try to maintain a daily routine and keep this visible using a calendar or chalkboard.
- Use things you know the person enjoyed before to help get them started with activities.
- Start doing activities with the person until they continue by themselves – show rather than tell.
- Try positive phrases like “It’s time to go on our morning walk,” rather than asking the person if they would like to go.
- Try different strategies to see what works best for them. Some may work better than others.
Disinhibition
It can be confusing and confronting when the person you care for says or does things that are out of character or rude. These behaviours may occur due to changes in the brain, triggers in the environment, or through illness. The person may be responding to a situation that they have misread or misunderstood. Disinhibited behaviours are common and may include making tactless or offensive comments, taking clothes off in an unexpected setting/situation, talking to strangers as if they know them, or losing sexual inhibition.
For more information, download the Understanding disinhibition helpsheet.
Tips:
- Remember, the person is not deliberately trying to offend or embarrass you.
- Remain calm and try not to react in a negative way. A quiet response will be helpful, even though you may find the situation embarrassing or distressing.
- Redirect the person’s focus onto something else and, if necessary, move to a different environment.
- Consider the potential causes. A quick mental checklist may help to identify the cause and support you to respond.
Hallucinations
Seeing or hearing things that are not there can be confusing and frightening for the person you care for and you. Hallucinations in dementia are most commonly visual but can involve other senses like hearing and touch. They may be a result of sensory or physical changes, or a response to medication.
For more information, download the Understanding hallucinations helpsheet.
Tips:
- Remember that what the person is experiencing is real to them and may make them angry or feel frightened.
- Validate their feelings: let the person know that you understand what they are feeling and believing.
- Speak to their GP about possible physical causes, such as delirium, dehydration, infections, or reactions to medication.
- Get the person’s eye health and vision checked. Hallucinations may be related to some eye conditions that can cause vision loss.
Personal care
Many things can lead to changes in personal care routine. The person you care for might be in pain, feel cold or confused, or can no longer recognise objects, like a toilet or shower. They might feel embarrassed or scared of someone else being there.
For more information, download the Understanding distress during personal care helpsheet.
Tips:
- Consider their personal preferences: do they prefer a warm bath before bed, or have they always taken a morning shower?
- Ask or look for signs of pain and discomfort, e.g. wincing, grimacing, clenching teeth, groaning or frowning. Address any pain before helping with personal care.
- Consider the bathroom environment: is it warm enough and well lit?
- Encourage the person to do as much as they can for themselves, such as undressing or using a face cloth.
- Use music to reduce anxiety for everyone. Try playing the person’s favourite music as they get ready for a shower or bath.
- If the person becomes agitated, take a step back and stand quietly until they are ready for you to help again.
- Be realistic and flexible: showering a couple of times a week is perfectly acceptable. Take the wins, making a note of what worked and what did not.
Sleep changes
The person you care for may be restless at night or wake very early in the morning. They may not be able to tell the difference between night and day. There are many reasons why a person’s sleep might change, including their environment (like feeling too hot or cold), new medications or other causes.
For more information, download the Understanding sleep changes helpsheet.
Tips:
- Speak to a GP to make sure it isn’t triggered by physical or medical causes.
- Check the bedroom: is it too hot or cold? Is it quiet and dark enough?
- Keep the environment consistent: did they sleep with a hot water bottle in winter?
- Cut down caffeine and alcohol. If they like a cup of tea or coffee in the afternoon, switch to decaf.
- Keep active: schedule activities during the day and avoid sleeping in the afternoon.
- Aim for at least 30-60 minutes of daylight exposure every day to help reset the ‘body clock’ and regulate sleep patterns.
Wanting to leave
When a person with dementia doesn’t recognise their surroundings or the people around them, they may want to leave. They may ask to go home, go to work or to pick up their children from school. Often what they’re looking for is somewhere familiar or more comfortable, but they may also be unwell or experiencing pain, unable to express this. They can also become agitated and upset if you try to stop them.
For more information, download the Understanding wanting to leave helpsheet.
Tips:
- Store items such as keys, coats, handbags, and suitcases out of sight.
- Ask the person where and why they want to go. Give them time to talk and reassure them about their wishes and concerns.
- Try to redirect the person’s attention to something that they enjoy.
- Think about the environment the person is in: Has it changed recently? Are there ways to make it feel more familiar, e.g. family photos, familiar objects or their favourite music.
Walking or pacing
The term ‘wandering’ is often used to describe the movement of people with dementia and is best avoided as it implies the walking is not purposeful or meaningful. In fact, there is often a reason or a purpose from the person’s perspective.
Walking, in itself, is not an issue if the environment is safe. However, repetitive walking which results in distress or discomfort for the person living with dementia needs further evaluation.
For more information, download the Understanding walking or pacing helpsheet.
Tips:
- Consider the person’s social, cultural and occupational history and their preferences for physical activity – e.g. have they always been an avid walker, did they previously lead an active lifestyle?
- Consider pain as a potential contributing factor – look out for signs of pain or discomfort from the person’s facial expressions, other changes in behaviour, any vocalisations and abnormal rubbing, leaning or limping. It is common for person with dementia to stand, walk more or avoid sitting due to pain.
- Consider wayfinding difficulties or environmental triggers – e.g. the person might be looking for their room, an exit, or wanting to get access to the outdoors.
- Supportive strategies for addressing repetitive walking and pacing need to be tailored to the person and their needs – e.g. engagement in activities appropriate to the person’s interest and ability to concentrate, or providing access to outdoors.
Understanding Behaviour Support Plans
It is now a legislative requirement for Aged Care providers to use Behaviour Support Plans.
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