Dementia and challenging behaviour sometimes go hand in hand on a daily basis if you work in a dementia care home. This could be mentally or physically from the person such as pushing you away or verbally shouting at you. Working in health and social care can be challenging at times and in this article, we will provide you with some tips for dealing with challenging behaviour in dementia clients.
We emphasise that proactive practices can help move away from reactive crisis management. The aim of this article is to outline behaviours that can be proactively identified, with strategies developed to enhance the lives of those living with Dementia.
There are many forms of challenging behaviour, but as Leanne Cunliffe from Care for Me Training points out; not all of these behaviours are aggressive.
Here are some examples of aggressive behaviours that challenge:
Examples of behaviours that challenge which are non-aggressive forms are:
As dementia develops, it can cause behaviour changes that can be confusing, irritating or difficult for others to deal with, leaving carers, partners and family members feeling stressed, irritable or helpless. By learning to understand the meaning behind the actions, it can be easier to stay calm and deal effectively with the challenges that arise.
Depending on the progression of dementia, then the levels of challenging behaviour will vary and the individual’s background may also explain their frustration. Imagine being in their position if they cannot verbally communicate or you do not understand them, how else would you communicate with someone?
Peter Gathercole from Endeavour Care Training adds:
Often we look at behaviour as a challenge rather than look at the cause of the distress, establishing why someone is distressed will help us formulate the correct response in reducing the distress the person may have. Like any good detective, you are gathering the facts, assessing the information, evaluating the evidence and planning your response. You can ask some key questions to ascertain the cause of the behaviour.
Suggested questions you could ask as the detective are.
Nicola Le Prevost, Clinical Lecturer Pilgrims Hospice Kent adds:
“Does the person have other conditions which are not stable, or are they developing an illness such as urinary tract infection or chest infection, for instance, which can produce changes in behaviour or exacerbate confusion? Management involves recognition and measures to manage the problem in addition to the behaviour. Care staff can be unaware or forget to look at early signs of illness affecting behaviour before the person is showing more physical signs of the problem.”
Jane Chatterjee, lecturer in palliative care at St Gemma’s hospice adds further:
It is important to consider the potential of physical illness and pain particularly in an older population likely living with co-morbid conditions. Behavioural pain assessment tools such as the Abbey pain tool detect the wider concept of distress and it is important to rule out other causes of distress before assuming the pain is the cause unless there are obvious physical signs.
One distress is detected using such a tool then ABC charts can help determine the potential cause of the distress which may be physical pain/discomfort, psychosocial or emotional or a combination of these. Sometimes it is difficult to identify distress if it is more subtle and that is where behavioural assessment tools are useful as well as information from those who know them well.
Any intervention should aim to help avoid people with dementia feeling undervalued, vulnerable, their rights infringed, loss of dignity, a sense of shame or hopelessness. It should also reduce the likelihood of living in an environment that is poor, chaotic, hostile with little opportunities for positive interaction or positive routines.
Ensuring workers have the confidence, skills and knowledge to deal with challenging behaviour in dementia clients is essential. The Skills Platform provides a wide range of dementia training and challenging behaviour training courses to ensure their safety and help resolve challenging situations.
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