Old couple walking while holding hands

Most challenging behaviors in dementia are mild or moderate and can be treated at home. Appropriate, non-pharmacological handling is usually sufficient and there is no need addressing to a physician or to specialized dementia care. Proper education is essential to deal with challenging behaviors at home. 

When a new behavioral symptom is observed or changes its character, it is very important to rule out a medical condition as a possible cause. Urinary tract infection, constipation, pain and other conditions, such as arthritis may be the cause of a challenging behavior. It is very important to visit a GP, not to miss such a diagnosis.

Proper observation and detailed recording of the behavior is also essential. What are the characteristics of the behavior? How often does it happen? What time of the day? Is the person with dementia alone or with others when the behavior appears? Is s/he easily reassured? How severe is the behavior and how easily does it resolve? Has the person eaten? Has s/he gone to the toilet? 

What can I do as a caregiver?

Let’s take a look at some key strategies for dealing with challenging behaviors:

  • Arm yourself with patience, no matter how difficult it is. Do not take it personally. It has nothing to do with you, nor does the patient want to bother you. It is common for challenging behaviors to be directed towards primary caregivers or others providing care. 
  • It is important to understand that patients’ suspicions and false accusations are caused by the disease and are not a reflection of them.
  • Try to listen to the person with dementia and understand their own reality. In fact, people with dementia have a different idea of ‘reality’ – or sense of what is really going on – from our own. Their own reality must not be disputed and cannot be fixed. If, for example, the person with dementia believes we are in 1987, we have no reason to correct him/her. They will not remember it anyway. They will only be upset.
  • Do not argue, do not try to convince them. Unfortunately, reasoning does not help with dementia. If they believe they are in their native village, it makes no sense to try to convince them that they are in the city. Respect their own idea of reality, without making fun of them.
  • Instead, reassure them. Make them feel safe and show that you care about what they tell you, that you take them seriously.
  • Change the topic of discussion or find an activity to keep them busy. You can tell them, “Yes, we will do what you say, but please I need to do something first and I need your help.”
  • If they keep repeating the same question, try to answer it each time without criticizing them. If you are tired, you can walk away and take some time for yourself.
  • If they lose objects, you could get duplicates or more of the items they are looking for and place them in different parts of the house (e.g. their watch or wallet).

How can I communicate with a dementia patient?

  • Regarding communication with the person who has dementia and exhibits challenging behaviors:
  • Use a calm and reassuring tone of voice. Use simple words, short sentences and ask one question at a time.
  • We always prefer a positive approach instead of a negative one (no “do not do it” but “let’s do something else, help me”).
  • Maintain eye contact
  • Approach the person from the front and not from behind
  • Avoid sudden movements and voices, they can be scared and get upset
  • Humor and laughter usually help
  • Reduce the stimuli of the environment that can distract them, turn down the bright lights and loud music, on the contrary relaxing music can help

Before resorting to medication, there must always have been previous non-pharmaceutical interventions.

However, in cases where the patient’s own safety or the caregiver’s safety is at risk or if despite proper handling, symptoms persist, medication may help.