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Skip to 0 minutes and 7 seconds Sometimes when a person’s needs and wishes are not being understood, then may react in ways that people around them might view as unusual or problematic. What sort of behaviours might indicate a person’s needs are not being met? Sure. I mean, I guess one of the things that I think, again, the first thing to say is that all are behaviours are driven by our needs. It’s sometimes where we see some of the behaviours displayed by people with dementia, associated with dementia, where actually, they’re just behaviours. I mean the sorts of things that we typically get referred to in our clinics are things like aggression, it might be verbal or physical aggression, or sometimes disinhibition.

Skip to 0 minutes and 50 seconds The important thing is that we view them in terms of an unmet need or the distress and we see them as a feature of the person. In the past, we would have medicated a lot of these difficulties. We would’ve given them tranquillisers or sedatives, anti-psychotics, or benzodiazepines. But we’re far more enlightened these days. We look at what was driving some of the behaviours, some of emotions that were driving it. And these days, we’re much more likely to look at the background features underlying these. You’re trying to understand what’s happening to a person to understand what they’re experiencing in order to then understand the response. Yes, because all of these behaviours will have patterns.

Skip to 1 minute and 37 seconds And often, because of what people are saying, it sounds very confused and sometimes the settings they’re in, the person’s not orientated. But if we look properly, they will have a pattern. And in discovering that pattern, then we will almost inevitably understand what’s driving it. And that’s the thing we need to treat. In the past, if we gave someone a tranquilliser, we were tranquillising the whole person, so they wouldn’t be able to perhaps engage in the problematic behaviour. But then they wouldn’t be able to look after themselves, take themselves to the toilet, and other things. And that’s the consequence of using that strategy.

Challenging behaviour as unmet need

Challenging behaviour is not senseless behaviour – there is usually a reason and a purpose behind it. It often occurs as a result of an unmet need. In this video, Dr. Ian James describes how useful it is to think of challenging behaviour in this way.

Ian mentions ideas developed by Cohen-Mansfield that describes ways a person living with dementia may respond to their unmet needs. They may:

  • Engage in behaviours to directly meet a need (e.g. moving/touching to create stimulation)
  • Communicate a need to others (e.g. by repeatedly asking questions)
  • Engage in behaviours that signify a need (e.g. acting aggressively in response to physical pain)

Does thinking about challenging behaviours as unmet need help you?

In the next steps, we will consider how we can use some non-confrontational approaches to respond to challenging behaviour.

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Dementia Care: Staying Connected and Living Well

Newcastle University

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