What is challenging behaviour?
Before we talk about handling challenging behaviour it is helpful to define this term:
Challenging behaviour is behaviour which creates unacceptable risks, or has an adverse effect on the person living with dementia or their carer. This can be in terms of physical, emotional or impact on their environment.
Challenging behaviours can be in ‘excess’ (too much emotion, e.g. aggression/anger) or in ‘deficit’ (lack of social interaction, poor self-care). Up to 80% of people living with dementia develop challenging behaviours at some point.
The behavioural and psychological symptoms of dementia vary depending on the type and stage of the dementia. They tend to appear in clusters or syndromes:
- psychomotor cluster - (e.g. agitation, aggression, euphoria, disinhibition, irritability)
- psychosis cluster (hallucinations and delusions)
- mood lability cluster (depression and anxiety)
- instinctual cluster (appetite disturbance, sleep disturbance, apathy).
Specific behaviours can include aggressive forms such as hitting, kicking, throwing objects or shouting and non-aggressive forms such as making repetitive noises, following others around, hoarding and so on. Verbal aggression is the most frequent type of challenging behaviour.
Dealing with challenging behaviours
There are some medications (such as anti-psychotic drugs) that are used to treat these symptoms, however, there can be adverse effects for some people, especially people with DLB.
Other approaches are increasingly used to manage these symptoms. We will explore these together in the next few steps.