Identifying unmet need
Some people living with dementia may exhibit challenging behaviours that 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.
In the last step, Ian mentioned that these behaviours were the consequence of unmet needs. He described ideas developed by Cohen-Mansfield that he found useful.
A person living with dementia 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)
What to look for
- Emotional – anxiety and anger may be a response to visual hallucination. This may be communicated by verbal outbursts, repetitive questioning or by facial expression.
- Level of stimulation – a person may be bored, overwhelmed, or have low social contact. This can be communicated by repetitive physical movement, touching, talking or apathy.
- Physical – a person may be in pain or discomfort. This can be communicated in a number of ways, depending on where the discomfort is (e.g. rubbing face (dental pain); pulling at clothes, or fidgeting in chair (needing to go to toilet)).
- Low self-worth – a lack of positive experiences or lack of control can lead to a person hiding or hoarding things.
There may be patterns or triggers to look out for - some of these behaviours may occur at particular times of day, certain places, or with certain people or activities.
Help for carers
Carers may fear being assaulted or hurt by verbal abuse. Feeling out of control in situations that occur every day can lead to increased stress and eventual burn-out. Talking to other carers or seeking professional intervention can be helpful. There are many websites providing useful resources that may help. Also, regular respite can make a difference.
We’ve provided a few examples below for carers in the UK. Please share information about support for carers in your area.