How to Manage Responsive Behaviours?

Responsive or reactive behaviours are actions, words, or gestures exhibited by a person with dementia in response to something unfavourable, frustrating, or perplexing in their social and physical environment.

Below are examples of responsive behaviours:

• Aggression
• Agitation
• Wandering
• Restlessness
• Hallucinations
• Paranoia
• Making strange noises
• Increasingly withdrawn

Memory, judgement, coordination, emotion, and behaviour are all affected by changes in the brain.

The following are the principles that guide responsive behaviour:

• Every personal expression (words, gestures, and acts) has significance.
• Meanings, needs, and concerns are communicated through personal expressions.
• In order to comprehend their significance, you must assess the conditions that influence such actions, such as physical, emotional and environmental elements.

Consider whether a responding behaviour is an issue for the individual who has been diagnosed, or for you. Will the supposed solution deepen the issue? Will modifying my expectations affect the situation?

Considerations

Consider the true importance of the techniques presented on this page for in the-moment behaviours. Reflect on the following questions regarding the events preceding, occurring during, and following the event:

Basic needs – Are the person’s basic needs being fulfilled? Are they in pain or discomfort? What physical changes do I notice in them (e.g., grimacing, eating habits, energy level)?

Intellectual – Have they noticed any changes in their memory recently? Have they been acting erratically? Are they having trouble with communication or with doing tasks in a certain order (like getting dressed)?

Emotional – Have they been crying or showing signs of anxiousness lately? Do they appear to be lonely? Are they acting strange lately (e.g., being wary of others)?

Noise – Is there too much noise or a large crowd around your loved one? Is the lighting dim, making it difficult for them to see? Is there sufficient stimulation?

Your actions – What am I doing, or not doing, that might be contributing to their behaviour?

Aggression and agitation – two specific reactive behaviours

Physical and emotional outbursts are examples of aggression (i.e., shouting, hitting). Anger is a complex emotion that can represent a variety of feelings and can emerge for a range of reasons. We can speculate as to why, but we must also respond to the behaviour.

An individual experiencing agitation may pace nervously, drum their fingers, for extended periods of time. It is your responsibility to educate yourself on your loved one’s condition.  You must comprehend the disease, exhibit patience, and be accepting of the individual. 

It is essential to remember that if your personal safety is in jeopardy, you must leave the room for a safer location, such as a hallway. Do not place yourself in a position where you cannot leave the room. Immediately after leaving, seek assistance from your loved one’s caregiver staff.

If this behaviour begins to negatively impact the quality of life of a loved one or other residents, you should contact a care professional to modify their care plan.

Causes for aggression and agitation

Aggression

• Fatigue or a change in sleeping patterns.
• Physical discomfort or pain.
• Feelings of being overwhelmed.
• Feelings of insecurity or thoughts of being forgotten.
• Loss of emotional control.
• Difficulty in expressing rage and acting violently (e.g., striking, biting, kicking).

Agitation

Agitation can result from:

• Changes in the environment, such as living arrangements or carers.
• Being in unfamiliar surroundings.
• Having your clothes changed or being bathed.

Responding to responsive behaviours

How to React to Aggression

• Respond with encouragement and reassurance in a calm voice.
• Reduce the amount of noise.
• Break down care tasks into manageable chunks.
• Distract your loved one from the mode of their distress.
• Slowly approach from the front, keeping eye contact.
• Take a “time out” from the room if your loved one becomes violent.
• Avoid arguing and displaying wrath or irritation.

Scenario example A

In the dining area for residents, you are eating dinner. You observe an elderly man attempting to cut a steak. You offer to help and immediately begin chopping his food. He lets you go for a moment before grabbing your wrist and threatening to “smack you if you do it again!” You are stunned by what has just occurred.

Don’t

• Grab his hand and try to gain control of the situation from him.
• Act surprised or yell.
• Justify your actions by stating that you were attempting to assist.

Do

• Allow your arm to get limp, apologise, and engage him in conversation.
• Allow him to cool down once he has let go. Consider what caused his rage. Was he ashamed of himself? Is it possible he mistook you for someone who was stealing his food?
• Redirect the focus of his attention. Maintain a calm and cheerful attitude.
• Make use of both visual and verbal signals (gestures)

Tasks and routines should be simplified.

Give your loved one with dementia options wherever possible. Limit them to one or two options to avoid overwhelming them.

Scenario example B

During a visit with his wife, an elderly man fidgets with his clothes and appears agitated. His wife is becoming irritated by his inability to sit still.

Don’t

• Request that he refrain from picking.
• Tell him to relax.
• Raise your voice.

Do

• Make sure he has something to hold.
• Use music to divert his attention.
• Talk to him about a pleasant memory.
• Take a walk.
• Consider the environment; is it too loud or too bright?
• Consider the time; is it past his bedtime or too early in the morning?

Want to learn more?

Reach us at wecare@considracare.com, or call us at 1-855-410-7971, and we will be happy to assist. Learn more about caring for patients with chronic conditions in our information booklets or on our resources page.