Unusual behaviourUnusual behaviour

If you are caring for a person with If you are caring for a person with dementia, you may sometimes find their dementia, you may sometimes find their

behaviour confusing, irritating or difficult to behaviour confusing, irritating or difficult to deal with, leaving you feeling stressed, deal with, leaving you feeling stressed,

irritable or helpless. By learning to irritable or helpless. By learning to understand the meaning behind the understand the meaning behind the

actions, you will find it easier to stay calm actions, you will find it easier to stay calm and deal effectively with the challenges and deal effectively with the challenges

that arise.that arise.

What do we mean by 'unusual What do we mean by 'unusual behaviour'?behaviour'?

Certain types of behaviour are particularly Certain types of behaviour are particularly common in people with dementia. These common in people with dementia. These include:include:

Repetitive questioning, actions or Repetitive questioning, actions or movements movements

Trailing the carer around the house Trailing the carer around the house

Hiding and losing things Hiding and losing things

Shouting and screaming Shouting and screaming

Why do some people with Why do some people with dementia behave like this?dementia behave like this?

People often behave in certain ways in order to People often behave in certain ways in order to communicate what they want or how they are communicate what they want or how they are feeling. If the person you are caring for has feeling. If the person you are caring for has difficulty expressing themselves in words, their difficulty expressing themselves in words, their behaviour may become more extreme. You will behaviour may become more extreme. You will find it easier to deal with the challenge if you find it easier to deal with the challenge if you understand what the person is trying to tell you. understand what the person is trying to tell you. This information sheet outlines some of the most This information sheet outlines some of the most typical sorts of unusual behaviour in people with typical sorts of unusual behaviour in people with dementia and explains some common causes.dementia and explains some common causes.

Unusual behaviourUnusual behaviour

Certain forms of behaviour are particularly Certain forms of behaviour are particularly common in people with dementia. By common in people with dementia. By working out what each behaviour means, working out what each behaviour means, and finding ways to overcome the and finding ways to overcome the problem, the situation can become more problem, the situation can become more manageable. manageable.

Repetitive behaviourRepetitive behaviour

People with dementia often carry out the same People with dementia often carry out the same activity, make the same gesture or ask the same activity, make the same gesture or ask the same question repeatedly. Medical professionals question repeatedly. Medical professionals sometimes call this 'perseveration'. This can be sometimes call this 'perseveration'. This can be because they don't remember having done it because they don't remember having done it previously, but it can also be for other reasons, previously, but it can also be for other reasons, such as boredom. If the behaviour is becoming such as boredom. If the behaviour is becoming very repetitive, try to distract the person with an very repetitive, try to distract the person with an activity. If you can't contain your irritation, make activity. If you can't contain your irritation, make an excuse to leave the room for a whilean excuse to leave the room for a while

Asking the same question over Asking the same question over and over againand over again

As well as memory loss, this can be due to the As well as memory loss, this can be due to the person's feelings of insecurity or anxiety about person's feelings of insecurity or anxiety about their ability to cope. Try to be tactful and patient, their ability to cope. Try to be tactful and patient, and encourage them to find the answer for and encourage them to find the answer for themselves - for example, if they keep asking themselves - for example, if they keep asking the time suggest that they look at the clock the time suggest that they look at the clock themselves. People with dementia may become themselves. People with dementia may become anxious about future events such as a visitor anxious about future events such as a visitor arriving, which can lead to repeated questioning. arriving, which can lead to repeated questioning. It may help if you don't mention the event until It may help if you don't mention the event until just before it takes place. just before it takes place.

Repetitive phrases or Repetitive phrases or movementsmovements

This can be due to noisy or stressful This can be due to noisy or stressful surroundings, or boredom. Encourage the surroundings, or boredom. Encourage the person to do something active, such as person to do something active, such as going for a walk. It can also be a sign of going for a walk. It can also be a sign of discomfort, so check that the person isn't discomfort, so check that the person isn't too hot or cold, hungry, thirsty or too hot or cold, hungry, thirsty or constipated. Contact the GP if there is any constipated. Contact the GP if there is any possibility that they are ill or in pain, or if possibility that they are ill or in pain, or if medication is affecting them. medication is affecting them.

Repetitive actionsRepetitive actions

Actions such as repeatedly packing and Actions such as repeatedly packing and unpacking a bag, or rearranging the chairs unpacking a bag, or rearranging the chairs in a room, may relate to a former activity in a room, may relate to a former activity such as travelling or entertaining friends. If such as travelling or entertaining friends. If so, it may serve as a basis for so, it may serve as a basis for conversation. Alternatively, it could signify conversation. Alternatively, it could signify boredom or a need for more contact with boredom or a need for more contact with people. people.

Repeatedly asking to go homeRepeatedly asking to go home

This can take place in residential care, or This can take place in residential care, or when the person is already at home. It can when the person is already at home. It can be a sign of anxiety, insecurity, fear or be a sign of anxiety, insecurity, fear or depression. The concept of 'home' might depression. The concept of 'home' might evoke memories of a time or place where evoke memories of a time or place where they felt comfortable or safe, or of a home, they felt comfortable or safe, or of a home, family and friends that no longer existfamily and friends that no longer exist

Repeatedly asking to go homeRepeatedly asking to go home

. If the person doesn't recognise where . If the person doesn't recognise where they are now as home, then it isn't home they are now as home, then it isn't home for them. Try to understand and for them. Try to understand and acknowledge the person's feelings and acknowledge the person's feelings and reassure them that they are safe and reassure them that they are safe and loved. loved.

RestlessnessRestlessness

Some people with dementia suffer from Some people with dementia suffer from general restlessness. This can be a sign of general restlessness. This can be a sign of hunger, thirst, constipation or pain, or they hunger, thirst, constipation or pain, or they may be ill or suffering from the side-effects may be ill or suffering from the side-effects of medication. Other possibilities are of medication. Other possibilities are boredom, anger, distress or anxiety, stress boredom, anger, distress or anxiety, stress due to noisy or busy surroundings, or due to noisy or busy surroundings, or because they need more exercisebecause they need more exercise

RestlessnessRestlessness

. It may also be due to changes that have . It may also be due to changes that have taken place in the brain. If they seem taken place in the brain. If they seem upset, try to find the reason and reassure upset, try to find the reason and reassure them, and try to distract them with an them, and try to distract them with an interesting activity or by involving them in interesting activity or by involving them in some form of exercise. some form of exercise.

Pacing up and downPacing up and down

Pacing may indicate that the person wants Pacing may indicate that the person wants to use the toilet but is unable to tell you. to use the toilet but is unable to tell you. Try asking them whether they need to use Try asking them whether they need to use the toilet or leading them towards the the toilet or leading them towards the toilet. toilet.

Pacing up and downPacing up and down

If they are adamant that they want to pace, If they are adamant that they want to pace, try to find somewhere they can walk try to find somewhere they can walk safely, help them choose comfortable safely, help them choose comfortable clothes and shoes, offer drinks and clothes and shoes, offer drinks and snacks, check their feet regularly for snacks, check their feet regularly for redness, swellings or blisters, and try to redness, swellings or blisters, and try to persuade them to rest from time to time. persuade them to rest from time to time.

FidgetingFidgeting

People with dementia may fidget People with dementia may fidget constantly. As with pacing, try to distract constantly. As with pacing, try to distract their attention and offer reassurance. Try their attention and offer reassurance. Try giving them something to occupy their giving them something to occupy their hands, such as a soft toy or worry beads, hands, such as a soft toy or worry beads, or provide a 'rummage' box containing or provide a 'rummage' box containing interesting objects. interesting objects.

Other types of unusual Other types of unusual behaviourbehaviour

There are a number of other types of There are a number of other types of behaviour that are particularly common in behaviour that are particularly common in people with dementia. In general, try to people with dementia. In general, try to distract the person and offer plenty of distract the person and offer plenty of reassurancereassurance

Shouting and screamingShouting and screaming

The person may continually call out for The person may continually call out for someone or shout the same word or someone or shout the same word or scream or wail over and over again. scream or wail over and over again.

The person could be in pain or ill, The person could be in pain or ill, experiencing hallucinations, or their experiencing hallucinations, or their behaviour could be a result of brain behaviour could be a result of brain damage. In these cases, talk to the GP. damage. In these cases, talk to the GP.

Shouting and screamingShouting and screaming

They could be lonely or distressed, They could be lonely or distressed, anxious about their failing memory, anxious about their failing memory, bored, or stressed by too much noise bored, or stressed by too much noise and bustle. and bustle.

If they shout out at night, a nightlight in If they shout out at night, a nightlight in the bedroom may be reassuring. the bedroom may be reassuring.

If they are calling for someone from their If they are calling for someone from their past, try talking to them about their pastpast, try talking to them about their past

Lack of inhibitionLack of inhibition

The person may behave in a way that other The person may behave in a way that other people find embarrassing because of their failing people find embarrassing because of their failing memory and general confusion. In a few cases, memory and general confusion. In a few cases, this may be due to specific damage to the brain. this may be due to specific damage to the brain. Try to react calmly. Try to react calmly. If they undress or appear naked in public, they If they undress or appear naked in public, they may have forgotten when and where it is may have forgotten when and where it is appropriate to remove their clothes. Take them appropriate to remove their clothes. Take them somewhere private, and check whether they are somewhere private, and check whether they are too hot or are uncomfortable or whether they too hot or are uncomfortable or whether they want to use the toilet. want to use the toilet.

Lack of inhibitionLack of inhibition

Lifting a skirt or fiddling with flies may be Lifting a skirt or fiddling with flies may be a sign that the person wants to use the a sign that the person wants to use the toilet. toilet. If they start to stroke their genitals in If they start to stroke their genitals in public, discourage them tactfully and try public, discourage them tactfully and try to distract their attention. If such to distract their attention. If such behaviour is frequent or persistent, behaviour is frequent or persistent, consult the GP. consult the GP. ..

Lack of inhibitionLack of inhibition

If they behave rudely - for example, by If they behave rudely - for example, by insulting people or swearing or spitting - insulting people or swearing or spitting - don't attempt to argue or correct them. don't attempt to argue or correct them. Just try to distract their attention, and Just try to distract their attention, and explain to other people later that their explain to other people later that their behaviour is due to dementia and is not behaviour is due to dementia and is not directed at them personally.directed at them personally.

Night-time wakingNight-time waking

Many people with dementia are restless at night Many people with dementia are restless at night and find it difficult to sleep. Older people often and find it difficult to sleep. Older people often need less sleep than younger people in any need less sleep than younger people in any case. Dementia can affect people's body clocks case. Dementia can affect people's body clocks so that they may get up in the night, get dressed so that they may get up in the night, get dressed or even go outside. This can be very worrying - or even go outside. This can be very worrying - and exhausting - for carers. Make sure the and exhausting - for carers. Make sure the person has enough exercise during the day and person has enough exercise during the day and that they use the toilet before bed. Try a walk that they use the toilet before bed. Try a walk before bedtime, a warm milky drink and soothing before bedtime, a warm milky drink and soothing company before they fall asleep. If they wake company before they fall asleep. If they wake up, gently remind them that it is night-time. up, gently remind them that it is night-time.

Trailing and checkingTrailing and checking

Living with dementia makes many people Living with dementia makes many people feel extremely insecure and anxious, feel extremely insecure and anxious, which can result in constantly following the which can result in constantly following the carer round, or calling out to check where carer round, or calling out to check where they are. A few moments may seem like they are. A few moments may seem like hours to a person with dementia, and they hours to a person with dementia, and they may only feel safe if you are nearby. may only feel safe if you are nearby.

Trailing and checkingTrailing and checking

This behaviour can be very difficult to cope This behaviour can be very difficult to cope with, but try not to speak sharply. If you with, but try not to speak sharply. If you are busy, give them something absorbing are busy, give them something absorbing to do - perhaps a pet or toy to play with, or to do - perhaps a pet or toy to play with, or you can hum or sing, or put the radio on. you can hum or sing, or put the radio on. Make sure you also find some time for Make sure you also find some time for yourselfyourself

Hiding and losing thingsHiding and losing things

People with dementia sometimes hide People with dementia sometimes hide things and then forget where they are - or things and then forget where they are - or that they have hidden them at all. The that they have hidden them at all. The wish to hide things may be due to feelings wish to hide things may be due to feelings of insecurity and a desire to hold on to the of insecurity and a desire to hold on to the little that they still have. However impatient little that they still have. However impatient you feel, try to be reassuring. you feel, try to be reassuring.

Hiding and losing thingsHiding and losing things

Don't leave important documents lying Don't leave important documents lying around, and make sure you have a spare around, and make sure you have a spare set of keys. Try and find out the person's set of keys. Try and find out the person's hiding places so that you can tactfully help hiding places so that you can tactfully help them to find 'missing' items. If they hide them to find 'missing' items. If they hide food, check hiding places regularly, and food, check hiding places regularly, and discreetly dispose of any perishable items. discreetly dispose of any perishable items.

SuspicionSuspicion

Some people with dementia can become Some people with dementia can become suspicious. If they mislay an object, they suspicious. If they mislay an object, they may accuse someone of stealing from may accuse someone of stealing from them, or they may imagine that a friendly them, or they may imagine that a friendly neighbour is plotting against them. These neighbour is plotting against them. These ideas may be due to failing memory, an ideas may be due to failing memory, an inability to recognise people, and the need inability to recognise people, and the need to make sense of what is happening to make sense of what is happening around themaround them

SuspicionSuspicion

. If this happens, state calmly what you . If this happens, state calmly what you know to be true, if appropriate, and then know to be true, if appropriate, and then reassure and distract the person. Explain reassure and distract the person. Explain to others that they shouldn't take to others that they shouldn't take unfounded accusations seriously. unfounded accusations seriously. However, don't automatically dismiss the However, don't automatically dismiss the person's suspicions if there is any person's suspicions if there is any possibility that they may be true. possibility that they may be true.

How to cope with unusual How to cope with unusual behaviour behaviour

Try to remember that the person you are Try to remember that the person you are caring for is not being deliberately caring for is not being deliberately difficult. difficult. Ask yourself whether their behaviour is Ask yourself whether their behaviour is really a problem. really a problem. Try to put yourself in the person's Try to put yourself in the person's situation. Imagine how they might be situation. Imagine how they might be feeling and what they might be trying to feeling and what they might be trying to express. express.

How to cope with unusual How to cope with unusual behaviourbehaviour

Offer as much reassurance as you can, Offer as much reassurance as you can, by touching and holding. by touching and holding. Distract them with calming activities such Distract them with calming activities such as a hand massage, stroking a pet, a as a hand massage, stroking a pet, a drive in the country or by playing their drive in the country or by playing their favourite music. favourite music. Try to make sure that you have support Try to make sure that you have support for yourself and breaks when you need for yourself and breaks when you need them. them.

How to cope with unusual How to cope with unusual behaviourbehaviour

If you find the person's behaviour really difficult If you find the person's behaviour really difficult to deal with, ask for advice from professionals to deal with, ask for advice from professionals or other carers before you become too or other carers before you become too stressed. Medication may sometimes be used stressed. Medication may sometimes be used for these behaviours. The person with for these behaviours. The person with dementia's GP must monitor and review such dementia's GP must monitor and review such medication very carefully. Ask about the side-medication very carefully. Ask about the side-effects of any drugs so that if they appear you effects of any drugs so that if they appear you do not automatically assume that the dementia do not automatically assume that the dementia has become worse. has become worse.

UNUSUAL BEHAVIOURSUNUSUAL BEHAVIOURS

Thank you for your time.Thank you for your time.

Mr C SpainMr C Spain