Understanding Alzheimers & Dementia: Behavior Management Techniques

• Why work with behaviors?

• Defining a “problem” behavior

• Observing behavior

• Developing a plan

• Does changing behaviors mean ignoring emotions?

People who have Alzheimer’s disease often pose severe behavior management problems for those who provide care. Since Alzheimer’s disease and other dementias attack the brain in different places and at different rates of speed, you will find that each person’s behavior is different. But overall, when caring for dementia patients, you will see certain types of behavior problems. You can learn techniques to change behaviors that may be making your job difficult. Most importantly though, these techniques will help you observe and manage patient behaviors as they change over time and will allow you to adapt and change your interactions for the best results.

Demented patients show a variety of different behavioral problems, including (but not limited to) anger, agitation, depression, suspiciousness, paranoia, wandering, sexual inappropriateness, hallucinations, and delusions. All of these behaviors can pose serious difficulties for the person trying to provide care.

What is meant by the term “behavior”? Behavior is an action that you can see and describe. While a behavior might result from an emotion, this section will not be exclusively concerned with emotions, but will concentrate on behavior, or on what you see happening. Because you can see behavior, you can get information about it such as how often does it happen, or, who is around the patient when it happens?

Why work with behaviors?

Although you can’t yet change the course of the patient’s disease or how it will damage the brain, you can change behaviors. Behavior affects the quality of both of your lives. By changing an unpleasant behavior you can increase the quality of life for the patient and make caregiving easier on yourself.

Changing behavior involves the following steps:

• Learning to observe and define problem behaviors.
• Developing a plan to change the behavior.
• Evaluating your plan’s effectiveness in changing behaviors.
• Changing your plan and reevaluating to make your plan more effective.

Before starting to work with difficult behaviors, be sure that the person’s medications or medical conditions are not causing or contributing to their problems. Be alert for sudden illness, effects of new medication or change in dosage, or any other recent changes in the patient’s life or surroundings.
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Defining a “problem” behavior

A behavior can be considered a “problem” if for some reason it is not suitable or acceptable to you or others. This could mean that the behavior is dangerous to someone (like striking someone), or it damages something (like breaking objects), or it is unpleasant to experience (like yelling or arguing). Sometimes several behavior problems occur at once (the patient yells and strikes out). Return to top

Observing behavior

Behaviors always occur in three parts. These parts we call A, B, and C.

A is a triggering event (often called an antecedent or cause)

B is the behavior itself

C is the consequence of the behavior (what happens because of the behavior)

As you observe (see and pay attention to) a behavior you will learn to look for these three parts and they will be your key to changing the behavior. Think about the problem and gather information:

• First, define the behavior (B). What is the current behavior? What is happening? What did the person do? Describe the action-for example, the patient yelled, the patient struck out, the patient paced, the patient asked the same question ten times, or the patient pinched the nurse’s aide. Also notice when, where, and how often the behavior occurs.
• Next, look for prior events that may have triggered the behavior (the antecedent (A)). Did anyone or anything trigger the behavior? What was happening before the behavior started? Look for clues, like somebody demanding too much, being angry at the person, or for disturbing noise or activity around the person. Were there any changes in the environment beforehand?
• Lastly what is the consequence (C) of the behavior? What happens as a result of the behavior? What changes occurred in the environment or in the behavior of other people because of the patient’s behavior?

Observe and write down your observations about the behavior. It’s easiest to work with one behavior at a time, so target just one to watch. Behavior, even in a confused person, results from a cause. Understanding the causes can help you figure out what to do to help.
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Developing a plan

Once you have identified a behavior, gathered information about it, and viewed the patterns of its occurrence, it is time to see if you can change it by developing an individual plan. A plan that is individualized, designed specifically around the ABC’s of a given situation, is likely to be much more effective than one developed generally for everyone.

It is important to set realistic, reachable goals tailored to the individual. Divide your plan and goals into small easy-to-do parts. Be creative.

Changing behaviors can be very hard work so don’t forget to reward yourself and the patient for successes, no matter how small. Also, changing behavior is an ongoing process. What was once successful may no longer work over time, so remember to continually evaluate and change your plan as necessary.
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Does changing behaviors mean ignoring emotions?

Working with behaviors doesn’t mean ignoring feelings or emotions. You should focus on the behavior but keep in mind that feelings are often displayed in behavior. As the patient’s ability to communicate and understand the world around them gradually declines, a friendly touch, a smile and a reassuring tone may be the only way to communicate to the patient that they are safe and that you care about them.
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