For individuals experiencing cognitive changes, it can become increasingly difficult to communicate unmet needs. If these needs remain unaddressed, it is common for them to be expressed through different types of behaviors which can be seen as aggressive such as spitting, hitting or engaging in sexually inappropriate behavior. 

These behaviors can be disruptive in long-term care communities and affect the quality of life of the person living with dementia as well as others, such as fellow residents or team members.

Rather than immediately looking to pharmacological answers to these behaviors, providers can have a positive impact on residents’ wellbeing by offering personalized engagement so they can live meaningfully even in the later stages of dementia. Providers need to offer more than just medicine. There are many non-drug options that can help health and wellbeing. 

A “social prescription” is something that senior living and long-term care professionals can use to offer these non-drug solutions that are based on life history, individual preferences and current abilities. These types of “prescriptions” are affordable and can have a more positive impact on health when compared to medicine. A social prescription considers who a person really is and offers options to improve their wellbeing in a meaningful way.

It is important to point out that unwanted behaviors are common when people get to the mid and later stages of dementia. The brain structures that deteriorate and make unwanted behavior more likely are the same structures that develop during childhood and during teenage years (i.e., prefrontal areas). We often see a lack of awareness, empathy and understanding of how their behavior is affecting others. 

Keeping this in mind can help us be more patient and respond effectively. Care professionals are often very aware of how common these types of unwanted behaviors are, but it is family members who need reassurance and an understanding that these behaviors are not unexpected. 

Tracking when the behavior occurred, who is present and what might have triggered the behavior, can be an excellent first step in addressing them. Some common times that care professionals report increases in unwanted behavior are when staff shifts change, when people are in pain or when they are overstimulated. Be aware of those times and see if they are correlated with more challenging behaviors in specific individuals. 

If you find a connection, try to remove the resident from the situation that triggers them. For example, think of a memory care community where there is a small sitting area near the main entrance and a reception desk. One resident who has difficulty communicating verbally after a stroke may randomly start screaming and becoming upset. The screaming can be loud and affect other residents. The staff may document the antecedent conditions or what was happening before and when the screaming took place. They could come to realize that it happened when men that the resident did not recognize were buzzed in through the front door. Once the staff realized this, they could quickly introduce unfamiliar men to the resident (e.g., “This is Margaret’s son, he is her to visit his mom…”) if she was in the sitting area, close to the door, which would likely reduce the screaming behavior.

Redirecting attention away from the situation that is causing a resident distress is one of the most effective ways to respond in the moment. If someone is continually upset and acting out against staff or residents, we can ask the family members for some old photographs of good memories for their loved one. Photographs with several people in them that the resident can recognize can also be effective because we can ask the resident who someone is or if they recognize someone. If the names are also shared with us, we can give them a cue, for example, “Is that Aunt Charlotte or Aunt Ruth?”. The resident will usually become quite focused on the photograph and stop perseverating on what was making them upset. If the resident is living in the past, then get photos from the past. Music through headphones can also be used in situations like this.

It can be challenging to address unwanted behaviors and engage with residents experiencing them in a meaningful way but don’t give up on trying to figure out what is causing them and making adjustments to reduce the behavior, as that behavior is a sign of distress in the resident. It often takes considerable time and patience, but it can make a huge difference in the resident’s quality of life.

Rob Winningham, Ph.D., received his Ph.D. in neuroscience from Baylor University and joined the faculty at Western Oregon University in 2000, where he served as a Professor of Psychology and Gerontology. He helped create the Gerontology Department, when he was Division Chair of the Behavioral Sciences Division. He has served as the Dean of the College of Liberal Arts and Sciences and Provost and Vice President for Academic Affairs at Western Oregon University.

Charles de Vilmorin is the CEO and co-founder of Linked Senior.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.