As dementia progresses and more brain cells are affected, the person with dementia is often left struggling to make sense of the world around them. The ability to manage everyday life skills becomes compromised and even the tasks which previously appeared to need no effort become increasingly difficult and potentially frustrating.

Therefore supporting and caring for the person to meet both their physical and psychological needs can be challenging for care workers. For example an angry reaction by a person with dementia to some situations, and any physical affront experienced, can be hard to understand and can feel emotionally distressing for a care worker..

There are a wide variety of changed behaviours which can pose difficulties for the person trying to provide support. These behaviours include:

• Angry (aggressive) behaviour This could be verbal such as shouting angrily or non verbal behaviour such as hitting out at others in many different forms e.g. kicking, pinching, slapping others.
• Excessive walking (wandering behaviour) This is when people spend long periods of time walking either repetitively or walking long distances. It is sometimes described as agitated behaviour. This can also be described as ‘risky’ behaviour if it is considered that there is a risk of the person falling or getting lost when outside.
• Repetitive behaviours This might be repetitive movements or speech – saying words, asking questions or making sounds, rocking, rubbing parts of the body repeatedly.
• Vocally disruptive behaviours This might be shouting, swearing, screaming or grunting.
• Dis-inhibited behaviours This ranges from taking clothes off, masturbating or making sexual advances.

There are also many other behaviours such as being withdrawn and unresponsive, suspiciousness of other people, making accusations, sleep disturbance etc which staff can struggle to know how best to respond.

These range of behaviours are often described as ‘difficult’. People with dementia can sometimes be labelled according to the behaviour. For example ‘he is a wanderer’. This ‘label’ can have a negative impact on both how the individual is perceived and how the person is supported.

How we make sense of a person with dementia’s behaviour, its cause and its purpose has been and continues to be a controversial issue within dementia care. But this is a crucial area because how behaviour is interpreted will influence how we respond. For example if we consider a person’s behaviour as resulting purely from brain dysfunction we are more likely to propose drugs as a solution. However if we adopt a bio-psychosocial approach this suggests that a person’s behaviour is the result of the interactions between biological aspects, psychological and social environment. Taking this approach we are more likely to seek explanations from the interactions between the person and their environment.

This workbook takes this bio-psychosocial approach and aims to consider these behaviours as a communication by the person with dementia in an attempt to address unmet needs. For this approach to be successful it is necessary for those in caring roles to be curious about and understand all aspects of need and how they interplay with a person’s current situation – taking a ‘inquiring’ approach to discovering helpful approaches.

Initially this workbook will highlight key factors and theories which may help understand the differing needs of people with dementia and to understand factors that can result in challenging behaviours. This is followed by a focus on a few specific behaviours that workers appear to struggle with most, suggesting possible causes and what might help. Finally other general approaches are described in order to give you a range of ideas and tools to assist you when caring or working with people with dementia, and thereby minimising difficult situations.

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