Challenging Behaviour – An Everyday Issue

Members article

By Jane Verity © Dementia Care International

Challenging behaviours are defined under many different terms; difficult behaviours, inappropriate behaviours, problem behaviours, undesireable behaviours, unacceptable behaviours and many more. They tend to be expressed in three major ways: repetitive behaviours, accusations and verbal and physical aggression.

Instead of defining challenging behaviours as an expected symptom of dementia – they can be understood as an attempt to problem-solve, express distress or communicate unmet needs (physical, environmental or emotional).

Examples of unmet physical needs can be inflammations and other medical illness, constipation, hunger or thirst, pain etc. Unmet environmental needs can be anything from the experience of home, peace and quiet or pleasant sounds, daylight and pleasant smells, or a personally chosen chair.

The Spark of Life 5 Emotional Needs are:

  1. To be needed and useful
  2. To have opportunity to care
  3. To love and be loved
  4. To have self-esteem boosted
  5. To have the power to choose

These needs can not be weighed or measured. They are universal and they do not change. What does change is the opportunity to have these needs met – especially for people with dementia or anyone living in an institution where the focus is on tasks and routines rather on the social and emotional wellbeing of individuals.

The diagnosis of dementia and the subsequent move to a residential care facility can result in a multitude of losses. Familiar roles and jobs or the feeling of being needed and useful are lost and family, relatives and friends may withdraw from the relationship, diminishing the opportunity to love and be loved. The loss of one’s home and pets can lead to having no one or nothing to care for and the person’s identity changes as people begin to define them via their diagnosis resulting in low self-esteem. The loss of control of almost every aspect of daily life can be overwhelming.

When social inhibitions lift and verbal communication diminishs, it is likely that the person with dementia will become more direct in their expressions. This means the way they express their unmet needs can be unexpected, strong, or even aggressive.

Real Life Example

‘Linda’ assisted ‘Jack’ with his shower. She checked the water was the right temperature and proceeded to wash him. Unexpectedly, Jack lashed out, wheezing into her face, ‘Get out!’

The Spark of Life Solution

The first step is to check for any unmet physical or environmental needs and solve these before identifying unmet emotional needs. A useful question to ask is, ‘What is the need that is not being met?’ Once identified, find the best possible solution to meet that need.

When Jack became angry and aggressive, Linda did not identify any unmet physical or environmental needs. Instead, Jack had an unmet emotional need to know what was going to happen in that situation and exercise some choice.

If Jack was able to do some of the washing himself, Linda could say, ‘Jack, do you prefer to wash yourself or can I assist you?’ Or if Jack needed full assistance, ‘Jack, do you prefer to have your back or your front washed first?’ Remember to only give two choices.

Identifying the unmet need and finding a solution addresses the problem at its core, enabling the challenging behaviour to dissolve and disappear. In Linda’s case, she made sure she addressed Jack’s emotional needs when assisting him with his shower. This made Jack happy and he had no need to get angry with her.

Further Reading

A Positive Approach to Challenging Behaviour – Members article – (Understand cause & effect, understand how to work with the need rather than against it & discover successful strategies for preventing challenging behaviour)

The Bus Stop Band-aid – Members article – Jane Verity (Discover the emotions and reasons behind the words, ‘I want to go home;’ learn positive ways to fulfill unmet needs & proven strategies to remove the necessity for the bus stop & other band-aid solutions.)

Relevant Resources

How to Dissolve Difficult Behaviour – Program – How to Dissolve Difficult Behaviour’ introduces the Spark of Life Philosophy, which dissolves challenging situations & creates a nurturing environment where everyone can thrive – Visit our Product Page
How to Dissolve Difficult Behaviour – Manual – ‘How to understand, deal with and prevent difficult behaviour – A manual by Jane Verity – Visit our Product Page
Top Tips to Turn Around Difficult Behaviour – A3 poster – Visit our Product Page