Rethinking Challenging Behaviors in Dementia Care: How to Respond Effectively
Are you frustrated by the so-called “challenging behaviors” of your loved one with dementia? You’re not alone. In this episode, we take a deep look at what we often label as “challenging behaviors” and how to approach them in a way that truly helps your loved one.
This episode explores how changing our perspective can reduce frustrations and create a calmer caregiving environment. If you’re struggling to understand your loved one’s actions, this episode will give you a new lens to see things differently.
What Are “Challenging Behaviors,” Really?
The term “challenging behaviors” often includes actions like wandering, resisting care, or expressions of anger and anxiety. But who are these behaviors truly challenging?
Most of the time, these behaviors are more challenging for the caregiver than for the person with dementia.
Rather than seeing them as “bad behavior,” it helps to understand that these actions are a form of communication. When a loved one resists care, it may be because they’re uncomfortable, tired, or trying to communicate a need.
Recognizing this shifts the focus from trying to stop the behavior to understanding its underlying cause.
Three Perspectives on Understanding Behavior
The episode explores three approaches for understanding challenging behaviors:
1) Behavioral and Psychological Symptoms of Dementia (BPSD): This approach categorizes behaviors based on medical symptoms like anxiety, hallucinations, or aggression.
While medication is often used to manage these symptoms, it should be a last resort rather than the first line of action. It’s crucial to address other factors before turning to medication.
2) Symptom-Based and Underlying Cause-Based Approaches: These approaches look at what may be triggering a behavior, such as physical changes in the brain or external factors like overstimulation.
For instance, behaviors may emerge due to fatigue, hunger, or feeling overwhelmed by a noisy environment. By addressing these triggers, caregivers can often reduce the frequency and intensity of challenging behaviors.
3) Control vs. Connect Framework: This perspective asks whether the person is trying to control their environment or connect with others. If a loved one is pacing, they may be seeking control over their surroundings.
If they’re crying, they may be seeking connection. Understanding this can guide caregivers in responding appropriately.
How Small Changes Can Make a Big Difference
A key takeaway from this episode is that changing how we respond to our loved ones can significantly reduce their anxiety and discomfort.
Lizette shares a personal story about learning to avoid pointing out memory lapses, which helped reduce their loved one’s anxiety. Instead of correcting the person, they simply acknowledged the situation without adding pressure. This approach made daily interactions smoother and less stressful for both parties.
Practical Tips for Reducing Challenging Behaviors
Lizette concludes with practical suggestions for caregivers:
1) Give Space When Needed: If your loved one seems overwhelmed, allowing them some quiet time can help them regain control over their emotions.
2) Avoid Over-Correction: Constantly pointing out memory lapses can increase anxiety. Instead, find ways to validate their feelings and redirect the conversation.
3) Understand the Triggers: Observe patterns in your loved one’s behavior to identify possible triggers like fatigue, hunger, or environmental factors.
By approaching challenging behaviors with empathy and understanding, caregivers can foster a calmer, more supportive environment for their loved ones.
Ready to change how you see challenging behaviors? Tune in to this episode for a deeper dive into these strategies and practical advice for more peaceful dementia caregiving.
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Read More:
Talking About Caregiver Burnout With Michelle Gordon
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Transcript
Introduction to Dementia Caregiving
[0:00] Hey Christian caregiver, welcome to Christian Dementia Caregiving, the podcast where I teach Bible-believing Christians how to navigate dementia with practical solutions, a kingdom focus, as well as help you find hope for the future. These episodes are brought to you by Think Different Dementia, where we create better futures for caregivers by building community around caregivers. Thank you for listening to today’s repeat episode of Christian Dementia Caregiving. I live in the affected area from Hurricane Helene and currently still do not have internet or access to all of my various ways of doing recording. So enjoy the next three repeat episodes that have been the most listened to episodes since the start of Hurricane than what my family was. We have been excessively blessed, but I did not have the ability to record the podcast as I hoped I would have. So listen to today’s repeat episode. What are we going to talk about today? Let’s look at this. The first thing I wanted to say is that if you are here with me today.
[1:20] You’re likely struggling with somebody who has dementia. And for that, I am very sorry. I know it is a difficult road for many people. And I believe that the reason it is such a difficult road for many people is because the healthcare system is failing us and not giving us the right information at the right time. And you are pretty much left up to figuring it out on your own. And as a healthcare provider, I apologize for the healthcare system because we have made it so much harder and so much more burdensome than it has to be for the family caregivers of somebody living with dementia. So first off, because you’re here today, I know you’re likely struggling with dementia in your family. And for that, I am super, super sorry.
Understanding Challenging Behaviors
[2:07] Join me on this journey and we will make it easier for you. So what I wanted to talk about today are challenging behaviors. What are challenges? And I’m doing for the people listening, air quotes, challenging behaviors, 14 hour credit seminar for physical therapists, occupational therapists.
[2:26] And speech therapists on the topic of managing perspective. And in this week, I have been working on the section called air quotes, challenging behaviors. And I started to look at it in a little bit of a different way. And there are so many different definitions of different things and different ways to look at challenging behaviors. There are a few ways to look at challenging behaviors. One is called the behavioral and psychological symptoms of dementia or challenging behaviors. So it’s divided into two separate sections.
[3:03] One, you know, are the challenging behaviors that are behavioral in nature. So things like shadowing or wandering through the house or being resistant to care or those kinds of behaviors that we call, air quotes, a behavior.
[3:23] And then some of them are so behavioral and psychological symptoms of dementia. So the psychological symptoms, things like anger and anxiety and depression and apathy. So that’s one way of looking at what we call challenging behaviors. And that puts it very squarely into the medical model. And the way that these, air quotes, challenging behaviors are addressed is typically through addressing medication or looking at medication management to address the things like hallucinations or the depression or how to manage these behaviors using medication. And it doesn’t necessarily always keep the person who is living with dementia front and center related to their behaviors because it’s treated like a symptom that just needs to be managed. And the easiest way to manage it is with medication.
[4:24] So there are pros and cons to everything in life, right? And so one of the pros of a behavioral and psychological symptom approach to managing the behaviors, in air quotes, of a person living with dementia is that For some people, medication is a necessary solution, but I believe it should be the last line of defense related to how to help a person living with dementia and not the first line of defense.
[4:53] So behavioral and psychological symptoms of dementia is one way of looking at
Approaches to Managing Behaviors
[4:59] challenging behaviors. A different way of addressing challenging behaviors can be considered what is called a symptom-based approach or an underlying causes-based approach of behavior management, right? So what is a symptom-based approach for, air quotes again, challenging behaviors? These are directly resultant of the physical changes in the brain caused by the dementia, right? So for example, hallucinations.
[5:29] So hallucinations typically occur frequently because there is an actual physical reason in the brain for the hallucination, even though there are parts of a hallucination that can be managed better by changing some things. And we’ll talk about that later on. And then the other one is the symptom-based behaviors and then underlying cause-based behaviors. So an underlying cause behavior may be because of something going on with the person due to them being tired or them being overwhelmed or overstimulated, etc. So symptom-based behaviors and then underlying cause-based behaviors. So this model also has some pros and cons because it’s not cut and dry related to a, quote.
[6:19] Challenging behavior that a person, it’s hard to determine for any person whether or not the challenging behavior, in air quotes again, is due to a physical underlying cause or if it’s due to a something going on with the person or the environment or their care part. So that’s a different way of classifying challenging air quotes, again, behaviors. And then recently I went to a TIPA Snow presentation and she actually had a different approach, which I had never heard of before. And I don’t know that she necessarily categorizes, because I’m not TIPA certified.
[6:59] But she talked about control and connect, right? So we’re always looking to either control something or to connect with something. And so if you look at our, yet again, what we call challenging behaviors, they could be divided easily into, I’m trying to control my environment because I feel out of control. So I’m angry because I cannot do something and so therefore I’m trying to control
The Role of Caregiver Awareness
[7:22] or I’m pacing and I’m crying or I’m upset because I’m looking to connect with someone. So these were just three quick little down and dirty ways of kind of looking a little bit at challenging what we call in air quotes, challenging behaviors. And the reason I use air quotes, for challenging behaviors, is one of the things that I have come to conclude the longer I do this, and quite frankly, because of my personal experience with my parents, I finally started to recognize that we, and what I mean by we, I don’t want you to hear you, I want you to hear we, society.
[8:05] The people around people with cognitive impairment, are actually causing to a large extent the behaviors that we see. And the reason I say that is because dementia creeps up on you, doesn’t it? It’s insidious. You kind of, when you notice the first changes, you have that thought in your head. I’m like, did I really see that? Did that really happen? Was that there? Or is this, oh, they’re just tired or they’re overwhelmed or the person, oh, it’s just normal aging. We, people around people who are starting to have cognitive changes, we’re really far behind by the time we notice it that we, society.
[8:46] Everybody around this person has contributed to their sense of dis-ease or questioning, is this really happening to me? And so by the time we truly have either a diagnosis or things have progressed to the point where it is no longer a guessing game, there really is something wrong, we’ve done stupid things for a very long period of time. And for example, with me, what happened with me is when my mom first started repeating herself, I frequently would say to her, but mom, don’t you remember you said that to me already, right? Or, but mom, we’ve had that conversation before. All of these different types of things that I would say to her. And then my mom was super anxious all the time and I never could figure out why. And then my dad got sick, right? So you guys might have heard the story about my dad getting sick about two years ago. And when he first came out of the hospital, he was super, super confused.
[9:44] And the second time he came out of the hospital, he couldn’t stay at home with my mom. And he’s my mom’s primary caregiver. So they moved in with my husband and I. Well, thankfully, the second time around, I was a little smarter than the first go around. And I realized that saying to my dad, plus I’d had further education and training, that telling my dad that he wasn’t remembering something had created anxiety in my mom and I tried something different.
[10:09] And the difference was remarkable. I never would have guessed it could be such a tremendous big difference by just changing me and not trying to change my dad, right? And so when they lived with us for the first two months after he came out of the hospital, he was what I call generously cuckoo for Cocoa Puffs and was super, super confused. Every single morning, I would come out of the room and my dad would be in the living room where we kind of set up a little station for them to sit and be on their computers and do their daily things that they did at home. And he would say to me, good morning, Lizette, how did you sleep? And I would say, I slept great, Dad. How did you sleep? And I slept with my eyes shut every single morning. And then I’d go get my coffee. I’d go back to the office. I’d sit down and do my private space. And I would sit down and do my morning devotions. And I would finish my coffee or it would get cold. And then I’d walk back through the living room on the other side of the house. And my dad would look up and say to me again, well, good morning, Lizette. How did you sleep? every single morning, we had the exact same word for word, same conversation for three to four times every single morning before his brain was ready to move on. But what I realized from doing this little loop with him was that although it was something I had to work at, not to get frustrated because it’s super easy to say, but I told you so, right?
[11:34] We’ve already had this conversation. I know how hard it is. You got to bite your lip. But what happened was I started to realize that my dad wasn’t anxious.
[11:42] My dad was not anxious at all about the fact that he wasn’t remembering these conversations.
[11:49] Fast forward two years, he has hardly any recollection of the first two months when he came out of the hospital, when they were actually living with us. And so I concluded that my dad is not anxious at all. He still has difficulty. His difficulty is not as profound or as pronounced as it was when he first came out of the hospital. But what has happened though, is that I realized that I probably contributed to my mom’s challenging behaviors by the fact that I was caught by surprise. I did not have an awareness that my mom was having these changes earlier on. And now that her changes are more pronounced and it’s evident that she really doesn’t remember stuff, I have changed how I interact with my mom because I can change, my mom cannot. And so my mom right now, quote unquote, challenging behaviors are pretty well controlled, not because my my mom has changed, but because I have changed. And so I wanted to have this conversation today about, quote unquote, what we call challenging behaviors, because it is something that is so frequent
Who is Challenged by Behaviors?
[12:56] in our healthcare space, calling these things challenging behaviors. Another opportunity for you that I want to challenge you with on purpose, using the word challenge you with, is who is it challenging for? Who are quote unquote these challenging behaviors? Who do they challenge?
[13:16] Do they challenge the person living with dementia or do they challenge me? Because I would contend that nine out of 10 times, if not more.
[13:25] If not a hundred percent of the time, but most of the time, a quote unquote challenging behavior is challenging to me, the care partner, the care provider.
[13:35] The family member, they challenge me because I don’t know what to do, because I was caught unaware, because quite frankly, it impacts my life. I have to do things differently, right? I have to control my tongue. I have to change. I have to drop everything I’m doing to go intervene and try to get this person who is demonstrating this challenge, which is their way of trying to communicate something to me, that something’s going on, it challenges me more than it challenges them.
[14:08] Yesterday in my Facebook group, this person, she is looking for solutions. She is looking for answers to questions. Well, she posted that when her mom came home from the adult day program she was in, she left the house in the morning in a great way. And by the time she came home, she was all bent out of shape and it was really impacting this member of my community’s ability to function herself. And she reached out and asked a question. And so my answer to the question was to try to look at the situation related to whether this person who had been in the adult day program, what had happened at the adult day program? Did something happen there? Was she overwhelmed. Was there a care partner there that pushed every button of her? And what we’re seeing with and what we’re dealing with at home is related to what happened at the day program. But the description that the member in my group had given was that her mom, you know, was kind of being a little resistant to care. She had to change her. She was being resistant and then wouldn’t take her medication for her anxiety or for her behavior and then was sitting on the couch had pulled the covers over her head in the house.
[15:18] And my recommendation, my suggestion to the member of the community was to consider whether her mom was trying to control or connect, trying to figure out is the fact that she’s putting the blankets over her head. I’m trying to control my environment. I’m trying to, I can’t tell you what’s going on in my mind, but I can put the blanket over. I can cut off all of the stimulation because my brain is telling me I cannot do this. There’s too much going on. Leave me alone. Like the nonverbal to me said, leave me alone. I’m trying to control what’s going on with me, but I can’t tell you what’s going on.
[15:57] Just give me some space, right? or is she trying to connect with her daughter? And my gut spidey senses, my gut said that she was trying to control because of whatever was going on. What was interesting is that the member of the community came back later on and said that she just gave her some space. She didn’t want to eat. She wasn’t going to die of hunger, so she wasn’t going to force her,
Practical Solutions for Caregivers
[16:19] which was the right thing to do. But she waited and waited and waited and just gave her mom that space that she needed. And then the quote-unquote challenging behavior went away. She was able to gain control of the situation, help her mom with her basic self-care skills, give her her medication, and really was able to avoid a catastrophic response, which is, you know, a response. We’ve all seen them, right? We just don’t call them catastrophic responses, but a catastrophic response is a response to a stimulus that is way outside proportion to the actual stimulus. Where do we see these catastrophic responses all the time? Think about the two-year-old kid in the grocery store, right? That’s going, I want that thing and laying on the floor, the two-year-old kicking and screaming.
[17:10] So the response to the situation is way out of control to the actual stimulus. And the reason that that happens for people living with dementia is because as their brain is changing, the actual physical changes to the brain, some of the first things that go away is some of the higher level things. Prefrontal cortex parts of our brain, which include our ability to control our emotions.
[17:36] So back to my group member, the reason that she was able to avoid that catastrophic response is because she gave her mom the space that her mom needed in order for her mom’s brain to just process what was going on. So today’s program was really about challenging behaviors, what they are, what to do about them to give you a little bit of an idea of how to look at them from a couple of different perspectives. So we looked at the behavioral and psychological approach. We also looked at an underlying symptom and a symptom-based and an underlying cause-based program of, you know, way of looking at it. And we kind of looked at it from a control and a connect perspective. I gave you a couple of definitions of what challenging behaviors are. And what you as the family caregiver could do to actually help decrease the incidence or the frequency of what I called, air quotes, challenging behaviors.
Coaching Opportunities for Caregivers
[18:37] So I really know that this was a very valuable episode for you. If you haven’t yet signed up for one of our dementia audits, where I will sit with you for 20 to 30 minutes and have a conversation and help you along your journey, then please go to the show notes and sign up for one of these free coaching sessions. I’m really looking for people who are willing to come and actually dialogue with me. There is no pressure. I’m just here to serve. So I really do hope that you will join me for one of these episodes so I can answer your specific questions and we can help other people who are navigating dementia in a different way. And you can message me on Facebook, the word audit, or you can message me on Instagram, the word audit, and that’ll send you to a place where you can register for one of these free sessions. So I really hope you take me up on that. I’m hoping to grow that part of the program. If I can get a couple of people who are willing to come on and can be extremely valuable in helping you along this dementia caregiving journey. So as I end all of my episodes, may the Lord bless you and keep you, and I will see you in our next episode.
