Causes to challenging behavior

There may be several reasons why people with dementia develop BPSD, and both biological, psychological and social aspects may be important. Behavioral and psychological symptoms may also reflect disease mechanisms resulting from the neurodegenerative process due to the dementia disease itself. The symptoms may also exist because the environment, for example, does not adequately address the person’s basic needs in connection with activities and communication, or it may be a reaction to somatic problems such as pain, infection or dehydration. Unmet needs can cause behavioral symptoms, like basic physiological needs such as nutrition and sleep, or more existential needs such as social contact, communication, expectations of the environment or a meaningful everyday life. Generally, it is never the citizen’s disease alone that triggers the challenging behavior. The behavior typically arises in response to inappropriate conditions in the efforts towards the persons with dementia. It may also be due to conditions in the individual resident’s background that trigger strong reactions in certain situations, or it may be due to the functional loss that a person has because of the dementia disease.

The symptoms relate to:

• Lack of impulse control and inhibition

• Anxiety and depression

• Agitation and apathy (disinterest)

• Delusions, hallucinations and misinterpretations (illusions)

• Disturbed sleep

Behavior should be understood as communication. The person may react to unmet needs or unreasonable demands or a relationship in which he/she does not feel comfortable. To understand behavior as a challenger, you must look at the behavior from the persons perspective. Persons with dementia experience many losses and they may experience anger, frustration and depression, which is natural. If the citizen also has linguistic problems, the situation can be further aggravated.

Furthermore, violent reactions can e.g. this is due to previous trauma that occurs in connection with dementia. (As in second case example point 3 below. “A reaction to anxiety or stress that arises when the demands in the environment become too high”) this may require special attention, and an interdisciplinary effort may be needed. In the case of reactions to disease conditions or physical problems such as pain, and other physical malaise which can be treated medically or with e.g. physiotherapy, this should of course be done as soon as possible.

In many nursing homes in the care of people with dementia, the principle of person-centered care is used; a caring effort that values the person with dementia as an independent individual and creates a positive social environment where the person with dementia can experience well-being. Person-centered care and treatment safeguard individual rights, preferences, and needs of the person with dementia, thus presuming to prevent the development of behavioral and psychological symptoms. Person-centered care and treatment include a social-psychological, holistic approach and framework of understanding, which provides a framework for organizing and implementing care and treatment approaches for people with dementia.

Psychosocial interventions are targeted and structured activities aimed at supporting and promoting the psychological, cognitive, functional and social resources of people with dementia. Organizationally, person-centered care can be part of the values and guide the organization’s operations and development, including staff training and competence development. Challenging behavior can be defined as a reaction or indication of one or more problematic conditions in the citizen’s everyday life rather than a behavior triggered solely by the citizen’s illness. Problems may be, for example, that the physical framework does not match the citizen’s functional loss or that the citizen cannot express wishes or any discomfort.

In general, explanations of behavior can be classified as follows:

Explanations of behavior either individually or together

1. A response to a need that is not being met

2. A learned context, that is, the persons do something because they know from experience that the behavior triggers a reaction in the environment.

3. A reaction to anxiety or stress that occurs when the demands in the surroundings become too high. Both physical and existential needs become more difficult to meet when the person has dementia. It takes help, care and insight to meet the needs.