Responsive and reactive behaviours

Overview

Responsive behaviours and reactive behaviours are terms commonly used to refer to actions, words or gestures presented by a person living with dementia as a way of responding to something negative, frustrating or confusing in their social and physical environment.

Some common examples of responsive behaviour include:

• Aggression
• Agitation
• Wandering
• Restlessness
• Hallucinations
• Paranoia
• Making unexpected noises
• Becoming more withdrawn

They are the result of changes in the brain affecting memory, judgement, orientation, mood and behaviour.

Responsive behaviours follow these principles:

1. All personal expressions (words, gestures, actions) have meaning.
2. Personal expressions communicate meanings, needs and concerns.
3. To understand their meaning, you must consider the factors influencing his behaviour (physical, emotional and environmental elements etc.).

When someone exhibits a responsive behaviour, reflect on whether it is a problem for the person diagnosed or for you? Will the solution cause more anxiety? Will changing my expectations affect the problem?

Considerations

While this page offers strategies for in the moment behaviours, think about their true meaning. Consider these questions regarding what happened before, during and after the event:

• Physical – Are her basic needs met? Is she in discomfort or pain? What changes in her physical condition do I see (i.e. grimacing, eating patterns, energy level)?
• Intellectual – Has he experienced recent changes in his memory? Has he been showing impulsive behaviour (swearing, sexual behaviour)? Is he struggling with speech or sequenced tasks (getting dressed)?
• Emotional – Have you noticed increased tearfulness or anxiety? Does he seem lonely? Has he exhibited any new unusual behaviour (i.e. suspicious of others)?
• Capabilities – Can your Mom do more than you realize? Does your husband understand that he may need help?
• Environment – Is there too much noise or too large of a crowd around your friend? Is the lighting poor, making it hard for him to navigate? Is there enough stimulation?
• Social – Do her childhood, early adulthood or employment experiences offer insight? What do I know about his religion or culture?
• Actions of Others – What am I doing or not that may contribute to her behaviour?

Specific responsive behaviours: Aggression and agitation

Aggression involves physical and emotional outbursts (i.e., shouting, hitting). Anger reflects many feelings and occurs for reasons that aren’t clear. We can try to figure out why but also we must respond to the behaviour.

Agitation may involve the person pacing nervously, drums fingers, etc. for long periods of time.

Ultimately, we can’t expect the person with dementia to change; we must do the changing. We need to understand the disease, be patient and accept who the person is in this moment.

It is important to note that if your personal safety is at risk, leave the room for a safer place, even the hallway. Don’t get into a position where you can’t leave the room. Once you’ve left, get staff assistance immediately.

If such behaviour begins to impact the quality of life of your family member or those around him (co-residents), you should consult with the professional staff to adjust his plan of care.

Possible causes

Aggression

• Fatigue or disruption of sleep pattern
• Grief as his world becomes less and less familiar
• Pain or physical discomfort
• Sensory overload
• Feeling lost, insecure or forgotten
• Fear of a situation or a person he finds threatening
• Dementia may lessen his control over emotions
• As dementia progresses, he may struggle to express anger and will do so physically (hitting, biting, kicking) or verbally (shouting, name-calling).
• May happen suddenly without any apparent reason or after a stressful event

Agitation

• Environmental, such as changes to living arrangements or in caregivers
• Fear of bathing, unknown surroundings or having clothes changed
• Dehydration
• Fatigue
• Feeling overwhelmed or confused

Tips and strategies

Responding to aggression

• Watch for a sudden increase in movement to indicate anxiety.
• Respond in a supportive manner and reassure in a gentle voice.
• Reduce noise.
• Ensure that staff maintain a consistent routine.
• Speak slowly and use repetition.
• Break activities into manageable steps.
• Distract him.
• Approach slowly from the front at the same eye level.
• Leave the room for a “time out.” Remember it is the disease, not the person.
• Avoid arguing or expressing anger or irritation, verbally or non-verbally.

Example

You are having dinner with your father in the residents’ dining room. You watch your father struggle to cut his meat and get the food to his mouth. You offer to help and begin to cut his food. He lets you for a minute, but then grabs your wrist and threatens to “smack you if you try that again!” Your father has never laid a hand on you and you are horrified that this just happened.

Don’t

• Grab his hand and try to force him to let you go.
• Yell in surprise.
• Explain that you were trying to help.

Do

• Remain calm and don’t react.
• Let your arm go limp, apologize and distract him with conversation.
• Once he lets go, give him space to cool down. Later on, think about what was behind his anger. Was he embarrassed? Could he have thought you were taking his food?

Responding to agitation

• Redirect person’s attention Remain calm and positive
• Use visual and verbal cues (gestures)
• Simplify tasks and routines
• Whenever possible, give your husband options. But offer one or two choices to avoid overwhelming him. (e.g. do you want to wear this blue shirt or this red short? vs. what shirt do you want to wear?)

Example

During a visit with his wife, Jim fidgets, picks at his clothes and seems restless. He can’t sit still and his wife is getting upset with his behaviour.

Don’t

• Ask him to stop picking.
• Tell him to calm down
• Raise your voice

Do

• Give him something to hold.
• Distract his attention with music Talk about a happy moment in his life.
• Go for a walk.
• Consider the environment: is it too noisy or bright?
• Consider the time of day: is he tired?