Understanding Behaviour Guide
Learn to recognize that behaviour is a form of communication and develop compassionate, effective responses to common behaviours encountered in dementia care.
Core Principles of Behaviour Analysis
Behaviour is Communication
- • All behaviour has meaning
- • Look beyond the action to understand the message
- • Consider what needs might be expressed
Person-First Approach
- • Focus on the person, not the behaviour
- • Consider the individual's history and preferences
- • Recognize that behaviours are not deliberately difficult
Environmental Factors
- • Assess how the environment might contribute
- • Consider triggers that may prompt certain behaviours
- • Adapt surroundings to support needs
Behaviour Analysis
Agitation and Restlessness
Pacing, fidgeting, or appearing anxious and unable to settle
Possible Causes
- • Physical discomfort or pain
- • Medication side effects
- • Overstimulation from noise or activity
- • Unmet needs (hunger, thirst, toileting)
- • Feeling lost or insecure
Select Your Approach
Practical Tips for Responding to Behaviours
Do
- ✓ Look for patterns in when behaviours occur
- ✓ Consider physical causes first (pain, hunger, etc.)
- ✓ Respond with calm, reassuring communication
- ✓ Adapt the environment to reduce triggers
- ✓ Use validation rather than correcting or arguing
- ✓ Document behaviours to identify patterns
Don't
- ✗ Take behaviours personally or as intentional
- ✗ Argue or try to use logic to correct
- ✗ Rush or force compliance with care
- ✗ Use restraint or punishment for behaviours
- ✗ Label the person as "difficult" or "problematic"
- ✗ Overmedicate to manage behaviours without trying other approaches first
Professional Assessment Tools
Use these evidence-based tools to systematically assess and respond to behaviour changes, aligned with NICE NG97 guidance.
ABC Behaviour Chart
Systematic recording of Antecedent → Behaviour → Consequence to identify patterns and triggers.
A - Antecedent (What happened before?)
Time, location, people present, activities, environment
B - Behaviour (What exactly happened?)
Specific, objective description without interpretation
C - Consequence (What happened after?)
Response from staff/family, outcome, resolution
📋 Printable ABC Chart Coming Soon
Pain Assessment
Unrecognised pain is a common cause of behaviour changes in dementia.
PAINAD Scale Indicators:
- • Breathing patterns (laboured, rapid)
- • Negative vocalisation (groaning, crying)
- • Facial expression (grimacing, frowning)
- • Body language (tense, guarding)
- • Consolability (unable to comfort)
Action Required:
Score ≥2: Consider pain relief and medical review
De-escalation Pathway
Assess Safety
Ensure immediate safety for all. Remove or reduce triggers if possible.
Validate Feelings
"I can see you're upset" - acknowledge without agreeing or disagreeing.
Redirect Attention
Use meaningful activities or familiar topics to shift focus.
Follow Up
Monitor, document in ABC chart, and review patterns.
⚠️ Anticholinergic Burden Check
High-Risk Medications:
- • Antihistamines (e.g., diphenhydramine)
- • Tricyclic antidepressants
- • Antipsychotics (especially older ones)
- • Bladder medications (e.g., oxybutynin)
Signs of Anticholinergic Effects:
- • Increased confusion
- • Dry mouth, constipation
- • Drowsiness or agitation
- • Increased fall risk
🔍 Always collaborate with pharmacist to review medication burden when behaviour changes occur.