Behaviour as communication

How do we ever know why someone behaves in a certain way? If someone gets up from their chair, it’s not just a random act, it has a purpose. They may want to make a cup of tea, use the bathroom or have a change of scenery. The only way to really know why they got up from a chair is to ask them.

People with dementia are no different from all of us; their behaviour also has a purpose, a need that needs to be met. They may not have the language skills to tell you why they are behaving in a certain way or what it is that they want. If a person living with dementia cannot use language to tell us what we need, we may need to find clues that help us to understand. Behaviour is a form of communication, interpreting behaviour requires “listening” to the behaviours.

When we are trying to identify the unmet need that is being communicated through behaviour that challenges there are common physical and emotional needs that should be considered.

The table below illustrates some common unmet needs and possible responses.

Of these the most likely to be a factor in behaviours that may lead to physical restraint are anger, fear or a combination of the two. These usually relate to stopping someone doing something they want to do (such as leaving the ward) or more commonly making them do something they do not want to do (often intimate physical care).

It is important to make a personal connection before to try to undertake an activity with a person – it’s your relationship that is important, without this they may not accept the task. We should be aware that the person with dementia will take more notice of our appearance and behaviour that the words we use, facial expression and gestures are important. Do things with people not to them. 

Meeting physical and emotional needs

It is important that as well as responding to behaviour when it happens that we also proactively try to meet physical and emotional need to prevent distress. For physical need this means ensuring patients are eating and drinking enough, are given the opportunity to use the toilet, pain and delirium are recognised and treated.

Emotional need isn’t always considered in the acute setting but is equally important, especially for people with dementia who may find it harder to meet these themselves. Small things such as positive communication outside of care tasks, patients having their own clothes, using preferred names or knowing a little about our patients helps us to the meet their need for inclusion, occupation, comfort and safety, attachment and identity.

Routinely following the guidance in the See Me Care bundle helps to ensure our care is supportive and person centred.