Top Tips for Dealing with ‘Distress-related Behaviours’ in Dementia Care:
‘Wandering’ or Walking about?
Unfortunately, behaviours such as walking about are often described as ‘wandering’ which suggests purposelessness. This assumption ignores the feelings behind such behaviours.
However, this behaviour in people with dementia is often caused by a range of reasons, including: feeling lost, unsettled or distressed or wanting to find something/someone, existing in a past time (e.g. going to work/pick up children from school at a specific time or following earlier routines), or being disorientated within the care setting (e.g. being unable to find the lounge, toilet, etc.
There could be many causes. Remember All Behaviour Has Meaning
- Always start by considering what might be the cause behind the behaviour: this will require a team effort (e.g. is this behaviour related to the person’s earlier life – e.g. a previous nurse walking about as if she/he is checking on patients, a teacher checking their pupils work.)
- Arrange group walks for those who walk about a lot (e.g. outings)
- Assess for and deal with any reversible conditions such as pain, incontinence, infection, thirst, depression, delirium or Akathisia that may causing the behaviour
- Avoid stopping/restraining the person from what they are doing – this will simply lead to further distress, frustration and resistance
- Cohen-Mansfield (1989) found that applying masking tape to the floor in front of an exit door prevents the person trying to ‘exit’ whilst others have found that a mirror in front of the exit can have a similar effect. Similarly, blending the colour of exit doors into the background colour is suggested to have comparable results
- Consider fitting personal alarm devices (be aware of issues of unreasonable and unlawful restraint)
- Ensure the environment is safe for the person to walk: address any potential risks
- Give the person drinks/snacks to ensure hydration and calorie intake. Facilitate, rather than control the behaviour.
- Keep people active and engaged and enjoying themselves for as long as possible – with structured rest periods. Daily social gatherings, possibly involving physical exercise, may help to reduce ‘wandering’
- Provide access to a garden, as appropriate
- Provide meaningful tasks and activities to create a sense of usefulness and provide exercise and companionship, especially targeting “sun-downing”. Group sessions, usually held in the afternoon, involving activities such as music, exercise, dancing or ball games may provide a distraction for wandering or agitation.
- Put chairs in positions that will encourage the person to stop/rest
- Show the person who is walking during the night that it is dark outside this may orientate them to the fact that it is a time for sleep
- Use pictures and symbols on bathroom, toilet and bedroom doors
- Walk with the person and try to engage them in conversation, providing a distraction if appropriate (e.g. taking them to look at photos of relatives/past times).
“If time is devoted to reaching out to somebody with dementia, listening to them, appreciating their needs, feeling their suffering, understanding their ways, we are compelled to accept that a person with dementia”
Stokes, Challenging Behaviour in Dementia, 2000
Always record, document and communicate successful strategies when dealing successfully with behaviours. This can help your colleagues, whilst ensuring that everyone working with the person with dementia follows the same approach which will reduce confusion.
 Adapted from:
Stokes, G. Challenging Behaviour in Dementia (2000)
Bonner, C. Reducing Stress-Related Behaviours in People with Dementia (2005)
OVER TO YOU: RELEASE YOUR POTENTIAL!
These are my thoughts and perspectives (I’m not necessary right or wrong, simply starting a conversation).
So, what about your thoughts?
- I’d love to hear your thoughts, reflections, gut reactions, perceptions, experiences and wisdom.
- Do any of these things ring true for you and can you see yourself putting these into action?
- What would it look, sound and feel like (for you and others), if you put some of these tips into action?
- What barriers might you come against when putting these tips/ideas into practice? How might you overcome them?
- Who could give you support and how?
- Have you tried these tips and ideas out and, if so, what have you learned?
Remember that sharing our experiences can help others, so your thoughts and comments are always welcome.
Thanks, in advance, for adding to the conversation.