Recently I saw a commercial showing a woman who appears extremely agitated. It’s a commercial depicting what is commonly referred to as “dementia behaviors”. These include behaviors that one might refer to as aggressive, whether it be physical or verbal aggression. Heck, in nursing homes, when a person is behaving in this manner, they refer to it as “they are behavioral”. I hesitate use of the word ‘person’ in the last sentence because the reality is this reference is dehumanizing. It takes away the important part of the equation, the person. We must remember, and understand, that the person living with dementia is a person, a whole person, whose emotional, psychological and psychosocial needs must be taken into account.
We all have basic human needs; they are universal. Here they are in alphabetical order, not necessarily in order of importance: appreciation, autonomy, contribution, compassion, effectiveness, freedom, inclusion, love, purpose, security, to name a few.
Therefore, the needs of the person living with dementia should be seen and interpreted through this lens. What is the person trying to convey at that moment?
Can you relate to this scenario? A baby or child is irritable, is having a tantrum, crying. Isn’t there an attempt to interpret the behavior as conveying some need?
I certainly have experienced this when my own children were little, and now as my daughter raises her children. When they were infants without the ability to communicate, I immediately tried to determine if he/she was wet and need to be changed. The next thought was that they might be hungry, followed by maybe they are hot or cold. Lastly but certainly not least, they wanted to be held and soothed. The cry was seen as a cry out for help.
When the child is a little older, we may refer to the child as being “cranky” because he/she may be tired, or possibly hungry.
The example is not meant to imply that the person living dementia is a child. They are an adult. However, with an increasing loss in the ability to adequately communicate, their agitation could be nothing more than what is seen when a child who is crying out to fulfill some basic need.
Care and attention must be given to creating an environment where the needs of the person living with dementia needs are met and the person caring for them has the tools to understand how to interpret and meet that person’s needs. In nursing homes, I have seen many staff who understand and intuitively attempt to fulfill some of these needs, especially love and compassion. But what about the needs in other areas?
I use this example to explain the point. Think of yourself having an itch in the middle of your back, an itch you cannot reach. You first try to reach it with your hand. You then try picking up an object to try and reach it. No luck. The situation is intensifying. Then you stand against the edge of a wall, moving to and fro trying to relieve the itching sensation. It seems maddening. Lastly you call out to someone to help, directing their hand to just the right spot and finally, aaaahhhhh, the sigh of relief that the situation is resolved. You feel comfortable again.
To the casual observer who doesn’t understand what you have been experiencing they might interpret this string of events as sheer craziness.
Now think of a person living with dementia who does not have the reasoning, language, or physical capability for any of these maneuvers to have a basic need satisfied?
When we encounter a person living with dementia who seems “agitated” we must think of what they are trying to communicate. Is it a cry out for an unfulfilled need, a level of discomfort with their current state, their surroundings, or a cry out for compassion, love, affection.
One of the basic needs that is often not met for the person living with dementia is the need for compassion, love, affection, security. He/she may feel lost, and helpless. A mere hug, gentle touch, compassionate words, could be all that is needed to calm his/her feelings.
For more information on understanding and communicating with a person living with dementia, email: firstname.lastname@example.org
You can also visit www.babyboomer.org for courses that can help you learn more and care for a person living with dementia.
Essential Dementia Care 101
There Is a course entitled ‘Essential Dementia Care 102’. It may be worth considering bundling the courses.
Caregivers Guide to Caregiving - the Basics
Communicating Effectively with People With Dementia