Managing Behavior Problems

Managing behavior problems of people living with Alzheimer’s and dementia

How would you feel if:

  • You are asleep in a chair at home when suddenly you are awakened by a person you have never seen before trying to undress you?
  • You are feeling bored and restless at home, so you decide to go out for a walk but you find that your front door has been locked and a stranger appears and tells you to go and sit down?
  • You are trying to get dressed, but it seems that someone has stitched up the sleeves of your jumper, removed some buttons from your jacket and hidden your shoes?
  • You are feeling sick and lying in bed, but no one is around you to help you go to the toilet, and so you wet the bed?
  • Someone approaches you in the street and starts speaking to you in a foreign language? You tell them that you don’t understand, but they keep on repeating themselves.
  • You are feeling really angry about something, but nobody around you will take your grievance seriously and they keep telling you that everything is fine?
  • You open your front door to a stranger who tells you that it’s time you had a bath?
  • You’re on vacation with your friends, in an area you’ve never visited before. Suddenly you realize that you have become separated from your friends and you are lost in strange surroundings, with only a sea of strange faces in front of you?
  • You’re late for picking up your children from school and you’re in a hurry, but the person with you won’t let you go?

Communicating through behavior

  • Persons with AD retain their desire to control their environment and their lives.
  • Memory loss creates fear and uncertainty; these feelings may trigger challenging behaviors
  • Persons with dementia have lower stress (frustration) level than normal
  • Behavior is a form of communication
  • All behavior has meaning. It may not make sense to the caregiver, but it has a purpose for the person with AD
  • Often, both caregiver and patient are caught in a cycle of fatigue, which magnifies challenging behaviors
  • Try to interpret behavior as you would a “foreign language”

T–E–A–C–H: Strategy for responding to problem behaviors

Task, Activity

  • Too complicated?
  • Too many steps combined?
  • Not modified for increasing impairment?
  • Unfamiliar?


  • Too large?
  • Too much clutter?
  • Too much stimulation?
  • Too little stimulation?
  • No cues or orientation?
  • Poor sensory judgment?
  • Unstructured environment?’
  • Unfamiliar environment?

Attitude of Caregiver

  • Were you speaking for them?
  • Ignoring them?
  • Approaching them suddenly or from behind?
  • Rushing them?
  • Were you being vague or unclear?
  • Expecting perfection or consistency?
  • Were you arguing, correcting, criticizing, saying something like, “don’t you remember I told you…?”
  • Using “reality orientation”?
  • Asking for factual information or “quizzing” them?
  • Going on and on with logical explanations for whatever?
  • Bossing them around or treating them like a child?

Communication Problem

  • Person unable to express thoughts/feelings/needs to caregiver?
  • Person unable to understand what caregiver is saying or doing?
  • Person feeling frustrated? confused? patronized? anxious? afraid? etc.
  • Person feeling isolated and left out?Person feeling disoriented?
  • Person doesn’t understand, or misinterpreting, the situation at hand?

Health or Physical Concern

  • Effects of medications?
  • Impaired vision or hearing?
  • Acute illness?
  • Dehydrated?
  • Constipated?
  • Depressed?
  • Tired?
  • Has a physical need (e.g., bathroom)?