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Addressing Behaviors
Posted: Monday, July 13, 2015 7:47 AM
Joined: 5/20/2014
Posts: 4408

Practical steps to addressing BPSD

With research indicating 90 per cent of people with dementia will experience one or more behavioural and psychological symptoms of dementia (BPSD), it is essential that aged care staff know how to respond. Judi Weaver explains why these symptoms occur and outlines some strategies to alleviate them.

Dementia is the term used to describe the symptoms of a large group of disorders which cause a progressive decline in a person’s memory, intellect, rationality, social skills and physical functioning.

Research has reported that up to 90 per cent of people will experience one or more behavioural and psychological symptoms of dementia (BPSD) as a result of disturbances in perception, thinking, mood and behaviour. Behavioural symptoms include physical aggression, screaming, restlessness, agitation, wandering, socially inappropriate behaviours, sexual disinhibition, hoarding, cursing and shadowing. Psychological symptoms include anxiety, depression, hallucinations and delusions. BPSD causes excessive functional and physical disability and decreases a person’s quality of life. It also significantly increases carer and staff stress.

Knowing why these symptoms exist helps us understand how to alleviate them. One way is recognising how an undamaged brain functions and what can happen if it is damaged.

The brain has four regions responsible for specific functions that determine behaviour – which includes thinking, learning, memory, language, recognition, perception, emotion and movement. The regions are known as the frontal, parietal, temporal and occipital lobes and include the limbic system. The brain is not an isolated organ; it interacts with all aspects of our being. It is influenced by biochemical, psychological, social and environmental experiences.

The frontal lobe of the brain is responsible for stopping, starting, planning, initiating activity and regulating social behaviour. Damage to this area may result in an inability to solve problems, start activities, understand another’s viewpoint and empathise, think logically or rationally, to behave according to socially sanctioned behaviour and to regulate feeling.

The parietal lobe processes touch, pressure, temperature and pain. It integrates information that lets us understand ourselves in relation to the world around us. Damage to this area may result in an inability to understand pain sensations, recognise and find objects, orientate ourselves in the environment and coordinate movements.

The temporal lobe helps us learn, memorise, use language, recognise and perceive phenomena. Damage to this area may cause an inability to use and understand language, recognise faces and objects, remember immediate, short and long-term information. Damage may cause persistent talking and changed interest in sexual behaviour.

The occipital lobe converts information received from the eye and passes this information onto the parietal and temporal lobes for further use. Damage in this area can cause blindness, hallucinations, and an inability to see colour or motion.

The limbic system is within these lobes. Its main function is to process and regulate feelings, sexual arousal and consolidate memory. Damage to this area can cause disturbance in day/night cycle, changes to sexual arousal, inability to control emotions, increased agitation and difficulty learning new information.

BPSD: communicating feeling and need

We generally don’t think about brain function triggering behaviour. Usually we assume behaviours mean certain things based on what we have learned with in our cultural group. For example, if a person intrudes into another’s conversation we would probably think this rude and means the person is lacking social etiquette. However, a person with dementia may impulsively intrude into another’s conversation because they feel scared or in pain and they are trying to get help. The person has no sense of rudeness. Brain damage may have diminished their ability to wait or reason.

Social scientists have demonstrated that innate factors – such as the need to satisfy hunger and thirst, eliminate waste or repair normal bodily function – drive behaviour. Behaviour is also driven by needs to be physically and emotionally safe, to experience love and a sense of belonging, to sense self- worth. These needs exist whether or not a person has dementia.

Using this approach BPSD can be understood as a person’s way of communicating an unmet need. Damage to parts of the brain may diminish or distort the way the person tells us about their feelings and needs through behaviour but it always has meaning for the person. Using this approach to understand the intrusive behaviour described above we can assume intrusiveness could continue until the person senses safety and physical comfort.

Another way to understand BPSD is remembering that behaviour is triggered by stress. People with dementia have a lowered stress threshold. A person with dementia can have a catastrophic response in situations we would find tolerable. When a person experiences too much or too little stimuli the body senses danger causing the person to fight or flee for their safety.

Managing an immediate situation

When you experience a concerning BPSD you must try and enter the person’s perception of the experience to help them restore a sense of safety or hope that their need will be fulfilled. Do not try and make them experience your sense of reality (for example, saying “No one has stolen your money”). You help them feel safe through behaviour and words that convey your sense of what the person is feeling (for example, if a person states that their money is stolen you can say, “You must feel very worried”). Next, offer to help. Your intention is to lessen the distressing feeling such that they no longer need to communicate distress by continuing the behaviour. Your interpersonal relationship takes priority over completing any task or coercing the person.

Steps in problem-solving ongoing BPSD

Know the person deeply to understand how he or she experiences their world. Use these approaches for insight into any behaviour and working out the best solutions and care practice.

  • Firstly, ask the person what is upsetting and what they think could help. Listen and action what they say.
  • Check for physical and medical problems that cause ill-feeling such as, pain and infection, illness, or medication.
  • Check the presence of too much or insufficient stimuli.
  • Check what emotional experiences the person may lack which provide a sense personal comfort and wellbeing.
  • Find out more than you know. Ask more about what is important to the person, what gave meaning in their life, what have been their preferences in kinds of relationship, activity and physical surroundings, what experiences or situations have been hard or frightening, what makes them laugh and smile and feel peaceful.
  • Collaboratively generate actions and experiences that are tailored to the specific personal needs and that have relevance for the person.

Antipsychotic medication is a last resort and only if there is a risk to self or others. Research shows that these medications may have dangerous side effects when a person has dementia. Also pharmacological management only has a moderate effect on vocalisations, pacing, repetition, insomnia, withdrawal, thinking problems and voiding inappropriately.

Research is also indicating some non-pharmacological interventions may decrease agitation. Examples are the presence of pets, music, spiritual ritual, scheduled reassurance, physical exercise, a homelike environment, personally meaningful activity, meaningful engagement with others and the use of ‘essential’ oils. However, your relationship with the person is the most therapeutic agent for wellbeing.

A care worker is similar to a detective always looking for reasons. Consider the following:

  • What emotion or feeling triggered this behaviour?
  • What might be causing the person to feel this?
  • Could they have physical, social or spiritual needs they are trying to tell me about?

When you find the reason you are responsible to fix it rather than blame, restrain, ignore or punish this person. We must change because the person cannot.

Finally, if you think you might be causing distress, stop what you are doing immediately. Start doing something different with the person and keep doing what helps them feel safe, comfortable, relaxed and happy.

Judi Weaver is a senior dementia care advisor with Alzheimer’s Australia (NSW). Go For more information, see The Reducing Behaviours of Concernguide.

Posted: Tuesday, July 14, 2015 4:00 PM
Joined: 9/12/2013
Posts: 3608

the part about brain sections and functions really interesting.

I copied this and emailed it to myself to read later.

Again in the report what I see does not cover the ability to read the energy of other people or the environment. I believe consciousness, awareness, is not located totally in the mechanics of the brain.

Even when we no longer speak in words, the eyes and body language reveal a definite presence and distinct expressions.

My experience has been that even when a person has retreated within they are still experiencing life as a human being. People who have always been around animals know how to read energy without even being aware of it. You just know when a horse if off, a cow not well, your dog is not herself.

This much seems so obvious to me I can not understand how people are indifferent to dementia metaphors! "I want to go home" said repeatedly in a nursing home has ended when the person was given a room of their own and people asked permission before coming into the room.

Posted: Tuesday, July 14, 2015 10:09 PM
Joined: 12/5/2011
Posts: 795

Thanks for sharing this article.

"People with dementia have a lowered stress threshold!"

I hope many people read it and read this particular quote.

Peace and Hope,


Posted: Wednesday, July 15, 2015 11:52 PM
Joined: 9/12/2013
Posts: 3608

teachable method that allows people with dementia to live lives to the end as themselves.

I bought the book and been some crying by page 35. Tears of relief.

3 golden rules

  1. Don’t ask direct questions
  2. Listen to the expert – the person with dementia – and learn from them
  3. Don’t contradict

The Three Golden Rules may seem counter-intuitive at first, but when they are used by everyone coming into contact with the person with dementia, the benefits quickly become self-evident and life will be much easier.

Once SPECAL sense is used, many aspects of caring for the person with dementia will begin to fall into place.


Contented Dementia by dr oliver james is enjoyable to read but dense with information and I am forgetting more than ever while reading, for today anyway. Even though written to train care providers at home and in nursing home situations, this book is a comfort to me considering the ways I can see my life changing.

Here is link to Contented Dementia Training videos:

and book:

Posted: Thursday, July 16, 2015 6:11 AM
Joined: 5/20/2014
Posts: 4408

Thank you alz+ for my positive morning reading! The term "contented dementia" stuck in my mind when reading somewhere and I haven't had the chance to look it up and learn more.
Posted: Thursday, July 16, 2015 7:02 AM
Joined: 5/20/2014
Posts: 4408

Please click on the link to read our brochure on-line or download a pdf copy.

Link to Contented Dementia Brochure

Posted: Thursday, July 16, 2015 7:09 AM
Joined: 5/20/2014
Posts: 4408

  1. Specialised Early Care for Alzheimer's (SPECAL ...
    Alzheimer's Society
    Background. The Contented Dementia Trust is a charity based in Oxfordshire which offers its own unique approach (SPECAL) to the care of people with ...
  2. There is some critique to the SPECAL approach. My comprehension is not good this morning!

Mimi S.
Posted: Thursday, July 16, 2015 8:42 AM
Joined: 11/29/2011
Posts: 7027

Lee, I just gave it a quick look through.

It almost seems as if the group that wrote the response wants to go back to "reality based" care. One always tells the truth.

For example:
Where is dad? He died. And person goes through grief. An hour later, repeat the same scenario.I don't think we want that.

It seems that the paper is negating Naomi Feil's Validation Method. I strongly agree with her method although I may not agree with her thesis of the cause of the poor behavior.