It's important to recognize that most challenging behaviors are a result of fear, frustration, anger or physical pain or discomfort. Working to identify the cause can help us diffuse the behavior. Physical pain and discomfort should be ruled out first. For people who have difficulty communicating effectively with words, we must rely on non-verbal signs and signals. Observing facial expression, body position and carriage, degree of muscular tension, uncharacteristic actions such as pacing, and hand wringing can give us clues to physical causes.
After ruling out physical causes, we can utilize proactive strategies to reduce the likelihood of a challenging interaction escalating to violence. Try some of these strategies to diffuse challenging interactions.
Improve the Interaction
- Abandon the task and focus on the person. Sometimes people just need the loving presence of another person, without the pressure of having to complete a task.
- Change expectations. If you're working on something the person is unable to do for him/herself, increase the amount of assistance you provide to help complete the activity. You may even need to do the activity for the person, allowing him/her to be present with you while you do it.
- Improve/vary rewards. What you find motivating and inspiring may not be the same as what the person enjoys. Make sure you are considering her perspective.
- Validate feelings. Fear and frustration is a common cause of challenging interactions with people with dementia. Avoid dismissing or disagreeing with their feeling, rather work to validate them, even if what they are feeling does not make sense to you.
- Modify your tone. Warming your tone of voice and slowing your rate of speech can go a long way in making a person feel safer.
- Change your energy level. Generally, when we're dealing with a person with dementia, we need to slow down. Avoid rushing. Focus on the moment and be fully present. However, there are times when the need energy change is to speed up. If the person we are supporting is bored or agitated, we may need to put some "pep in our step."
- Involve choices, but not too many. People want to do things they like and find comforting, but providing too many choices can be overwhelming and stressful.
- Modify the environment. Change the lighting, reduce ambient noise (turn off music, television), eliminate clutter.
- Improve prompts. Use words that are easy to understand; cue with positive touch; hand over hand may be needed.
- Take a mini-break.
- Abandon the task. You may need to bail out of the interaction if it is specifically your presence that seems to be causing the distress.
When dealing with challenging interactions, the key is being at our very best when the people we are supporting are at their worst. We must be gentle, patient and kind and focus on positive interactions with few demands.