Meaning of Behaviours of Concern in Dementia

Behaviours of concern encompass a range of actions that can be distressing for both the individual and their family members or caregivers. In advanced stages of dementia, the individual might start showing aggressive behaviour, such as screaming, shouting, verbal abuse, and sometimes even physical aggression. The individual may also express intense feelings of agitation, such as restlessness and fidgeting.

People with dementia might also wander, potentially putting themselves at risk. This behaviour can be rooted in a search for familiar surroundings or unmet needs. Additionally, behaviours such as hallucinations or delusions might occur, where the individual sees, hears, or believes things that are not real. These experiences can cause fear and confusion, contributing to behaviours of concern.

Understanding challenging behaviour in dementia is crucial for caregivers and healthcare professionals to provide appropriate support and interventions. Approaches that focus on communication creating a calm environment, and addressing underlying physical or emotional discomfort can help manage and minimise behaviours of concern related to dementia.

Common Types of Challenging Behaviour

Signs and symptoms of dementia often include challenging behaviours stemming from the complex combination of memory problems, communication barriers, and emotional distress. These behaviours can put the individual and those around them in danger. Addressing these behaviours requires understanding their underlying triggers and a tailored approach considering each individual’s unique needs and experiences.

Aggression and Agitation

Aggression and agitation frequently emerge as distressing behavioural patterns in dementia. A person with dementia may exhibit verbal outbursts, physical restlessness, and emotional distress. These behaviours commonly result from the disorientation and frustration that individuals with dementia experience due to their memory loss and cognitive problems. Carers can help people with dementia to stay calm by providing them with soothing environments and employing effective communication techniques.


Wandering is a prevalent form of challenging behaviour in dementia that involves aimless movement and can pose significant safety risks for individuals. This behaviour often stems from confusion, restlessness, or a desire to fulfil certain needs. Wandering can lead to disorientation, potential accidents, and increased caregiver anxiety. People with dementia who are prone to wandering require preventive measures such as secure environments, engaging activities, and healthy routines.


Sundowning is a phenomenon in individuals with dementia, particularly Alzheimer’s disease, that refers to cognitive and behavioural challenges during the late afternoon and evening. This includes symptoms like confusion, mood swings, anxiety, and restlessness. While the exact cause of sundowning remains unclear, factors like disrupted circadian rhythms, fatigue, and sensory overload can contribute to its onset. Sundowning poses difficulties for the individual, and places added anxiety on caregivers.

Repetitive Behaviours

Repetitive behaviour is a common symptom of dementia and Alzheimer’s disease. These behaviours encompass a range of actions like repetitive talking, repeating questions, pacing, hand-wringing, or repeatedly performing simple tasks. They can be distressing for both the person with dementia and their caregivers. Repetitive behaviours arise due to the individual’s cognitive decline and subsequent struggle to effectively communicate their needs or feelings.

Delusions and Hallucinations

Delusions and hallucinations are symptoms that can occur in various forms of dementia, most notably in Alzheimer’s disease and Lewy body dementia. Delusions involve firmly held false beliefs, often of a paranoid or grandiose nature, while hallucinations entail perceiving things that are not present, typically involving auditory or visual experiences. These symptoms can be profoundly distressing for individuals with dementia and challenging for caregivers.

Triggers and Causes

Challenging behaviours in dementia can be triggered by a complex interplay of factors. These behavioural changes usually serve as a response to the progressive brain changes associated with dementia, leading to cognitive challenges and communication difficulties.

The most common triggers and causes of challenging behaviour in dementia include the following:

  • Physical pain or discomfort
  • Unmet needs
  • Emotional distress
  • Sensory overload
  • Confusion
  • Changes in routine or unfamiliar environments
  • Inability to express one’s thoughts and feelings verbally

Effective Strategies for Managing Challenging Behaviour in Dementia

Managing challenging behaviour in dementia is a complex and sensitive task, requiring a comprehensive approach to ensure the well-being of both the individual and their caregivers. Identifying and addressing the underlying causes of challenging behaviour is vital in supporting people with dementia. This may involve assessing the person’s physical health, medication side effects, unmet needs or environmental triggers. By understanding the root causes, caregivers can tailor their interventions accordingly, potentially reducing or even preventing challenging behaviours.

Individuals can benefit from a structured and consistent daily routine. People with dementia often feel more comfortable and secure when they know what to expect. Maintaining a regular schedule for meals, medication, and activities can help reduce anxiety and agitation and help caregivers manage challenging behaviour. Moreover, providing appropriate physical and mental stimulation, such as reminiscence therapy, music therapy, or simple activities like puzzles and games, can improve the person’s mood and decrease restlessness.

Positive Behaviour Support

Positive Behaviour Support (PBS) is an evidence-based approach used to address behaviours of concern in individuals with various cognitive challenges, including dementia. It emphasises understanding the reasons behind these behaviours and implementing strategies that promote well-being and quality of life. PBS focuses on creating a supportive environment and using proactive techniques to prevent challenging behaviours from occurring in the first place.

For instance, caregivers can identify triggers or stressors that may lead to agitation or aggression, such as loud noises or confusion, and work to minimise or eliminate them. PBS encourages the use of person-centred care plans, which take into account the individual’s preferences, history, and unique needs. Recognising and rewarding positive behaviours can also be highly effective in reinforcing desirable actions and reducing negative ones. By focusing on positive behaviour support, individuals with dementia can experience a higher quality of life, reduced distress, and improved overall well-being.

Person-Centred Approach

A person-centred approach to dementia care is a holistic and empathetic framework that recognises the person’s privacy, dignity, and agency. In this approach, caregivers prioritise understanding the person’s unique life history, preferences, and needs. By acknowledging the person behind the dementia diagnosis, this approach seeks to enhance overall quality of life, well-being, and self-esteem.

One of the central principles of person-centred care services is involving the individual in decisions about their care to the greatest extent possible. Furthermore, it encourages caregivers to create a familiar, safe, and comforting environment where distress and confusion are minimised. By focusing on the person and their individual needs, this approach improves overall quality of life and supports caregivers in providing more effective and compassionate care.

Support with Behaviours That Challenge with Nurseline Community Services

At Nurseline Community Services, we aim to reshape the approach to dementia care and create a more compassionate world. Our clinicians are trained to understand challenging behaviour in a humanised and empathetic way. By providing proactive home care services, we help individuals with dementia stay close to their loved ones and live as independently as possible.

Our clinicians carefully outline person-centred care plans that prioritise a person’s privacy and dignity. We work closely with specialists, the individual and their family members to assess health needs and personal preferences. This way, we maximise the safety of individuals with dementia and offer peace of mind for their whole families.

If you need professional support in caring for a loved one with dementia, Nurseline Community Services is the right choice for you. We deliver high-standard, CQC-regulated care to people across the UK, with offices in Bristol, Birmingham, and Gloucester.

Contact us now, and we will create a person-centred care plan tailored to your loved one’s specific needs.