Communication is at the seat of quite a few challenges for individuals with dementia, and a carers. The first in a special series of three for Dementia Awareness Week about dementia and communication, this article looks at some of the reasons why someone may behave strangely when they have dementia.
Whether you are the main family carer for a person with dementia, or you work for a home care company – or even in a dementia care setting – you are probably aware that when communication is better, behaviour and other challenges tend to be less disruptive.
How behaviour is connected to communication
All behaviour has a reason. Keeping this in mind, when someone has behaved in an apparently bizarre, or unexpected way, isn’t always easy, but it’s still true. The fact is, for persons with dementia (and anyone, really) most behaviour is based in at least one of three areas.
Imagine you are hot. Now imagine you can’t remember the word ‘hot’, or any words that are similar. Imagine you find it really hard to form the word after you have thought of it. You can’t write it, and you can’t speak it in a way that someone else understands. But you’re still really hot. What do you do? If you’re mobile enough, you may start shedding clothes. It’s the quickest way to feel cooler, given you haven’t got a pool you can jump in. Heat and cold aren’t the only stimuli. Noise or overwhelming anxiety due to a busy environment can cause a person to feel frightened, upset, frustrated, or even embarrassed. A bustling dining room, cafe, or another public area, may be enough to cause the person to try to get up and leave, or to throw their meal on the floor or otherwise create a situation.
If you notice someone is behaving strangely, and you know they have difficulty communicating, you should always look to see if there is anything obvious or possible in the immediate environment that could have caused the person a problem.
Someone curled up on their bed, crying or moaning, not responding to others’ attempts to comfort or rouse them … what would you think? Are they depressed about their condition? Feeling isolated? The fact is, you won’t know unless you communicate adequately with them. They could be in pain, or be otherwise very uncomfortable for some reason.
A person with dementia may not be able to tell you about it unless you help them do so. It’s worth remembering that a lot of medications that older people are prescribed for physical and mental illness can sometimes lead to very uncomfortable constipation, trapped wind, or related digestive difficulties. For example, codeine is well known to cause constipation.
The trouble is, how do you know? You can check medications information and see if any side effects might cause the person problems. You will probably be aware of their bowel movements, and whether or not they are successful. But really, the answer is, to be able to communicate better.
Just like anyone, a person with dementia feels sadness, happiness, loneliness, disappointment, fear and everything else that makes human beings human. These feelings emerge as a direct result of experiences the person has in their daily life. Maybe they watched something on the TV that made them feel sad. Perhaps they are depressed, not sad.
The biggest difficulty is for the person to express these emotions in a communicative way. Without all the words, it can be very difficult to get nuanced and unusual information across to someone else. Communication is reliant on certain behaviours with messages. If those behaviours aren’t delivered in the standard way, the messages become distorted or misunderstood. You can find some excellent information around understanding behaviour when someone has dementia at the Alzheimer’s Society.
Understanding dementia and communication better
Some types of dementia make communication much harder, and this means we risk it becoming one-way only if we don’t make special effort to understand the meaning behind the behaviour. In the next blog post in this short series, we will look at the reasons why dementia causes communication problems.