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Environmental / External Causes of Challenging Behaviors in Dementia


Updated February 29, 2012

Many of the behavioral concerns that arise in Alzheimer's and other dementia have specific causes. In order to effectively address and reduce some of those challenging behaviors, we need to first consider what might be causing the person to behave that way.

One way to approach this is to look at what's happening around, and outside of, the person with dementia. Evaluating the setting can help us determine if there are situations that may be triggering a behavioral reaction by someone whose memory, comprehension or orientation is limited.

Environmental Causes of Challenging Behaviors:

  • Overwhelmed by Stimulating Surroundings
    Are there too many choices, is it too noisy or is more than one person speaking at the same time to your mother with Alzheimer’s? These are examples of situations that can be overwhelming for someone with dementia. She can’t process everything as well as she used to, so if the environment is too busy, this can trigger anxiety, frustration, anger or withdrawal.

  • Change in Routine
    If your usual routine with your loved one is to rise mid-morning and eat a hot breakfast, getting up at 8 a.m. to rush off to an early doctor’s appointment might be difficult. Take this into consideration; when possible, keep consistency in the routine.

  • Unfamiliar Environment
    Changing someone's usual environment can trigger such behaviors as restlessness, aggression and agitation. For example, when your loved one is admitted into the hospital, provide extra reassurances through your presence and through verbal reminders like, "It's going to be okay; I'm here with you." You can also offer comforting touch such as holding his hand (if this is something that usually calms the person).

  • Lack of Personal Space
    Everyone has a personal bubble of space they’re used to keeping as their own. Individuals with Alzheimer’s or another dementia may have an increased sensitivity to a person coming into their space or a decreased awareness of others’ space.

  • Confrontation with Others
    Sometimes, other people unknowingly trigger uncooperative or aggressive behavior in others with dementia. For example, in a facility, one person who is confused may not realize that another person is also confused, and this may unknowingly trigger a reaction of anger or frustration.

  • Caregiver Approach
    This is a critical factor in the behavior of those with Alzheimer’s or other dementias. If the person receiving care feels rushed, patronized or unimportant, this can easily trigger frustration that shows up as resistance, hitting or verbal aggression. Focusing on how caregivers approach someone and interact with them is one of the most effective ways to manage and reduce challenging behaviors in dementia.
  • Sources:

    Alzheimer’s Association. How to respond when dementia causes unpredictable behaviors. Accessed February 24, 2012. www.alz.org/national/documents/brochure_behaviors.pdf

    Alzheimer’s Foundation of America. Behavioral Challenges: Potential Causes of Behavior Problems. Accessed February 24, 2012. http://www.alzfdn.org/EducationandCare/causes.html

    Family Caregiver Alliance. Caregiver's Guide to Understanding Dementia Behaviors. Accessed February 24, 2012. http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=391

    HelpGuide.org. Alzheimer’s Behavior Management. Accessed February 24, 2012. http://www.helpguide.org/elder/alzheimers_behavior_problems.htm

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