One of the hardest things to handle for caregivers and loved ones of those with Alzheimer’s or another kind of dementia can be the challenging behaviors that often accompany it. Dementia can completely change the way someone interacts with others, and can cause behaviors that would never occur prior to the onset of the disease.
We know that in many cases, behavior has meaning. So, an effective strategy in coping with challenging behaviors is to analyze them to figure out what’s behind them. What might the person be trying to communicate or express? What might be causing it?
Why Use a Behavior Log?
Developing a behavior log can be very helpful in preventing and reacting to difficult behaviors. A behavior log helps clarify what the behavior is, how often it happens, what happened right before it, what the response was, and how effective that response was.
A behavior log helps you gather information. It’s not the only way to do this, but it is one way to put the pieces of the puzzle together to help you get answers.
It also is helpful to provide specifics to a doctor about behaviors. It can help quantify behaviors and point out patterns and effective interventions.
How to Start
In order to set up a behavior log for your loved one or someone you’re providing care for, begin by identifying the specific behaviors you want to monitor. Generally, these are the more difficult behaviors that you hope to decrease. We’re going to use a column setup on the top of the paper, and then use rows underneath. We’ll start on the left side of the column section.
- Column 1 – Time and Date
Here, we’ll note the time and date the behavior occurred, and how long it lasted.
- Column 2 - Specific Behaviors
Under column two, let’s use each row as a behavior, like this:
- Screaming out
- Combative with care
- Column 3 – Triggers
This is where we’ll look at possible causes of behaviors. Sometimes, we have no idea what caused the behavior, but other times, it seems pretty clear. So, here’s how this column might look:
- Attempted to provide care
- She was alone in her room
- Environment was noisy / busy
- Unsure of trigger
- Column 4 – Interventions
Identifying interventions, i.e., how we react and respond to the behavior, can help us be intentional about how we choose to respond, and also assist in giving us some ideas about what may or may not be effective or helpful. Column 4 might include some of the following interventions:
- Ensure safety and then give some time to calm. Return in 15 minutes to retry care.
- Distract her. Ask about her family or her famous chicken noodle soup.
- Ask if she is in pain. Observe for any grimacing or other pain expressions and offer an over the counter medication (if approved by her physician).
- Provide reassurance that you are here to help her.
- Column 5 – Effectiveness
Here, we’ll simply be noting whether the intervention (response) you choose helped resolve the behavior or not, like this:
- Effective (behavior resolved or decreased)
- Not effective (behavior continued)
Recording Information in the Behavior Log
Now that we’ve set up the basic information of our log, we’re going to use it as behaviors occur by filling in the information in rows underneath the columns at the top of the page. So, you’ll make headings across the top of the section of rows that include:
- Date & Time
In each row, when a behavior occurs, you’ll fill in the date and time of the behavior, the duration (how long it lasted), which behavior it was (you can just use the number that you assigned to the behavior in the column at the top of the page),the trigger (what happened right before the behavior), the intervention (what your response was) and if it helped decrease or stop the behavior under the effective heading.
Reviewing the Data You’ve Collected in the Behavior Log
Here is where the effort you’ve put into setting up the behavior log should pay off. Take some time to review the information you've collected in the log. Does your loved one frequently display challenging behaviors in the evening? Does the person you’re taking care of often call out when she’s alone?
Take note of the triggers (what happens before the behavior) and interventions (how you responded when the behavior occurred) to see where you can head the behavior off. Perhaps you can change your approach by spending five minutes talking with the person before providing care to her. This may quickly calm her and prevent her from resisting or being combative with care.
Sometimes, using a behavior log to map out challenging behaviors shows us that a certain time of day always poses a problem for our loved one. For example, if your mother frequently is upset or anxious in the evening, choosing the morning to assist her with a bath or shower may prove to be a better option.
While behavior logs are frequently used in facilities where different staff provide care over the course of a day, they can also be helpful for those of us who are caring for loved ones in our homes.
Behavior logs also provide great information for a physician who may prescribe psychotropic medications for your loved one. Psychotropic medications are drugs that are sometimes used to respond to the emotional and behavioral symptoms of dementia.
Goals of Behavior Logs
The goal for setting up and using a behavior log is to provide a better understanding of the person we’re caring for, and a quantification of the behaviors. By figuring out what triggers behaviors, we can try to avoid those triggers, if possible, and also try to use different reactions to those behaviors.
A behavior log and other non-drug approaches can be very helpful in responding to the challenging behaviors that may accompany Alzheimer’s and other types of dementia.