4. How do I deal with changes in my client’s behaviour?
Key points
Look out for potential causes of behaviour change other than dementia
Changes in someone’s behaviour aren’t always because of dementia. Things like depression, grief, infections, constipation or pain can also cause changes. A urinary tract infection can cause confusion in an older person. Existing conditions such as having arthritis, which can affect mobility, may also contribute to their changing behaviour. These are just some of the many causes and changes in general health that can affect behaviour. Always check for other possible reasons and get medical help if necessary.
A change in surroundings can affect behaviour too. Noise, silence, strong smells, or a new carer might upset someone. Try to understand what may be happening from the client’s point of view and make adjustments if you can.
“What’s the bigger picture? Is there something else going on? Let’s be detective … is it stress from something that’s happened or are you reminded of something?”
Challenging behaviours related to continence and dementia
Some behaviours can be hard to deal with. Try to stay calm and composed, avoiding showing frustration or disgust. Some of the common challenges that you may face include your client:
- Hiding poo
- Denying they need the toilet
- Hiding incontinence pants / pads
- Handling / smelling poo
- Voiding bladder or bowels where they are – i.e. not going to the toilet
- Repeatedly going to the toilet
- Excessively washing their hands
- Unwilling to wash or change their clothes
- Unwilling to go to the toilet
- Refusing help
- Shredding toilet paper
- Saying they have been to the toilet when they haven’t
- Unable to control their bladder when walking to the toilet
- Withdrawing from going out or visiting people
- Becoming aggressive or rude
“I had a client who would very often hide it around the house. She would take faeces out of her pad, especially if it was quite hard, quite solid, and you would often find it hidden around the house”.
“Experience will show that the living environment of that individual will affect their continence. We have a lot of clients who are hoarders, so they haven’t got the room and, certainly with dementia, they haven’t got the capability or knowledge to go to the toilet. So, unless they are shown, they will do it there and then, and that’s something I’ve seen quite a lot”.
Your client may not be able to tell you how they are feeling, especially if their dementia is advanced. Caring with compassion is difficult, especially when you are required to work within tight time constraints and may not be getting much feedback from your client. Focussing on their needs and the discomfort they may be feeling can help.
“I had a client who became very aggressive when her pad needed changing. Sometimes it would have seeped through and you could see her pad sagging, and there’s that shame there. She wasn’t able to vocalise anything, so her physical behaviour was all she had to communicate that (need and) sense of shame”.
Talking to colleagues and your manager about client visits you have found difficult is important to help you process the situation, receive support, hear how other colleagues manage similar situations and get practical advice on caring for your clients in challenging circumstances.
“When faced with challenges like these, I find it helpful to remind myself to deal with one thing at a time, rather than getting swamped with trying to do everything at once”.
Practical Tips
Things to help you manage challenging situations:
- Focus on your client and their immediate needs, and not on how you are feeling
- Assess what you can realistically do and deal with one issue at a time
- If you need more time than expected with a client, if necessary let your manager know
- Discuss challenging situations you’ve had with colleagues for reflection, support and advice