12: Using Communication to Manage Challenging Behaviors

This program will help you to:

  • Understand the changes in communication associated with Alzheimer’s disease
  • Understand why good communication skills are critical
  • Use good communication skills to help manage challenging behaviors
  • Learn about care recipient abuse and how to prevent it
  • There are no easy answer when its comes to the care of another
  • Our hope is to offer you useful information and guidelines for caring for someone with dementia
  • These guidelines will need to be adjusted to suit your own individual needs
  • Language understanding decreases
  • Difficulty expressing thoughts, emotions and needs
  • Not making sense or repeating things
  • Lose reading and writing skills
  • Lose recent memories before distant ones
  • Shorter attention span
  • Loss of conversational social skills

What could Mary have done to prevent this difficult behavior?

  • A. Mary should have faced Robert, gotten his attention and made sure he understood the instructions
  • B. Mary should not have tried to force Robert to take off his robe.
  • C. Mary should have tried to find out why Robert did not want to shower, and address any issues.
  • D. Mary should have shown a relaxed attitude and used a calming tone of voice and body language.
  • E. All of the above.

Choice A: Mary should have faced Robert, gotten his attention, and made sure he understood the instructions, is an excellent choice.

  • Do not assume that the person with dementia remembers things or understands what you are saying

Choice B: Mary should not have tried to force Robert to take off his robe,is also a good choice.

  • You may have to demonstrate or assist the person in what steps you need them to do

Choice C: Mary should have tried to find out why Robert did not want to shower and address any issues,could also be a reason.

  • Remember that the disease is causing the change in personality and loss of abilities

Choice D: Mary should have shown a relaxed attitude and used a calming tone of voice and body language,is also a good answer.

  • Speak slowly and clearly with a pleasant tone of voice and comforting facial expressions and body language

Choice E: All of the above,is the correct answer.

  • Use a calm voice, pleasant facial expressions, body language and touch
  • Gain the person’s attention before speaking
  • Offer reassurance rather than criticism
  • Use empathy and validation
  • Remove triggers for unwanted behavior, or remove the person from the stressful situation
  • Redirect or distract
  • Try to be patient and flexible
  • Consider giving some alone time
  • Provide regular, undivided attention
  • Show that you value the person
  • Use appropriate touch to convey comfort and support
  • Try to preserve dignity and self-esteem
  • Listen to music or sing together
  • Use a conversation focus
  • Use pleasant smells, tastes, and textures
  • Exercise
  • Outings
  • Ridiculing or criticizing
  • Ignoring, neglecting, or providing poor care
  • Isolating or secluding
  • Punishing or retaliating
  • Hurrying or pressuring
  • Threatening or frightening
  • Using restraints

The Minnesota Department of Health has provided information to consumers on understanding the role of restraints in resident safety. Click here for more information on restraints NOTE: clicking on the link will take you to another website

Tips for Avoiding Care Recipent Abuse

  • Use good communication skills
  • Always asume that people with dementia are acting to the best of their abilities
  • Never treat them like children
  • If you feel overworked or frustrated, take a break before abusive behavior occurs
  • Make regular use of relaxation techniques
  • Talk to others about your feelings
  • Learn more about caregiver stress and how to manage it
  • Take care of the your health and needs
  • Good communication can help prevent and resolve challenging behaviors
  • Show respect, patience, and flexibility
  • Approach caregiving as a collaborative team effort
  • Use a non-judgmental, open-minded approach
  • Use empathy and validation
  • Keep a positive attitude and a sense of humor
  • Never force them to do things they do not want to do
  • Remain calm and use pleasant facial expressions and body language
  • Get and keep the person’s attention while speaking and listening
  • Remove environmental triggers and avoid situations that lead to difficult behaviors
  • Remove the person from the stressful situation
  • Give the person time to calm down
  • Redirect or distract with something pleasant
  • Try to find the meaning behind the behavior
  • Establish a caring, trusting relationship
  • Care recipient abuse comes in many forms
  • Criticizing, scolding, pressuring, punishing, threatening, isolating, ignoring, neglecting, restraining, and assaulting
  • Preventing abuse involves taking care of the caregiver and managing stress

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian


Guidelines for Improving Communication

Select the best answers from the list of choices following each question.

Click here to open Certificate of Completion

  • Bates, J., Boote, J. & Beverley, C.A. (2003). Psychosocial interventions for people with milder dementing illness: A systematic review. Journal of Advanced Nursing, 45 (6), 644-658.
  • Bayles, K. (2003). Effects of working memory deficits on the communicative functioning of Alzheimer’s dementia patients. Journal of Communication Disorders, 36 (2003), 209-219.
  • Bayles, K.A., Tomoeda, C.K., Cruz, R.F. & Mahendra, N. (2000). Communication abilities of individuals with late-stage Alzheimer Disease. Alzheimer Disease and Associated Disorders, 14 (3), 176-181.
  • Bethea, L.S., Travis, S.S., & Pecchioni, L. (2000). Family caregivers’ use of humor in conveying information about caring for dependent older adults. Health Communication, 12 (4), 361-376.
  • Broton, M., & Koger, S.M. (2000). The impact of music therapy on language functioning in dementia. Journal of Music Therapy Association, 37 (3), 183-195.
  • Chalmers, J. (2000). Behavior management and communication strategies for dental professionals when caring for patients with dementia. Special Care in Dentistry, 20 (4), 147-154.
  • Ekman, S., Norberg, A., Viitanen, M. & Winblad, B. (1991). Care of demented patients with severe communication problems. Scandinavian Journal of Caring Science, 5 (3), 163-170.
  • Ekman, S., Wahlin, T., Biitanen, M., Norberg, A., & Wiknblad, B. (1994). Preconditions for communication in the care of bilingual demented persons. International Psychogeriatrics, 6 (1), 105-120.
  • Epps, C.D. (2001). Recognizing pain in the institutionalized elder with dementia. Geriatric Nursing, 22 (2), 71-77.
  • Gerdner, L.A., Josefsson, K., & Kihlgren, M. (1998). Probable reasons for expressed agitation in persons with dementia. Clinical Nursing Research. 7 (2), 189-200).
  • Gotell, E., Brown, S., & Ekman, S. (2002). Caregiver singing and background music in dementia care. Western Journal of Nursing Research, 24 (2), 195-216.
  • Gleeson, M. & Timmins, F. (2004). Touch: a fundamental aspect of communication with older people experiencing dementia. Nursing Older People 16 (2), 18-21.
  • Hadjistavropoulos, T. & Craig, K.D. (2002). A theoretical framework for understanding self-report and observational measures of pain. Behaviour Research and Therapy, 40, (2002), 551-570.
  • Hansebo, G. & Kihlgren, M. (2002). Carers’ interactions with patients suffering from severe dementia: a difficult balance to facilitate mutual togetherness. Journal of Clinical Nursing, 11, 225-236.
  • Holm, A., Lepp, M., & Ringsberg, K. (2005). Dementia: involving patients in storytelling—a caring intervention. Journal of Clinical Nursing, 14, 256-263.
  • Kim, W.J., & Buschmann, M.T. (1999). The effect of expressive physical touch on patients with dementia. International Journal Nursing Studies, 36 (1999), 235-243.
  • Maas, M.L., Reed, D., Park, M., Specht, J.P., Schutte, D., Kelley, L.S., Swanson, E.A., Trip-Reimer, T. & Buckwalter, K.C. (2004). Outcomes of family involvement in care intervention for caregivers of individuals with dementia. Nursing Research, 53 (2), 76-86.
  • Mahendra, N. & Arkin, S. (2003). Effects of four years of exercise, language and, social interventions on Alzheimer discourse. Journal of Communication Disorders, 36 (2003), 395-422.
  • Mayhew, P. A., Acton, G.J., Yauk, S., & Hopkins, B. A. (2001). Communication from individuals with advanced DAT: Can it provide clues to their sense of self-awareness and well-being. Geriatric Nursing, 22 (2), 106-110.
  • Moore, T. & Hollet, J. (2003). Giving voice to persons living with dementia: The researcher’s opportunities and challenges. Nursing Science Quarterly, 16 (2), 163-167.
  • Murray, L.L., Dickerson, S., Lichtenberger, B., & Cox, C. (2003). Effects of toy stimulation on the cognitive, communicative and emotional functioning of adults in the middle stages of Alzheimer’s disease. Journal of Communication Disorders, 36 (2003), 101-127.
  • Normann, H, K., Norberg, A.& Asplund, K. (2002). Confirmation and lucidity during conversations with a woman with severe dementia. Journal of Advanced Nursing, 39 (4), 370-376.
  • O’Donovan, S. (1996). A validation approach to severely demented clients. Nursing Standard. 11 (13-15), 48-52.
  • Packer, T. (1999). Dementia Part 3: communication. Professional Nurse, 14, (10), 727-730.
  • Reese, D. (December, 1998). Through their eyes. Contemporary Long Term Care, pp. 44-52.
  • Ripich, D. (1994). Functional communication with AD patients: A caregiver training program. Alzheimer Disease and Associated Disorders, 8 (Supplement 3), 95,109.
  • Roudier, M., Marcie, P., Grancher, A-S., Tzortzis, C., Starkstein, S., & Boller, F. (1998). Discrimination of facial identity and of emotions in Alzheimer’s disease. Journal of Neurological Sciences, 154 (1998), 151-158.
  • Runqvist, E.,& Severinsoon, W. (1999). Caring relationships with patients suffering from dementia—an interview study. Journal of Advanced Nursing. 29 (4), 800-807.
  • Savenstedt, S., Brulin, C., & Sandman, P-O. (2003). Family members’ narrated experiences of communicating via video-phone with patients with dementia staying at a nursing home. Journal of Telemedicine and Telecare, 9, 216-220.
  • Silvestri, A., Rosano, G., Zannino, G., Ricca, F., Marigliano, V., & Fini, M. (2004). Behavioral Disturbances in Alzheimer’s Disease: A nonpharmacological therapeutic approach. Archives of Gerontology, Geriatric Supplement 9, 279-286.
  • Smith, J. (2001). Communication and dementia. Nursing Older People. 12 (10), 14-15.
  • Sutor, B., Rummans, T.A., & Smith, G.E. (2001). Assessment and management of behavioral disturbances in nursing home patients with dementia. Mayo Foundation for Medical Education and Research, 76 (5), 540-550.
  • Tappen, R.M., Williams-Burgess, C., Edelstein, J., Touhy, T., & Fishman, S. (1997). Communicating with individuals with Alzheimer’s disease: Examination of recommended strategies. Archives of Psychiatric Nursing, 11 (5), 249-256.