Changed Behaviours: Definition and Context in Care

Key Takeaways

• Communication Tool: Actions are often a way for an individual to communicate unmet needs or distress when verbal language fails.
• Cause-Based: These actions usually stem from physical pain, environmental factors, or emotional states rather than malice.
• Language Shift: The term replaces negative labels like "challenging behaviors" to reduce stigma and promote empathy.
• Management: Identifying the root cause is the primary method for managing these shifts in personality or action.

Quick Definition

Changed behaviours refer to any significant shift in an individual’s personality, actions, or reactions, commonly associated with conditions like dementia, where the person expresses distress or unmet needs through non-verbal actions rather than words.

Detailed Explanation of the Concept

The term "changed behaviours" is widely used in healthcare, particularly within the sectors of aged care and dementia support. It serves as a clinical and descriptive framework to understand why a person acts differently than they did prior to a diagnosis or health event.

You must understand that these changes are not random. They are often the result of damage to the brain caused by disease progression. This damage affects the parts of the brain responsible for:

• Regulating emotions.
• Processing sensory information.
• Controlling impulses.
• Formulating language.

When a person loses the ability to say "I am in pain" or "The lights are too bright," they may express this discomfort through agitation, withdrawal, or aggression. Therefore, these actions are best viewed as a form of communication.

The Role of Triggers

A core component of this concept is the "trigger." This is an internal or external factor that precipitates the change. You can categorize triggers into three main areas:

1. Biological Factors:
   
   
   
   • Physical pain or discomfort (e.g., arthritis, constipation).
   • Acute illness (e.g., urinary tract infections).
   • Medication side effects.
   • Fatigue or sleep disturbances.
2. Psychological Factors:
   
   
   
   • Depression or anxiety.
   • Hallucinations or delusions.
   • Feelings of loneliness or boredom.
   • Loss of inhibition.
3. Environmental Factors:
   
   
   
   • Excessive noise or loud televisions.
   • Poor lighting (too bright or too dim).
   • Unfamiliar surroundings.
   • Changes in routine or caregivers.

By viewing these actions through this lens, you move away from blaming the individual and toward investigating the root cause.

Why Understanding This Term Matters

The specific language used in care settings has a direct impact on how support is delivered. Historically, terms like "challenging behaviors," "difficult behaviors," or "problematic behaviors" were standard. These terms implied that the person was being difficult on purpose, which often led to punitive approaches or immediate sedation.

Adopting the terminology of changed behaviours is important for several reasons:

• Promotes Dignity: It separates the person from the disease. It reminds caregivers that the individual is not "being bad," but is struggling with a condition.
• Encourages Investigation: When you label an action as a "change," it prompts the question: "What caused this change?" This leads to better problem-solving.
• Reduces Stigma: It helps families and staff maintain empathy. It is easier to care for someone when you understand they are reacting to a stimulus rather than attacking you personally.
• Improves Safety: By focusing on triggers, you can modify the environment to prevent distress, leading to a safer environment for both the individual and the caregiver.

Common Usage and Examples

You will encounter this term frequently in care plans, medical reports, and family meetings regarding aged care. It covers a broad spectrum of actions. These are generally categorized into aggressive, physical, verbal, and psychological changes.

Aggressive or Agitated Actions

• Verbal aggression: Shouting, swearing, or making accusations.
• Physical aggression: Hitting, pushing, biting, or scratching caregivers during personal care tasks.
• Restlessness: Pacing back and forth, wringing hands, or inability to sit still.

Non-Aggressive Physical Actions

• Wandering: Walking aimlessly or attempting to leave the facility (often searching for "home" or a past workplace).
• Shadowing: Following a caregiver or family member closely due to anxiety or fear of abandonment.
• Repetitive movements: Tapping, rocking, or rummaging through drawers (often mimics past work or domestic routines).
• Inappropriate social actions: Undressing in public or making inappropriate comments due to a loss of social filters.

Psychological and Emotional Changes

• Apathy: A lack of interest in activities, hobbies, or social interaction that was previously enjoyed.
• Depression: Persistent sadness, tearfulness, or hopelessness.
• Sundowning: Increased confusion, anxiety, or agitation occurring in the late afternoon or early evening.

Synonyms and Antonyms

To help you navigate medical literature and care discussions, it is helpful to know related terms.

Synonyms (Similar Terms):

• Responsive Behaviours: Highlights that the action is a response to a stimulus.
• Behaviors of Concern: Used when the action poses a risk to safety.
• BPSD: Behavioral and Psychological Symptoms of Dementia (clinical term).
• Distress Reactions: Emphasizes the emotional state of the person.

Antonyms (Opposite Terms):

• Baseline Behavior: The person's standard or typical way of acting.
• Typical Behavior: Actions that are expected or within social norms.
• Pre-morbid Personality: The personality and character traits evident before the onset of illness.

Related Concepts

• Person-Centered Care: A care philosophy that prioritizes the individual's history, preferences, and needs over institutional schedules.
• Dementia Care Mapping: A method used to observe and improve the quality of care by recording interactions and behaviors.
• Non-Pharmacological Interventions: Strategies to manage behaviors without medication, such as music therapy, massage, or environmental modification.

Frequently Asked Questions

Are these changes permanent?

Not always. While some changes related to brain tissue damage may be permanent, many behaviors fluctuate. If the behavior is triggered by a treatable condition like an infection, pain, or dehydration, resolving the medical issue often resolves the behavior.

How should I react to aggression?

You should remain calm and avoid arguing. Do not take the aggression personally. Step back to ensure safety, validate their feelings (e.g., "I can see you are upset"), and try to distract or redirect them to a different activity once they are calmer.

Can medication fix these behaviors?

Medication is rarely the first line of defense. Psychotropic medications can have serious side effects in older adults, including increased risk of falls and stroke. Guidelines recommend attempting to identify triggers and using environmental or social strategies first. Medication is typically reserved for situations where there is a severe risk of harm or extreme distress.

Is it helpful to correct the person?

No. Correcting or arguing with someone experiencing cognitive decline usually increases distress. It is more effective to acknowledge their reality. For example, if they are looking for a deceased parent, asking them to tell you about their parent is better than telling them the parent has passed away.

Building a Supportive Environment for Care

Addressing changed behaviours effectively requires a shift in perspective. You must view yourself not just as a caregiver, but as a detective and a partner in care. When you observe a shift in action or personality, your primary goal is to identify the unmet need driving that expression.

By focusing on the person rather than the problem, you create an environment that fosters safety and dignity. This approach minimizes reliance on medication and maximizes the quality of life for the individual. Remember that behavior is communication; listening with your eyes and your heart is the most effective tool you possess.

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