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How To Change The Outcome Of Challenging Behaviors in Dementia

Have you ever wondered why certain behaviors in dementia care are called "challenging"?

In this episode, we explore how to manage these behaviors using a simple and effective framework. This method can bring peace and clarity to your caregiving journey.

Understanding Behaviors

Dementia often magnifies normal human behaviors. What may seem challenging is usually an attempt by your loved one to communicate. Recognizing this can change your approach and improve outcomes.

Introducing the PEACE Framework

To address these behaviors, a repeatable framework called PEACE can be invaluable. Here’s how it works:

P: Person with Dementia - Focus on their immediate needs and feelings.
E: Environment - Consider the setting and its impact.
A: Activity - Look at the activities they are engaged in.
C: Caregiver’s Response - Reflect on your reactions and responses.
E: Evaluate and Educate - Assess the situation and learn from it.
Real-Life Example

In a recent coaching session, a caregiver shared a story about her husband. He got angry when water accidentally spilled on him.

Using the PEACE framework, we analyzed the situation:

Person: He was uncomfortable and startled.
Environment: The TV was on, and the room was busy.
Activity: It was mealtime, and he was ready to eat.
Caregiver’s Response: She tried to help him change his clothes.
Evaluate: She realized it might have been better to wait until he calmed down.

By applying this framework, the caregiver could approach similar situations more calmly and effectively in the future.

Practical Tips

Here are some strategies to handle challenging behaviors:

Stay Calm: Your calmness helps your loved one feel safe.
Adjust the Environment: Reduce noise and distractions.
Engage in Meaningful Activities: Keep them involved and stimulated.
Be Patient: Give them time to process and respond.

Join Our Community

Caring for someone with dementia can be isolating. Joining a supportive community can make a big difference. Our Facebook group, “Dementia Caregiving for Families,” offers practical tools and support in a positive environment.

Final Thoughts

Remember, challenging behaviors in dementia are a form of communication. By using the PEACE framework, you can better understand and respond to your loved one’s needs. This approach not only makes caregiving easier but also strengthens your bond with your loved one.

Get in Touch

If you have specific questions or need personalized advice, visit You can leave a voicemail with your question, and it might be featured in a future episode.

May you find peace and strength in your caregiving journey. Join us next time for more insights and support.

Listen to the Podcast

Listen to the episode on the player above, click here to download the episode and take it with you or listen anywhere you normally listen to podcasts.

family caregiver with person living with dementia

Introduction to Challenging Behavior in Dementia

[0:00] Have you ever wondered why it is called a quote-unquote challenging behavior when it really is just a normal human behavior that we see in a person living with dementia that has been magnified by the fact that they have dementia? I would love for you to listen to episode 122 where we are going to talk about how to change the outcome of challenging behaviors by following a repeatable framework that will solve this problem for you each and every time once you start to use it. So listen to today's episode.

[0:52] Have you recently found out someone you love has dementia? Struggling to wrap your head around how to be a Christian caregiver? Searching for answers by joining countless Facebook groups but find them toxic? Learning how to cope with dementia feels difficult, but learning a Christian caregiving worldview can be easy. Hey, brother and sister in Christ, I'm Lizette, occupational therapist, pastor's wife, turned dementia coach and a daughter of dementia. In this podcast, you will learn the truth that the way to make dementia care easy is your faith. Knowing that a loving God has decreed this hard providence in your life makes all the difference. Here you will gain skills. You will be challenged by what God says in his word about caregiving, and you will learn exactly what dementia is and is not. Find clarity and certainty from God's Word so you have perseverance for this journey. Use science-backed solutions and biblical principles to redeem your time. Praying this blesses you as we dive into dementia from a Christian perspective. Let's glorify God despite dementia.

Unpacking a Repeatable Framework for Challenging Behaviors

[2:19] I thought I would do something different today in this particular episode. We had a wonderful group coaching session yesterday, and this question or this situation came up in relation to one of our group members. And it was a wonderful opportunity to just take a couple of minutes and give the members of the group a little bit of a repeatable framework that they could use to help figure out when things are challenging at home related to what is called in the healthcare space, challenging, in inverted commas, dementia behaviors, right? I hate that term. However, it is what is commonly known as. And what it really is, is a way for a person living with dementia to try to communicate something to us.

[3:23] And I want us to consider, you know, when our kids were little, we automatically knew sometimes when they had a meltdown or when their behavior was off, that they were just exhibiting normal human behavior. And dementia behaviors are normal human behaviors. They're just magnified. They are a result often of certain things that are happening and that that person isn't able to actually express and tell us what happened. So let me set the stage for you. A couple of times a week at a couple of different times in the week, we have a group coaching program that people are in and they join me in a Zoom room where they each get an opportunity to bring to the table particular challenges that they are struggling with at that moment in time. And what has happened through this consistent coaching is a lot of the people in these meetings in this group learn over time by listening to other people's struggles or situations or things that are happening in their lives, how to problem solve and how to respond appropriately to whatever life situation is occurring related to dementia.

[4:53] So this is what happened this past week. One of the members mentioned to me that her husband was having a little bit more difficulty, with communicating and his words and finding the right words and telling her what to.

[5:12] Do or what he wants. And because of his frustration, he is very easily annoyed and gets very angry very quickly. And she was expressing a situation that had occurred earlier in the day where they were getting ready to have lunch. And her husband was sitting at the television and there was a little table. You know, you can picture it, right? The TV is on in the background and she brought him his lunch, but there was a water glass or a water container that accidentally was knocked over. And so the water spilled onto him, but the result was that he got super angry and she was trying to help him get changed out of his wet clothes and he wouldn't eat his lunch and the whole entire thing kind of fell apart and unraveled. Now, I don't know about you guys, but I've definitely had situations like that with my dad. Mine is usually related to something else. We, I'm a very strong personality, my dad and I had a lot of conflict. When we were living together, lots of arguments. And so, of course, I go back into that whole.

[6:40] Relationship way of communicating, which is not right. It's one of my biggest sins. And the thing that I struggle with the most is trying to not get angry with my dad.

[6:52] And so I know that all of us have been in a situation like this where something happened outside of our control and the person responds in a specific way. But what we ended up doing in this particular coaching session was I was able to give the group a framework that I developed from 30 years of working in healthcare as an occupational therapist and taking multiple, multiple, multiple multiple specialty certifications in dementia and dementia caregiving, specifically how to help people with managing challenging behaviors.

[7:37] So today's episode, we're going to unpack the framework I put together just real quick, because what I want to do is I want to equip you with a way of looking at whatever situation happens at that period of time for you to start to plug into the situation, this particular framework, so that you can have an easy way to start to learn how to speak dementia. So here we go. Here's the framework. I use the word piece, P-E-A-C-E, to come up with an acronym to help people remember what to do or what to look for.

[8:25] In a challenging behavior situation.

[8:30] The P stands for the person living with dementia, whatever's going on with them, right? The E stands for the environment that things happen in, the environment that we are in right during that situation.

[8:47] The A stands for the activity. Is the person engaged or being engaged in an activity or not, right? And then the C is the caregiver or the care partner's contribution or response to the situation. And then E is we evaluate and we educate. We evaluate and we educate. So, we always just run every situation through this little framework. So, in this specific situation in our coaching call about the gentleman with the water and what happened, and I want you guys to kind of picture the situation and how it could have unfolded in relation to the husband and wife combination. Nation, his response to the water and her trying to help him and him not being receptive to being helped at that moment in time, then not wanting to eat, and her probable increase in frustration and stress herself because she's trying to anticipate and meet his needs. So I want you to picture that whole little scenario. And now let's unpack it related to this framework, this peace framework.

[10:08] Because I want people to actually have dementia caregiving peace, right? So the person, what's happened with him, what his, what's, what's unfolded right there. A bunch of cold water got dropped on his lap. He's uncomfortable, he was startled, and he responded immediately to that particular thing that happened.

[10:35] One of the biggest struggles many people over the years have told me about helping somebody they love living with dementia is their inability to engage them in meaningful activities or engage with them in their environment. So for this Memorial Day weekend, I have created a short mini course for you on how you can engage the person that you love with dementia in meaningful activities so that you can make memories this Memorial Day. The course is super short. It is less than three hours. It has a lot of information that you can apply immediately today, and it is less than the cost of four people going to Chick-fil-A for lunch. So I invite you to check out our Memorial Day special, this mini course on how to engage a person with dementia in activities.

Analyzing a Specific Challenging Behavior Scenario

[11:44] He got angry and frustrated, probably because of the cold water. It startled him. So the environment, what's happening in the environment. The water got dumped on his lap accidentally. This was an accident, right? Nobody does this type of stuff on purpose. But in the environment that they were in, they were sitting by the TV, a TV tray, lots probably going on. The television might have been on in the background, and now an item in the environment caused him discomfort and stress.

[12:22] The activity, activity engagement. So it was a meal time, there was perhaps, you know, he was hungry, he was getting ready to eat, and this all happened in the activity of meals or meal preparation. And usually when I look at activity, I'm looking at seeing is the person, you know, being engaged in an activity or are they understimulated and bored in certain situations or overstimulated and stressed because of that. So in his particular situation, he was overstimulated by this water on him, his response, and then the activity that followed from that. The C in this is the care partner or the caregiver's response.

[13:16] And she appropriately was trying to help him. And probably because of his reaction, we could anticipate a person on the receiving end of that anger to start to feel frustrated or afraid or stressed or annoyed because of the situation. And by no stretch of the imagination am I saying that my client, my group member was experiencing that. I'm just saying that those are possible things that a person could be experiencing emotionally, the care partner.

[13:56] And I want you to recall that people living with dementia have very limited capacity to control their own emotions and so they'll take on the emotional energy of the people around them. So if she were stressed.

[14:13] Or if she were frustrated with the situation, he easily could take on that energy too, and it can continue to help to contribute to this perfect storm that we have right at this moment in time. And then the last E is evaluate or educate. So when I go in, I educate. When you're doing this, you are going to evaluate what happened, and you're going to run it through that filter, the peace filter, P-E-A-C-E. So as we were talking about this and I kind of unpacked it for her, the strategies that I gave her, the tips that I gave her that she could consider using or in the future if something happened again could consider is the first thing, you know, water is his water. It's not hot. It's not going to burn. It is just uncomfortable, but his clothes are still clean, and it's kind of like pick your battles.

[15:17] You know, maybe if he looked annoyed and frustrated already, an idea could have been not to try to change his clothes right at that moment in time and just to leave him and settle back down. One of her concerns was that he didn't want to eat after that we talked about that a little bit too I wanted her to consider and think through that he wasn't struggling to eat his appetite was normal he's not losing weight so.

[15:50] Missing a meal or delaying the meal or not going back to that particular activity right when he was experiencing this emotional response to the situation, is also something that she could consider, just put the food away.

[16:06] Give it a half hour, an hour, and come back and try again later. And so, you know, we kind of unpacked it a little bit in our coaching call related to how I wanted her to look at all of these little micro situations occurring on a daily basis and using this framework to start to pay attention to what has contributed to that little situation, the perfect storm. Because her husband has a lot of these type of responses and my role in my job

Empowering Caregivers with a Simple Framework

[16:48] is to empower her to figure it out on her own. So today's episode was very different than what I've been doing lately.

[16:56] But it really, it was, the Lord laid it on my heart that I wanted to really take Take this moment in time and educate everybody about this very simple framework that you absolutely can use on your own to try to figure this stuff out. Now, I do want to invite you that if you are truly, truly struggling with challenging behaviors, sometimes it's helpful to have another person look at the situation. Situation because we're so close to our own situation and it took me 30 not 30 years to learn how to speak dementia but 30 years to learn how to speak dementia.

[17:40] Very proficiently. So if you truly are struggling with challenging behaviors, hop onto the website, and go, you can leave me a voicemail. There's a little button on the website that will allow you to leave me a 90 second question and you can ask me anything. You can ask me anything and I will then take that question and I'll turn it into an episode specifically for you. So I'd love to invite you guys to actually do this. Come up with a question. Give me a scenario. This is my passion.

[18:21] This is the thing I love to do. I love to help you guys figure it out because there are things that we can do to absolutely, absolutely mitigate or or change the outcome of some of the behaviors that people are experiencing that are directly related to their dementia and their dementia changes in their brain. Their brain is absolutely changing. They are not doing this on purpose. So reach out, go on my website, Think Different Dementia, click on the little microphone that says leave a voice recording, and send me a 90-second question, and I will answer the question for you on one of the episodes. So I hope you've enjoyed today's episode. It's a little bit different. I kind of like the format.

[19:16] This is my superpower. So I would love to really include you guys in this process in really curating information that's It's helpful to you. So I really hope that this has given you some encouragement today that you can learn how to do this in an easier way.

[19:41] Music. Thanks for joining me today, Success Seeker. I pour my heart and soul into this program to serve you. You can serve me by leaving a review on Apple Podcasts and join our free Facebook group, Dementia Caregiving for Families. It's a positive and proactive space to navigate dementia caregiving together, get practical tools and find support, but without the verbal vomit. Be a part of our community where we seek to find peace of mind and ease, despite the dementia diagnosis. So join today and see you next time as our flight takes off.

[19:42] So like I end every program, may the Lord bless you and keep you. And I will see you in the next episode.

Lizette a dementia caregiving

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About the author

“Think Different” Dementia’s owner, Lizette Cloete, OTR/L graduated as an Occupational Therapist from the University of Pretoria in South Africa in 1992. Lizette has almost 30 years of experience as an Occupational Therapist in a variety of settings, the latest being in the home health environment. She enjoys teaching on the topic of dementia, most recently presenting at a national conference on the topic “Dementia Made Simple”.

Disclaimer: These blogs, videos and any work done by Lizette Cloete OT, as a Member of Think Different Dementia, LLC, is given only as educational content and consulting work. This does not create an Occupational Therapist-Patient Relationship. The educational content and consulting work performed should not be considered medical treatment as an Occupational Therapist. The consulting work does not take the place of medical work normally performed by a licensed Occupational Therapist. Please consult a licensed Occupational Therapist for medical advice.

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