It is not uncommon in services when discussing distressed behaviour in an individual to hear someone say ‘there isn’t any trigger’. Learning to unpick what has caused someone to become distressed is a skill that takes time and practice to develop in carers. Just like any other skill, you may have colleagues who are naturally more in tune with behaviour change and what has caused it, but all people can learn to be better at understanding the potential causes of distressed behaviour in someone with dementia that they are supporting.
One of the frequently missed contributors to distress is our own attitude to risk, particularly preventing a person with dementia from doing something because we feel it is ‘too risky’. The ways we restrict a person’s choices are not always obvious. For example, attempts to restrain someone can include taking subtle steps, such as locking the door to the garden, or ‘tidying away’ shoes so that people cannot go outside when they wish.
People with dementia should not unreasonably be prevented from doing the things they want to do. Reflective practice can be a helpful way of identifying how our behaviour might be limiting the freedom of those we support, resulting in stress, and in distressed behaviour. For example, try and imagine being confronted by a locked door when all you want to do is get outside for some fresh air. You would probably become annoyed or frustrated. It is important to have a system in place for assessing risk, but the desired outcome of risk assessment should be to reduce risks where possible so that a the person with dementia can be supported to do what they like as safely as possible, not to eliminate risk entirely by removing the person’s freedom and choice.
When providing care for people with dementia, it is vital to avoid a ‘one size fits all’ approach when responding to their choices, movement or opportunities. Something that might be too risky for one person may be appropriate for another. Restricting people unnecessarily can cause ‘silent harm’ to their psychological and emotional wellbeing. Sometimes we need to accept that a person will experience more harm by being prevented from taking a small risk than they would if the risk itself actually occurred.
Restricting personal freedom and choice often leads to distressed behaviour and can result in aggression which can in turn result in harm for both the person themselves and those who support them. You can access an excellent online resource related to risk and people living with dementia: ‘Nothing Ventured, Nothing Gained’: Risk guidance for people with dementia.
The blog above was a (modified) excerpt from The DSDC’s popular resource and workbook: Supporting People with Dementia: Understanding and responding to distressed behaviour.