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Behavior Management for Dementia Caregivers

Carrie Steckl, Ph.D., edited by Natalie Staats Reiss, Ph.D.

In addition to communication changes, a significant part of caregiving involves managing the challenging behaviors that often accompany dementia. Most of the time, problem behaviors are the reason for placing a person with dementia into a nursing home. Behavior management techniques are a way to structure the environment to increase safety and decrease frustrations for a person who can no longer regulate his or her own behavior. Using behavior management techniques to manage problems like aggression and wandering can often keep a person with dementia in the home for a longer period of time.

One way to approach challenging behaviors is by using the A-B-C method of behavior management. The method is based on the theory that changing what happens directly before or directly after a problem behavior can be used to alter, or at least decrease the frequency of such behavior. A large body of research has shown that the A-B-C method can be used to deal with a wide variety of problematic behaviors (described below).

The A-B-C Behavior Chain

The A-B-C Behavior Chain can be used to track and analyze challenging behaviors in order to develop new ways to approach and respond to them. There are three components in the A-B-C Behavior Chain:

  • Antecedent - The "A" stands for antecedent, which is anything that happens before a challenging behavior or "sets the stage" for it to happen. Antecedents can be internal (e.g., thoughts or physical sensations occurring within the person with dementia) or external (e.g., environmental characteristics). Some examples of antecedents include hunger, pain, frustration at not being able to communicate, loud noises, hot or cold room temperatures, a busy environment, fluorescent lights, unfamiliar surroundings, or overwhelming tasks.
  • Behavior - The "B" stands for the problematic or challenging behavior. Examples of challenging behaviors, which will be discussed in more detail later, include agitation (becoming restless, anxious, or upset), aggression (shouting, cornering someone, raising a hand to someone, or actually pushing or hitting), repetition (repeating a word, question, or action over and over again), hallucinations (sensory experiences that seem real to the person with dementia, yet they are not really happening), suspicion (perceiving situations inaccurately and accusing others of theft, infidelity, or other offenses), apathy (a lack of interest in anything; not wanting to do anything), confusion (becoming confused about person, place, and time), sundowning (becoming more confused and agitated in the late afternoon and early evening), and wandering (on foot, in a car, or using some other mode of transportation).
  • Consequence - The "C" stands for consequence, which is anything that happens right after the behavior occurs. Consequences can "reinforce" the behavior (i.e., increase the likelihood that the person will behave in the same or similar fashion in the future) by encouraging or rewarding it. On the other hand, consequences can also "punish" the behavior (i.e., decrease the chances of it being repeated in the future). Examples of consequences are providing calm reassurance, offering the person a desirable item like food or a photo album, yelling, taking something away from the person, or removing the person from the situation in which the behavior occurred.