Holistic assessment is a critical tool for supporting changing behaviours of people living with dementia

There has been a lot of noise in the media in Australia recently about what happens when behaviours and psychological symptoms of dementia are not managed as well as they can be. Over half of people living in residential care have a diagnosis of dementia and at some point, up to 95% living with dementia will experience changes in behaviour.

Common behaviours people with dementia might experience include agitation, anxiety, attempts to leave care and pacing.

At first glance, it can be hard to understand what's driving these changes, but one thing is certain, there's often an underlying cause that isn't immediately apparent.

Common factors that can influence a person's behaviour

• Unidentified or under-treated pain
  

  Pain affects up to 85% of aged care residents and for people living with dementia, it can often be an underlying cause of changed behaviour.

• Environment
  

  A busy environment or one that is difficult to navigate can exacerbate behaviours.

• Communication
  Active listening, reduction of noise and attention to non-verbal cues are all strategies that have been shown to reduce behaviours.
  
• Knowing the person
  Understanding and prioritising the person's preferences and needs go a long way to understanding what is driving their behaviour.
  

It's important to remember that behaviour is a form of communication, so when a person's behaviour changes, it can let you know that something has changed for them.

See the full picture

Once you've identified changes in behaviour, holistic assessment is a valuable tool to help identify possible underlying causes.

Holistic assessment involves considering three types of factors:

• Biological or medical factors like pain, cognitive and sensory changes.
• Personal or psychological factors like cultural background or lived experience of trauma.
• Social or environmental factors like the care setting, socials needs or communication issues.

Performing a holistic assessment allows you to see the full picture and gain a deeper understanding of what is causing the behaviour, so you can provide an appropriate and effective intervention. This way you can support the person with dementia and their carers to adapt and cope with the changes the person is experiencing.

Find out more about supporting people with dementia who are experiencing behaviours and psychological symptoms of dementia in the BPSD Textbook.