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  • Peter Gathercole

Distress Behaviour in Dementia With Coping Strategies Part 3.


Physical needs.


Distress behaviours may result from pain which, due to confusion and dysphasia, may be poorly communicated.

Older people DO FEEL PAIN, but may not understand it and respond with anger and fear.

Dental pain is notoriously under-recognised, arthritic pain is often under-treated, Even intense pain can go undetected, e.g. from a fracture, because the person can’t report it.

Privacy, dignity and respect in care, is often reduced for the confused person, with staff assuming the person will not realise or complain.

Poor care often results in frustration and annoyance which are common triggers for distress behaviours.


  • Make a list of physical needs a person may have

  • How would you recognise these needs if the person cannot verbally tell you?

Points to Consider

Acute or chronic pain or is it a physical or mental pain

  • Pain and discomfort are common causes of individuals withdrawing, becoming agitated, and/or striking out at caregivers. Remember that pain can be physical (such as pain or discomfort from arthritis, poor circulation, or cancer) or it can be mental (such as grieving for a loved one, anguish over moving from one’s home, loss of a relationship).

Illness or Injury

  • Changes in behaviour can be the first sign of illness or injury in frail older individuals. These changes may be the symptoms of “delirium”. Typical behaviours associated with delirium include fluctuations in levels of consciousness ranging from being hyper-alert to hardly responsive. The individual may see or hear things that are not there or misinterpret environmental sights and sounds. The individual may become agitated and strike out at caregivers or be withdrawn.

  • A rapid change (within hours or a few days) in behaviour of any individual should trigger an examination for possible infections, injuries or other causes. As previously discussed, pain may also be a cause of changes in behaviour. Look for signs of pain or discomfort.

Think about a time when you experienced pain (like a bad headache, back pain, grief over loss of a loved one), How did you act?


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