The Alzheimer’s Association CarePRO class includes a session on understanding difficult or challenging behaviors that a person with dementia might exhibit. The theory is that understanding the cause behind the behavior will make it easier for the caregiver to manage the behavior.
Challenging behaviors, such as anger, repetition, anxiety, are a result of changes in the person’s brain. These and other behaviors aren’t intentional or controllable by the person with dementia. In fact, they may well not even know that they’re exhibiting the challenging behavior. The key to the caregiver’s management of a behavior is recognizing what the caregiver actually controls.
The class teaches the Trigger-Behavior-Response (T-B-R) Chain concept. This concept describes how an event or activity can trigger the person with dementia’s behavior, which results in a response from the caregiver. In this chain of events, the caregiver has influence only on the trigger and response portions of the chain.
Identifying and mitigating potential triggers that result in challenging behaviors is the first step in the process. The caregiver might not be able to totally avoid these triggers, but it may be possible to reduce the impact of the trigger.
I came to learn that being tired or feeling rushed were big triggers for Deena, which led to behaviors like anger, anxiety, frustration. I couldn’t always avoid the life events that made Deena especially tired or rushed, but I could manage our schedule better. For example, about 9 months before Deena died, I told our friends that we wouldn’t be available for dinners anymore. Lasting through even a simple dinner party left Deena exhausted, a sure recipe for a disaster. Instead, our revised social life revolved about Happy Hours, that literally lasted an hour. In that amount of time, Deena could enjoy being with our friends without being overwhelmed.
The one part of the T-B-R Chain that the caregiver can truly control is the response phase. This part of the chain relies on how the caregiver responds to the challenging behavior. Is the person with Alzheimer’s anger responded to with the caregiver’s own frustration and anger? Does hearing the same story for the millionth time result in the caregiver responding, “You’ve told me that already!”
Overtime, I developed some strategies that helped me to be better equipped to manage my own response to Deena’s challenging behaviors. I’ve written about these seven strategies in posts on this blog from April 2021. These strategies included recognizing that:
• Deena’s anger and agitation was a symptom of the disease and totally outside of her ability to control it. When I didn’t take her anger as a personal attack, I was better able to respond more calmly and kindly. (Strategy #1: It’s not Deena, It’s The Disease)
• Deena’s cognitive decline made trying to have a rationale conversation an exercise in futility for me and only increased her agitation. (Strategy #2: Being right is always wrong)
• Giving directions when Deena didn’t ask for help, wasn’t helpful. (Strategy #5: No Harm, No Foul)
• Deena’s disease made it impossible for her to change her behavior. I was the only one that can do things differently. (Strategy #7: I’m the only one that can change)
I recognized that while so much of this journey was out of my control, I could and should learn to manage my response in a way that made Deena feel loved, respected, happy and safe. I didn’t always get it right, in fact I stumbled all too frequently. But every time my response to her behavior moved us away from her feeling loved and safe, I tried to learn from my miscue and course correct the next time.
Source: CarePRO Workshop Manual, David W. Coon, PhD, Dolores Gallagher-Thompson, PhD, Larry Thompson, PhD, Aging and Behavioral Health Projects, College of Nursing and Health Innovation, Arizona State University.