Managing Difficult Dementia Behaviors: An A-B-C Approach

Maude came to a caregiver support group wringing her hands together. When the other caregivers asked what was wrong, she said that her husband, Chet, had dementia and had started becoming agitated in the late morning. Even though Maude made sure Chet ate a good breakfast and was clean and dressed, around 10:30 AM he would begin to pace, empty drawers, and yell. Maude would try to calm him, but most days she just had to wait it out until Chet became calm on his own. “I’m about at my wit’s end with this,” Maude said. “I have no idea what to do.”

Fortunately, the support group facilitator was presenting that day on the A-B-C method of managing dementia behaviors. Although dementia is complicated, this approach can help caregivers more easily understand and respond to challenging behaviors.

(c) Kip Curry

(c) Kip Curry

In the A-B-C approach, the letter “A” stands for “antecedent,” which is a fancy word for something that happens before the behavior in question. The letter “B” stands for the challenging “behavior,” while “C” stands for “consequence,” or what happens after the behavior occurs.

The idea behind the A-B-C approach is that identifying triggers to a behavior can point us toward ways to reduce that behavior. You’ve probably heard the joke about the man who goes to the doctor and says, “Doctor, my arm hurts when I move it like this.” The doctor replies, “Then don’t move it like that!”

The same concept applies here. Most dementia behaviors have a trigger. That trigger might be internal, such as hunger, not feeling well, or having to go the bathroom. The trigger could also be external, such as too much noise, a shower that’s too cold, or seeing someone or something that frightens the person. If we can identify the trigger, we can try to eliminate it. Doing so might also reduce the behavior.

As caregivers, we also need to pay attention to the consequences of the behavior. Some consequences happen in the environment, such as a fellow grocery patron scowling at you for bringing your loved one to the store (Do not let this bother you! See my post on reducing stigma for more on this.).

But most consequences to difficult behaviors are our own responses to our family members. When our loved ones become agitated, do we respond in a calm and reassuring way, or do we become agitated ourselves? How we respond to a challenging behavior can greatly influence whether the behavior will get worse or better, as well as whether it will happen again.

In Maude’s case, the support group members were able to help her identify the trigger to Chet’s late-morning agitation. The antecedent (A) was the mail carrier that came to the door around 10:30 AM each day. Chet was scared of possible intruders, so seeing the mail carrier triggered his agitated behavior (B). When Maude responded by taking him outside for some fresh air (C), Chet only became more upset because he was now even more vulnerable to the mail carrier he had just seen. The support group members helped Maude devise a plan to keep Chet occupied in another part of the house during the late morning so that he would no longer see the mail carrier come to their home.

I encourage you to try the A-B-C approach to managing dementia behaviors. Not only can you improve your loved one’s well-being; you will experience feelings of self-competence as a caregiver as well.

If you’ve already used this method, please tell us about it! Other caregivers can learn from your valuable experience.

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