Changing Inappropriate or Unpleasant Behaviors - Tip Sheet

People with severe dementia may behave in ways that can hurt them or other people. Sometimes they behave in ways that may be bothersome in public. They may have forgotten the proper time and place for certain behaviors, such as taking off shoes or pants when they are at home and keeping them on when outdoors.

Persons with severe dementia can still learn. However, they learn much more slowly than most people. By repeating things over and over, caregivers can help them learn. Rewarding desirable behavior with praise, affection or a snack for a period of several weeks or months may help establish that behavior. It is important not to reward problem behaviors by paying too much attention to them. Again, sometimes the best action is to switch to a different activity to distract them; sometimes the best thing is for the caregiver to leave the room for a few minutes (reverse time out).

People with dementia can learn appropriate behavior. Suggested steps for the caregiver to follow:

  1. Choose a behavior you want to change and work only on that behavior.
  2. Show the preferred action one step at a time. After each successful step, reward with a snack, a smile, or an enthusiastic compliment.
  3. Do not punish the behavior you are trying to stop.
  4. Give a reward for appropriate behavior. There are many kinds of rewards: love, food or candy, money, time with a pet, a neck massage, or a visit with a friend.
  5. Keep an hourly chart or daily record of the behavior to see if the rewards work.

For example, some people dislike bath time. They dislike undressing to change clothes. They get angry and hold tight to the clothing on their bodies as the family member tries to remove it for the bath. To change the behavior, the caregiver should:

  1. Choose one behavior, such as undressing at bedtime.
  2. Keep a pleasant mood and facial expression.
  3. Give the person something to do with their hands, such as holding a drink, while you do the undressing.
  4. Undress them from the side rather than standing directly in front of them.
  5. Keep smiling and praise each step of progress.
  6. Create other ways to make the undressing time positive, such as playing the music that they like or singing.
  7. Reward good results. After you are done, show your appreciation for the cooperation of the person.
  8. Plan ahead. When undressing at bedtime is routine, undressing at bath time should be easy. Next comes developing the steps to make the bath experience pleasant and routine.

Keep a record of the person's likes, such as a walk, some time outside in the yard, or a piece of fruit or cake. Use these as rewards for positive behavior.

Material taken from: Helping People with Progressive Memory Disorders: A Guide For You And Your Family, 2nd ed." (University of Florida Health Science Center). Used with permission from the authors: K. M. Heilman, MD, L. Doty, PhD, J. T. Stewart, MD, D Bowers, PhD, & L. Gonzalez-Rothi, PhD. (1999).

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College of Public Health and Health Professions, University of Florida