The Importance of Identifying Triggers in Managing Challenging Behaviours

Triggers are known to cause behaviours in those diagnosed with dementia. Stop for a moment and take a look around. Can you identify the triggers in your environment? Perhaps it’s the alarm clock that prompts you out of bed every morning, the sight of a long “To Do” list that makes you feel like getting back in that bed and taking a nap, or the comforting smells of your favourite home-cooked meal that remind you to give your mother a call. For better or worse, triggers influence our behaviour on a daily basis, and the same goes for those with dementia. As a dementia consultant, I’ve witnessed first-hand how being able to identify these red flags can play an important role in helping caregivers ease discomfort and avoid stressful episodes.

This certainly was the case for “Joanne” who would make frequent visits to the care home to spend time with her husband “Joe” who had dementia. Though the visits were pleasant, the peace would be broken whenever Joanne got up to leave. As she rose from her chair and reached for her purse to head back to her car, Joe would want to go with her. When he found out he couldn’t leave with her, he became angry with her and everyone else around him. Every time Joanne would start to leave, he had the same reaction. After a string of such episodes, Joanne started wondering whether she should limit her visits, for fear of causing him undue anxiety.

However, instead of depriving both her husband and herself of each other’s company, Joanne decided on a different strategy. She noticed that Joe’s negative reaction seemed to be triggered whenever she picked up her purse to leave. That particular action is what signaled to Joe that his wife was going away. So on her next visit, Joanne chose to leave her purse in the car and put her car keys in her pocket. It felt odd at first being without her purse, but she wanted to do a test run to observe if Joe’s reaction would change. When it was time to leave, instead of being obvious that she was going, she told Joe she had to go use the washroom and left the room (Therapeutic Reasoning). Before leaving, Joanne informed the nurses and they came in to keep Joe occupied so that he didn’t even realize that she had left. This way, when she left, he would not be in an anxious state. Using the same routine during subsequent visits, Joanne realized that she had accurately identified the trigger of Joe’s distress and now both of them were better able to enjoy the time spent together.

Triggers, as evidenced in Joanne’s case, can play a powerful role in causing a challenging behaviour. The good news is that, once identified, they can also be limited or taken away in order to end the negative reaction being caused.  In Joanne’s case, understanding that her purse was acting as a trigger was key to restoring peace of mind for both herself and her husband.