2.5 Observe the behaviour of an individual with dementia to interpret needs

This guide will help you answer 2.5 Observe the behaviour of an individual with dementia to interpret needs.

Observing the behaviour of a person with dementia helps you understand their needs when they may not be able to express them clearly through speech. Many people with dementia lose some ability to communicate verbally. Behaviour becomes a way of expressing feelings, discomfort, or needs. Your role is to watch carefully and interpret these signs in a supportive and respectful way.

Observation is more than just seeing what happens. It involves paying attention to small changes, using all your senses, and being aware of the person’s usual patterns. By linking what you observe to possible needs, you can respond in the most helpful way.

Common behaviours to watch include restlessness, pacing, changes in facial expression, repeated movements, verbal outbursts, withdrawal, changes in appetite, disturbed sleep, or increased agitation at certain times of the day. Each behaviour is a form of communication.

Why Observation is Important

When someone cannot explain what they feel, their body language and actions speak for them. They might show pain by wincing or rubbing a part of their body. They might express anxiety through pacing or fidgeting. Recognising these signs makes it possible to give the right support.

Without observation, needs may be missed. This can lead to distress for the person and can make caring tasks more difficult. By watching carefully, you may also detect early signs of physical illness, emotional upset, or changes in cognitive ability.

Observation also helps identify personal triggers that may cause difficult reactions. These could be environmental factors like noise, temperature, lighting, or even certain activities that cause stress.

Approaches to Observation

Observation should be discreet and respectful. Never make a person feel watched or judged. Position yourself so you can see and hear without intruding.

Approaches include:

• Casual observation – keeping aware of the person’s behaviour while carrying out normal care and interaction.
• Structured observation – watching and recording behaviour over a set period to identify patterns.
• Incident observation – focusing on what happens before, during, and after a certain behaviour.

Using all senses

You can learn a lot by watching body language, facial expression, and posture. Listen to tone of voice, breathing patterns, and changes in language. Notice scents that may indicate poor hygiene or incontinence. Touch can provide information about skin temperature, tension, or tremors, but always respect personal boundaries and consent.

Interpreting Behaviour

Every person with dementia experiences it differently. The same behaviour in two people can mean different things. You must consider what you know about the person’s usual habits, likes, dislikes, health conditions, and life history.

For example:

• A person pacing the corridor could be anxious, looking for a bathroom, or trying to find someone.
• Repeating a question might mean they have forgotten they asked, or they are feeling insecure and need reassurance.
• Refusing food could indicate dislike for the taste, difficulty chewing, or pain when swallowing.

Link what you see to possible physical, emotional, social, or environmental needs. Then act or pass the information to the appropriate colleague.

Recording Observations

Written records help identify patterns over time and allow other staff to give consistent care. Records should be:

• Accurate
• Clear
• Objective
• Free from personal opinion or judgement

Include:

• Date and time
• Description of behaviour
• What was happening around the person
• How the person reacted to others
• Your response and the outcome

Avoid vague phrases like “acted strangely”. Describe exactly what you saw or heard. For example “Jerry shouted loudly three times and banged his hand on the arm of the chair” is specific and useful.

Identifying Triggers

Understanding what caused a behaviour can stop it from happening again or reduce its impact. Look for links between events and behaviours.

Possible triggers:

• Pain or discomfort
• Hunger or thirst
• Boredom
• Needing the toilet
• Overstimulation from noise or busy activity
• Changes in routine
• Feeling lonely or frightened
• Physical illness

When you recognise a trigger, you can change the environment or activity to support the person better.

The Role of Communication

Observing behaviour is closely linked with how you communicate. Your tone of voice, body language, and expressions all influence the person’s reaction. Approach slowly, smile, and speak calmly. Give time for the person to process what you say.

If they appear upset, try to calm the environment before asking questions. Avoid too many words at once. Simple, clear sentences work best.

Considering Physical Causes

Some behaviours that seem linked to dementia can actually be signs of physical illness. For example:

• Restlessness could signal pain, constipation, or needing the toilet.
• Sudden aggression might be linked to infection such as a urinary tract infection.
• Withdrawal could be related to depression or low blood sugar.

This is why recording observations and sharing them promptly is important. A nurse or doctor can then assess the person for any medical issues.

Emotional and Social Factors

Dementia affects a person’s feelings as well as their memory and thinking. They may feel lonely, frightened, or confused. They may react strongly to losing independence or not recognising their surroundings.

Signs of emotional needs can include crying, refusing care, following staff closely, or holding on to familiar objects. Respond with reassurance, empathy, and attention.

Social needs can also drive behaviour. Someone used to being active in a group may become restless if left alone for long periods. Offering activities they enjoy or chances to interact may reduce distress.

Cultural and Personal History

A person’s behaviour is often linked to their past. For example:

• Someone who worked night shifts might be more active at night.
• A person from a certain cultural background might expect meals or interactions at particular times.
• Music, language, or traditions from their past can trigger strong emotional responses.

Knowing a person’s life story helps give context to their actions. Family members can offer valuable insights that explain behaviour patterns.

Ethical Considerations

Respect must guide all observation and interpretation. The person is an individual with rights and dignity. Never talk about them as if they are not present. Seek consent where possible, explain what you are doing, and avoid making them feel like a subject of study.

Confidentiality is also important. Share observations only with relevant team members and record them according to organisational policy.

Working with the Care Team

Observation is most effective when shared with others who care for the same person. Different staff may see different behaviours at different times of day. Sharing this builds a clearer picture of the person’s needs.

Handovers are a good time to pass on observations. Some care settings have behavioural charts or electronic records used by all staff. Use these tools to keep information consistent.

Using Observation to Plan Care

Patterns you identify from behaviour can help shape the person’s care plan. For example:

• If someone becomes agitated before lunch, offering a small snack earlier could help.
• If a person becomes confused in noisy environments, providing a quiet space can reduce stress.
• If they show signs of pain in the afternoon, a review of medication times may be needed.

Changes should be based on evidence from repeated, accurate observations.

Responding to Behaviour in the Moment

When you observe a behaviour, your first step is to keep the person safe and calm. Avoid sudden movements or loud voices. Give them space if they seem upset. Try to identify and remove possible triggers.

Simple strategies:

• Offer a drink or food if they may be hungry or thirsty.
• Guide them to the toilet if they seem restless.
• Change the conversation or activity if they appear bored or agitated.
• Adjust lighting or noise if these appear to affect them.

Afterwards, record what happened and how your actions helped or didn’t help.

Recognising Positive Behaviour

Observation is not only about negative or challenging actions. It is just as important to record positive behaviours. This could include participating in activities, smiling during interactions, or showing affection.

Positive observations can be used to encourage and reinforce activities or routines that lead to good outcomes for the person’s wellbeing.

Adapting Your Skills Over Time

The condition of a person with dementia may change over months or years. Behaviours can evolve as communication skills decline or physical abilities alter. Your approach to observation should adapt with these changes.

Learn from experience, reflect on what methods worked in the past, and stay open to new ways of interpreting actions. Training and feedback from colleagues can help improve your skills.

Common Challenges

Some common difficulties in observation include:

• Behaviours that happen when you are not present
• Misinterpreting signs and giving the wrong response
• Balancing observation with other care tasks
• Emotional impact of seeing distressing behaviour

Overcoming these challenges involves teamwork, good record keeping, and self-care to manage your own stress.

Final Thoughts

Observing the behaviour of someone with dementia is a key part of giving good care. It allows you to understand and meet needs that may not be spoken. By watching closely and linking behaviour to possible causes, you can improve comfort, safety, and quality of life.

Observation is not about catching someone doing something wrong. It is about seeing the person as a whole and responding with kindness and respect. With practice, you will notice subtle signs and patterns, and your care will become more responsive and personal.

If you would like, I can now create detailed example observation records that meet Level 3 RQF assessment standards for this unit. Would you like me to prepare that next?