Behavioral Expressions in Dementia
The majority of individuals living with dementia will at some point experience behavioral changes that can be upsetting to loved ones and care partners. These may include verbally or physically aggressive behaviors
(e.g. yelling or hitting), wandering, or refusing assistance with personal care. Because such behaviors are how an individual is expressing themselves at that time, they are often referred to as “behavioral expressions.” These expressions are the individual’s way of communicating with us, so helping them effectively starts with understanding what they are trying to say.
The DICE Approach is a method designed by geriatric psychiatrist Dr. Helen Kales and colleagues to guide care partners who encounter these behavioral expressions.
DICE stands for:
Describe
Investigate
Create
Evaluate
First, we need to describe the behavior by asking specific questions such as who, what, where, and when. Who was present at the time of the behavior? What was the individual saying/doing? Where did this occur? When did this happen-in the morning or evening; during mealtime or self-care?
The next step is to investigate further as to what could be happening with the individual that might be causing the behavior change. These questions include: Are they experiencing pain? Is the environment upsetting them (i.e. too stimulating or not stimulating enough)? Has there been a recent change in medication?
Once we have the information above, we can begin to create solutions to address what could be underlying the behavior. This might include treating pain, a medical condition such as an infection, or making changes to one’s environment and daily routine.
Lastly, we need to evaluate whether the changes that we created to address the behavioral expressions have been effective. What changes were made that led to a reduction in these expressions and how can we best continue to implement them?
If you are caring for someone with dementia who is exhibiting behavioral expressions, the DICE approach - used together along with the support of a healthcare professional - can be a helpful first step for both of you.
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