A = Activating Event

Questions to answer:
  • When & where did the behaviour occur?
  • What was the person doing immediately before the behaviour occurred?
  • What was happening around the person at the time?
Assess environmental factors:
  • Noise (eg. TV loud, music loud, staff change of shift, meal time clatter)
  • Clutter (eg. Furniture, people)
  • Bright lights/glare on the floor
  • Mirrors
  • Temperature (eg. Too hot/cold)
  • Recent changes to environment (eg. Renovations, staff/resident changes)
  • Does the environment provide a safe area for residents to wander around?
  • Does the environment encourage independence, dignity and mobility?
  • Does the environment accept the client's cultural and lifestyle habits?
Assess physical factors:
Metabolic Hyperthyroidism, hypothyroidism, hypercalcaemia, hyponatraemia
Infections Urinary tract infection, pneumonia, septicaemia
Neurologic Stroke, subarachnoid haemorrhage
Traumatic Chronic pain, head trauma, fractures such as hip & rib
Systemic Hypoglycaemia, vitamin B12 deficiency, folate deficiency
Medications Sedatives, antihistamines, alcohol
Impaction Faecal
Adapted from Banazak D. (1996) Difficult dementia: Six steps to control problem behaviours. Geriatrics, v.51,n.2
  • Has there been a recent change in medication?
Does the person have:
  • Impaired vision or hearing
  • Acute illness, eg. UTI, pneumonia
  • Chronic illness, eg. Angina, CCF, diabetes
  • Chronic pain, eg. Arthritis, ulcers, headaches
  • Dehydration
  • Constipation
  • Fatigue or physical discomfort
Assess psychological factors:
  • Does the person have a history of psychiatric illness?
  • Has the person experienced a recent loss or an accumulation of losses?
  • Does the person appear sad? Eg. Tearful, withdrawn
  • Are past events influencing present behaviours? Eg. Post traumatic stress, POW, abuse
  • Does the person appear to be responding to hallucinations?

References & recommended reading

Banazak, D. (1996) Difficult dementia: Six steps to control problem behaviours. Geriatrics, Vol.51:No.2

Behaviour Advisory Service (Aged Care) (2001) Behaviour Assessment Guide. Alzheimer's Association South Australia

Robinson, A. Spencer, B. & White, L. (1991) Understanding Difficult Behaviours: Some practical suggestions for coping with Alzheimer's Disease and related illnesses. Eastern Michigan University, USA

Teri, L. (1999) 'Latest advances in the assessment and management of behavioural symptoms: an international perspective'. Paper presented to a Symposium reporting the latest evidence-based practices in the care of behavioural symptoms of dementia, Melbourne.

Teri, L. (1999) 'State of the art strategies in approaching behavioural
disturbance and depression in dementia'. Paper presented to a Symposium reporting the latest evidence-based practices in the care of behavioural symptoms of dementia, Melbourne.