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Supporting strong emotional outbursts

 Vicki Leah 24 Oct 2017

The area of dementia care that causes the most distress for both family and professional caregivers is when those in their care experience emotional outbursts which may result in physical aggression.

This is one aspect of dementia that can result in that person being admitted to a long term care environment.

I have witnessed a real change in the language used in relation to the emotional outbursts seen in some people living with dementia. “Living with dementia” is in itself a recent departure from the old philosophy of dementia care when, “suffering from dementia” or, “a dementia patient” were the common terms used.

More recently, I have started to hear health care professionals talk of people living with dementia demonstrating behaviours of distress, as opposed to challenging behaviour, or behaviours of the psychological symptoms of dementia, or just simple aggressiveness.

I see this as a real change in how we are thinking about our patients. Using the phrase “behaviours of distress” suggests to me that we are moving away from describing the situation from our perspective to that of the person. We are now describing the emotions our patients may experience, for example, frustration, anger, embarrassment, fear and loneliness, which can lead to behaviours of distress, rather than just describing the behaviours.

If we describe the situation from the person’s perspective, does this inform our understanding of the situation and if so, does this understanding influence our actions?

For example, what level of support would I expect for one of my patients if I describe him to a colleague as aggressive and say that he can get punchy? I can’t help but wonder whether I would get a different response if I describe him as someone who can become upset, frightened and feel lonely as a result of his situation, which can lead him to becoming physically angry.

And if I describe this man’s strong emotions at handover, would the team try to work out what triggers his emotional outbursts, how we can best support him and prevent further outbursts? Would this result in us talking about supporting people rather than managing them?

Unpicking the emotional outbursts to identify the triggers and coming up with some possible interventions could lead to real therapeutic solutions that could be shared with future carers.

Our language reflects our understanding and our understanding influences our actions.


Vicky Leah

Vicki Leah

Chair, RCN Older People's Forum

Consultant nurse

Vicki is a consultant nurse for older people and the dementia lead at University College Hospitals, London. Her role is to improve the experience of older people attending hospital. She leads a team of older people’s clinical nurse specialists.