VIDEO: Screaming, Biting, Defiance? Get Help with Difficult Behavior in Seniors

difficult behavior in seniors

This video is provided by NuevaCare

Online caregiver training for families

Most family caregivers take on the role with zero training and have to learn as they go. That’s definitely doable, but it can make life…challenging.

Instead of struggling on your own, learn from experts in this free online caregiver training video. This online class teaches practical ways to handle difficult behavior in seniors, including: screaming, biting, and refusing to bathe.

Learn at your own pace with online training

NuevaCare, a San Francisco Bay Area in-home care company, is giving you free access to their online training classes for family caregivers. They’re practical and full of real-life examples.

We took notes for you

For this class, Handling Difficult Situations and Behaviors, we outlined the topics to let you know which slides they’re on. That way, you can skip around and watch the parts you find most helpful. We’ve also taken notes on the key points for each topic so you don’t have to.

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How to use the video player

You can move at your own pace in these online classes. Use the controls to play, pause, move forward or back, and more. Here are some tips on how to use this video player.

difficult behavior in seniors
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difficult behavior in seniors
Controls within the slides


Start the class!

Introduction (Slides 1-3)

  • Instructions on listening and reading
  • Class outline


Part 1. What are behavior challenges? (Slides 4 – 8)

Aggressive behavior (Slide 8)

  • Grabbing
  • Kicking
  • Biting
  • Scratching
  • Hitting
  • Cursing

Physically non-aggressive behavior (Slide 8)

  • Wandering
  • Pacing
  • Inappropriate handling of objects
  • Resistance to care (example: refusing to bathe)
  • Repetition
  • Restlessness
  • Sleep disturbances
  • Inappropriate sexual behavior

Verbally agitated behavior (Slide 8)

  • Repetitive complaining
  • Repetitive requests for attention
  • Yelling or screaming


Part 2. Reasons behind challenging behaviors (Slides 9 – 18)

Possible reasons: Physical factors (Slide 10)

  • Anger
  • Fear
  • Physical discomfort (example: constipation)
  • Fatigue
  • Environmental factors (example: temperature or noise)
  • Stress
  • Feeling of loss of control
  • Depression
  • Hallucinations
  • Feeling that personal space is being invaded

Additional reasons: Significant life changes (Slide 11 – 12)

  • Retirement – loss of work, income, status, friendships with colleagues, daily routine
  • Loss of relationships due to death or relocation
  • Loss of physical abilities
  • Loss of independence and privacy

Difficult behaviors are often hidden messages, including: (Slide 13)

  • I’m lonely.
  • I’m bored.
  • I have no power.
  • I don’t feel safe.
  • You don’t value me.
  • I don’t know how to tell you what I need.
  • I don’t feel well.

Underlying causes (Slide 14)

  • Cognitive issues, thinking problems.
  • People with violent backgrounds are more likely to repeat the same behavior. You may need additional help with interventions with this type of person.
  • Illness that causes extreme pain.
  • Medications that cause behavioral problems.
  • Drug or alcohol abuse that causes aggressive behavior.
  • Feeling threatened causes aggressive behavior

Irreversible dementias (Slide 17)

  • Alzheimer’s disease
  • Creutzfeldt-Jakob (CJD) disease
  • Multi-infarct dementia (MID)
  • Pick’s disease
  • Parkinson’s disease
  • Lewy body disease
  • Huntington’s disease

Reversible dementias (Slide 18)

  • Depression
  • Medication interaction
  • Normal pressure hydrocephalus (NPH)
  • Vitamin B-12 and folic acid deficiency
  • Infections
  • Thyroid hormones


Part 3. Understanding your loved one’s challenging behaviors (Slides 19 – 27)

Basic Principles

  • Behavior is triggered, it doesn’t just happen. (Slides 20, 21 – 25)
  • Don’t take it personally. Repeat to yourself “It’s the disease causing the behavior, not the person.” (Slide 20, 26)
  • You can’t change the person, but you can learn techniques to prevent out of control behaviors. (Slide 20, 27)
  • Medications or infections can cause changes, especially if sudden. (Slide 20)
  • Stay calm, be patient and flexible. Your anxiety will increase their agitation. Medications or infections can cause changes, especially if sudden. (Slide 20)
  • Reassure them you’ll be around for them. Sometimes they’re feeling afraid or alone. (Slide 20)
  • Put your own and others’ safety first. (Slide 20)
  • Offer choices, not ultimatums. (Slide 20)
  • Be creative. Explore many different solutions. (Slide 20)
  • Honor their dignity and support their rights. (Slide 20)
  • Keep your sense of humor. (Slide 20)


Part 4. Preventing challenging behaviors in those with dementia or memory loss (Slides 29 – 50)

John’s Story: Dementia patient striking out due to fear (Slide 30)

  • Approach slowly and slowly explain what’s going to happen.

Step 1: Accept their feelings as a normal response to what has happened in their world (Slide 31)

  • Imagine yourself in their shoes, going through the memory changes and loss.
  • Think of how you’d act if you had those same feelings.

Step 2: Communicate your acceptance of these feelings (Slide 32 – 33)

  • Learn to communicate to your older adult that you accept their feelings.
  • Tone, pauses, sighs, and body language are the most important in communication.
  • Only 7% of your message is verbal. 55% is communicated in body language.

Virginia’s Story: An effective intervention to frustration and aggression (Slide 34)

  • Simple steps can relieve frustration and prevent aggressive behavior.
  • Acknowledge their feelings and reassure that you’ll be there for comfort and support.

Step 3: Reassure (Slide 35 – 36)

  • You’re the tour guide for this world where nothing makes sense.
  • Let them know that you’ll be there whenever they need you.
  • Follow through on your promise and be there when they need you.

Step 4: Accept their efforts (Slide 37)

  • They’re always doing the best they can.
  • Rarely are they doing something to make you crazy. Don’t let their challenges make you crazy.
  • Telling someone to try harder can make them more aware of their challenges, which may lead to increased behaviors.
  • Focus on the behavior and on finding the underlying cause.

Step 5: Move into their reality (Slide 38)

  • Reality is a flexible concept.

Amy’s Story: Dementia patient who insists on going to “meet her children” (Slide 39)

  • Stay in their reality, go with the flow, but calmly redirect to get a sweater first.
  • Distract and reassure with warm, pleasant conversation on the way to get a sweater.
  • After Amy’s moved past her original goal, engage her in another activity.

Samuel’s Story: Dementia patient who refuses to sleep until he’s in “his room” (Slide 40)

  • Show respect by not insisting that Samuel is wrong.

George’s Story: Dementia patient who only showers “on Fridays” (Slide 41)

  • Shower day is every other day. So, when it’s a shower day, it’s Friday – no matter what day it is.

Step 6: Use distraction (Slide 42)

  • Focus on things that bring joy and comfort.
  • Food and physical activity work well for most people.

Marcus’ Story: Dementia patient who wants to walk outside even in freezing weather (Slide 43)

  • Offer an alternative activity that meets the original goal (exercise), but in a safer way.

Step 7: Be creative (Slide 44 – 45)

  • Try different solutions, one solution might not all work every time.
  • Provide one-on-one attention.
  • Encourage physical activity to increase circulation.
  • Provide conversation.
  • Treating them with dignity.

Helen’s Story: How to get Mom to take a shower (Slide 46)

  • Go for a long walk that ends up in the bathroom, with everything ready to go.
  • Ease Mom into a shower by cleaning one body part at a time.

Step 8: Keep your sense of humor (Slide 47 – 48)

  • Laugh at yourself and each other.
  • Be sure to laugh with them, not at them.
  • Laugh, hug, and even cry with your older adult.
  • Don’t take yourself too seriously, keep joy in both your lives.
  • Don’t spend time trying to correct them or orient them to “normal” reality. It just leads to frustration for both of you.

These interventions diffuse extreme behavior and help you intervene before behavior gets out of control (Slide 49 – 50)

  • If you practice these skills, you might find you have to use interventions less frequently and you’ll have better outcomes.
  • Knowing what to do if a difficult situation comes up will give you confidence and will increase your ability to calm your older adult.

Next Steps 

For more tips on how to manage difficult behaviors, take a look at Dealing with Difficult Alzheimer’s and Dementia Symptoms.

Special thanks to NuevaCare for providing this online family caregiver training video!

By DailyCaring Editorial Staff
Image: Emily’s Quotes

NuevaCare provides responsive, quality, and affordable in-home care to those who need help due to old age or recovering from surgery or illness. NuevaCare is a member of California Association of Health Services at Home (CAHSAH), and Companion Connection Senior Care (CCSC), with access to recognized experts in the field of home care and the most current educational resources, which enable us to provide the highest level of care to our clients. We work with local hospitals, skilled nursing facilities and other senior housing communities to educate, inform and promote awareness about importance of senior safety and healthy living. We provide hourly, live-in, overnight, and 24/7 care.


  • Reply August 7, 2015

    Kimberly Clovis

    I work in LTC. This video will be used to show my staff how to handle behaviors. I want to say thank you for putting it together and making it available for my use!

    • Reply August 7, 2015

      Connie Chow

      Thank you Kimberly, that’s great to hear! I’m so glad you found this video and guide helpful. Kudos to you for seeking out new ways to handle difficult behaviors and working to improve the lives of your clients and staff!

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