When a person living with dementia suddenly becomes agitated, begins wandering, refuses care, or repeatedly calls out, one question often follows:
“Can we get them something for that?”
I’ve heard those seven words hundreds of times throughout my career.
I’ve heard them in hospitals.
I’ve heard them in nursing homes.
I’ve heard them in memory care communities.
I’ve heard them in people’s homes.
Those seven words have become one of the most predictable responses in dementia care.
To be clear, this article is not about criticizing medication.
Psychotropic medications have an important place in dementia care. There are situations where they are appropriate, necessary, and can significantly improve a person’s quality of life.
This article is about something that often happens before medication ever enters the conversation.
The Questions We Sometimes Skip
In many situations, medication becomes part of the discussion before we’ve fully explored what might actually be causing the behavior.
Instead of immediately asking whether medication is needed, we should first ask questions like:
- Is the person in pain?
- Are they frightened or overwhelmed?
- Has something changed in their environment?
- Are they hungry, tired, constipated, or ill?
- Could they be trying to communicate a need they can no longer express with words?
Behavior rarely occurs without a reason.
The challenge is that dementia often changes how people communicate that reason.
Recognizing a Behavior Is Not the Same as Understanding It
One of the biggest challenges in dementia care is that many healthcare professionals are taught to recognize dementia-related behaviors but receive far less education on how to investigate them.
We learn to identify:
- Wandering
- Agitation
- Aggression
- Resistance to care
- Calling out
- Repetitive questions
Recognizing these behaviors is important.
Understanding why they are happening is even more important.
Without that understanding, medication can quickly become the next conversation—not because anyone has bad intentions, but because many professionals have never been taught another way to approach the situation.
A Woman Who Wandered Every Night
I once worked with a woman living in a memory care community who frequently received a PRN medication because she wandered throughout the night.
The wandering itself became the problem.
But after spending time getting to know her, another explanation became clear.
She had very few opportunities for meaningful movement during the day.
Her need for movement hadn’t disappeared because she had dementia.
It simply wasn’t being met.
Once staff intentionally incorporated regular movement into her daily routine, her nighttime wandering decreased significantly.
The medication hadn’t changed.
Our understanding had.
A Hospital Stay That Changed My Perspective
Another experience has stayed with me for years.
A man with dementia was admitted to the hospital because his behaviors had dramatically worsened.
He became increasingly agitated.
He refused care.
He was no longer cooperating with staff.
He had even begun engaging in self-injurious behavior.
The behaviors became the primary focus.
Staff worked to calm him.
He was sedated.
For several days, everyone believed they were treating worsening dementia.
They weren’t.
Eventually, someone discovered that he had a severely infected tooth.
His agitation wasn’t caused by dementia.
His refusal of care wasn’t caused by dementia.
His self-injurious behavior wasn’t caused by dementia.
They were caused by pain.
The behavior wasn’t lying.
Our interpretation was.
Behavior Is Communication
That experience has never left me because it raises an important question:
How many behaviors that we label as “dementia behaviors” are actually attempts to communicate something else?
Pain.
Fear.
An infection.
Constipation.
Hunger.
Fatigue.
Loneliness.
Boredom.
An unfamiliar environment.
After more than two decades working in dementia care, I believe this happens far more often than we’d like to admit.
Behavior is communication.
Sometimes it is the only communication a person has left.
Looking Beyond the Behavior
Medication has an important place in dementia care, and there are absolutely times when it is appropriate.
But medication should ideally follow a thoughtful investigation—not replace one.
When we understand the reason behind a behavior, we often uncover opportunities to address unmet needs, modify the environment, improve communication, or build on the person’s preserved abilities.
Those interventions won’t eliminate every behavior.
But they often reveal that the behavior itself was never the true problem.
A Different Question
I’ve worked alongside extraordinary physicians, nurses, therapists, nursing assistants, and caregivers who genuinely want to do the right thing.
This isn’t about blaming healthcare professionals.
I believe many have simply never been taught another way.
We’ve done an excellent job teaching people to recognize dementia.
We need to do a better job teaching people how to understand it.
Before we ask,
“Can we get them something for that?”
perhaps we should first ask,
“Why is this happening?”
Because sometimes the behavior isn’t asking for medication.
It’s asking to be understood.
If this article challenged the way you think about dementia-related behaviors, please consider sharing it with a colleague, caregiver, or healthcare professional. Better questions lead to better understanding, and better understanding leads to better care.
Want to learn more about the Preserved Abilities Method™?
Visit https://preservedabilities.com to explore resources, articles, and tools designed to help caregivers and healthcare professionals better understand and support people living with dementia.
You can also read my Newsweek article, “Dementia Care Should Begin With What Is Preserved, Not What Has Been Lost,” here:
Healthcare professionals often recognize dementia-related behaviors, but understanding the reason behind those behaviors should come before considering medication.