Welcome to guest blogger and occupational therapist:
Rachel Wiley, MS, OTR/L, CDP
Introduction
Have you ever worked with a person living with dementia who experiences agitation, resistance, or withdrawal and felt like nothing you tried was working?
Here’s the truth: those “behaviors” are not random. They are communication.
And occupational therapy has a powerful, often underused tool to decode them: activity analysis.
Most providers attempt to manage dementia’s responsive behaviors with redirection or medication. OTPs, however, have the ability to look deeper, at the task, the environment, the communication, and the cognitive demands being placed on the person.
That is the OT advantage!
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In this article you will learn:
• Why dementia’s responsive behaviors are communication, not defiance
• How activity analysis reveals the true trigger of behaviors
• Practical OT strategies that reduce behaviors immediately
Keep reading to discover how to see dementia behaviors through an OT lens.
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Dementia Behaviors Are Communication, Not “Bad Behavior”
In dementia care, behaviors are often labeled as:
• Agitation
• Aggression
• Repetition
• Wandering
• Resistance
• Hoarding
• Shadowing
• Withdrawal
But these are not personality problems. They are responses to unmet needs, overwhelm, confusion, or environmental mismatch.
Research shows behavior is best understood through models like:
• The Triadic Model (person, care partner, environment)
• The Progressively Lowered Stress Threshold (PLST)
• Lawton’s Competence–Environmental Press Model
When we reframe behavior as communication, we stop asking:
“How do I stop this behavior?”
and start asking:
“What is this behavior telling me?”
This shift changes everything.
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How Activity Analysis Reveals the Real Trigger
This is where OTPs shine.
When a person becomes agitated during a task, most people look at the behavior.
OTPs look at the demands of the task.
Using activity analysis, we break the task into:
• Motor demands
• Process demands
• Sensory demands
• Environmental demands
For example:
A caregiver asks,
“What kind of ice cream do you want?”
The person becomes agitated.
This is not about ice cream.
This is about:
• Open-ended questioning
• Too many choices
• Noise in the room
• Hunger
• Heat
• Cognitive overload
Activity analysis lets us identify the real trigger, not the visible behavior.
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OT Strategies That Reduce Dementia Behaviors
Once we understand the trigger, we can modify four key areas.
1. Communication
• One direction at a time
• No more than two choices
• Avoid open-ended questions
• Slow pace, calm tone
• Match communication to cognitive level
2. Environment
• Reduce noise and clutter
• Improve lighting
• Remove unnecessary items
• Label drawers/cabinets
• Control temperature and odors
3. Task Adaptation
• Simplify steps
• Set out only needed items
• Establish routine
• Lower expectations
4. Activity Engagement
• Use lifelong roles and interests
• Focus on enjoyment, not outcome
• Keep an “activity box” ready
• Use repetition and familiarity
These strategies don’t only “manage” behavior, they can prevent them from occurring in the first place.
Research shows tailored OT interventions reduce agitation, anxiety, aggression, and caregiver burden while improving quality of life.
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The Power of Occupational Therapy in Dementia Behaviors
Dementia behaviors are not random.
They are often predictable, preventable, and understandable through activity analysis.
As OTPs, we have the skills to:
• Identify the true cause of behaviors
• Adapt tasks and environments
• Coach caregivers effectively
• Improve quality of life for everyone involved
This is the OT advantage in dementia care.
