If Behavior Is Communication, Why Are We Still Missing the Message?

Few statements are repeated more frequently in dementia care than:

"Behavior is communication."

Clinicians teach it. Caregivers hear it. Training programs emphasize it. Most professionals would agree with it.

Yet our documentation, interventions, and care systems often suggest otherwise.

When a person living with Alzheimer's repeatedly attempts to leave a unit, refuses care, yells, strikes out, removes clothing, or repeatedly asks the same question, the behavior itself frequently becomes the focus.

The more important question is often overlooked:

What is this behavior communicating?

The Difference Between Description and Understanding

Behavioral documentation is necessary. It provides a record of events, supports continuity of care, and helps identify patterns.

However, documentation frequently stops at description.

• A resident was agitated.

• A patient refused care.

• An individual became combative during bathing.

• A resident wandered into another room.

All of those statements describe what happened. None explain why it happened.

The distinction is important.

Describing a behavior is not the same as understanding it.

Behavior Rarely Occurs in Isolation

Behavioral expressions in Alzheimer's disease often emerge in response to an unmet need, environmental mismatch, cognitive limitation, or physiological concern.

• The person refusing a shower may not be refusing hygiene.

• They may be frightened.

• The individual repeatedly attempting to leave may not be wandering aimlessly.

• They may be searching for familiarity.

• The resident striking out during personal care may not be aggressive.

• They may be confused, startled, embarrassed, or unable to understand what is happening.

The behavior may be the visible event.   The cause is often something else entirely – but often not even considered.  

A comparable analogy: we see blood on the floor.  The blood is the visible event – but it is not the issue; we investigate to resolve and stop the issue causing the visible event.  Why do not not follow that same protocol within Alzheimer’s treatment?

What Are We Assessing?

When behavioral symptoms occur, care teams often document the visible event, not the issue.

Questions such as these are frequently more clinically useful than the behavior itself:

• What occurred immediately before the behavior?

• Was there a change in routine?

• Was the environment overstimulating?

• Was the individual fatigued?

• Was pain considered?

• Was the task too complex?

• Was communication adjusted to match current abilities?

• Was the person given sufficient processing time?

These questions shift the focus from controlling behavior to understanding it.

Understanding leads to effective intervention.

The Cost of Missing the Message

When behaviors are viewed primarily as problems to eliminate, interventions often become reactive.

• Additional medications.

• Additional restrictions.

• Additional documentation.

Yet if the underlying cause remains unidentified, the behavior frequently returns. Not because the intervention failed but because the message was never fully understood  “… doing the same thing over and over and expecting different results.”

The result can be frustration for staff, distress for families, and affecting the quality of life for the person living with Alzheimer's disease.

A Different Clinical Lens

Perhaps one of the most important shifts in dementia care is moving from:

"How do we stop this behavior?"

to

"What is this behavior telling us?"

That shift does not excuse unsafe actions, nor does it eliminate the need for intervention. Rather, it encourages a more complete assessment process, one that recognizes behavior as meaningful clinical information rather than simply disruption.

Because if behavior is communication, then every behavioral expression becomes data.

And data should be investigated, not merely documented.

The Question Worth Asking

What if some of the most challenging behaviors in dementia care are not treatment failures?

What if they are assessment opportunities? Because before behavior can be effectively managed, it must first be understood - and understanding begins by asking a better question.

Not: "How do we stop this?"

But: "What is this person trying to tell us?"

Next in this series:

Functional Decline Requires Functional Planning