Behavior as an Expression of Unmet Needs in People with Late Stage Alzheimer's

Health Professional

It has been argued that much of human behavior is motivated by a group of hierarchical needs that have to be met.  Abraham Maslow, a psychologist, suggests these needs  must be met in  a certain sequence beginning  from basic and  mostly physical levels of need (the need to eat, sleep and feel safe), to higher order needs such as the need for belongingness, love and esteem.

If you cannot tell someone what you want or need because you cannot express yourself well enough to get your message across, what do you do? People with late stage Alzheimer's   are in just that situation. Imagine they have been moved to an alien environment, surrounded by strange faces and perhaps given unfamiliar clothes. You already feel confused and disorientated but this new change far exceeds anything you've experienced before. You feel vulnerable, uncertain, and worse still, unable to comprehend or communicate this to others.  This is a glimpse of what it must be like to have Alzheimer's disease.

You can blame the resulting behavior, shouting, screaming, hitting out, acting in an apparently uncooperative way, as brain dysfunction directly linked to the slow, progression of the disease. But we, as caregivers, look beyond the purely physical and adopt a more bio-psycho-social model to understand dementia; one that seeks explanations of the person's behavior in their environment and one that sees behavior as an expression of unmet needs.

Research has shown that people with dementia who demonstrate severe cognitive impairment, problems with thinking, problem solving, learning and  judgement, still have higher order needs that must be met. Social contact, praise, a sense of being needed and wanted and sensory stimulation form just a part of such needs. The difference in people with Alzheimer's is that their ability to recognize, express and resolve their needs without the help of others is impaired. It does not mean they no longer have no higher needs.

In her Sharepost, Dorian Martin talks of  Seeing Mom's humanity First, Instead of her Disease. She  describes the importance of seeing the person, rather than an Alzheimer's victim. Someone with a need for tenderness, for inclusion in a social group, someone who needs a person-centred care plan.

The term 'needy' is frequently used in a disparaging way. We all have needs and our daily interactions are specifically designed to ensure some, if not all of these are met. We've adopted a subtle system of communication which is mostly related to shared reinforcement. So when a person's needs are greater than our own it can be off putting and difficult to maintain a relationship with them.  With Alzheimer's  the bottom  line is that their needs will always be greater than their caregiver's. Appreciating this simple regard for the human condition often costs very little but in terms of dignity and respect for others it  can achieve such a lot.

More Information on Alzheimer's Needs:

Seeing Past the Patient and Into the Whole Person

Ways to Encourage Communication

Seven Stage of Alzheimer's disease

Inhome care: Advice for Late stage Alzheimer's