Looking for physical causes and health problems

Physical causes are a major reason for distress and behaviour change in people living with dementia. When someone cannot explain clearly what hurts, what feels wrong, or what they need, the first sign may be resistance, agitation, restlessness, sleep disturbance, calling out, or hitting out during care.

Common physical causes to think about

• Pain or discomfort: arthritis, pressure damage, dental pain, bruising, a sore shoulder, poor positioning, or uncomfortable clothing can all trigger distress.
• Constipation, urinary retention, or toileting need: these are common, often under-recognised, and can strongly affect behaviour.
• Infection or delirium: a sudden change over hours or days should raise concern about acute illness.
• Hunger, thirst, tiredness, or poor sleep: basic needs can be missed in busy settings.
• Medicine effects: sedation, confusion, dizziness, or constipation can all worsen the picture.
• Sensory problems: poor hearing, poor vision, sore feet, or ill-fitting dentures can make daily care much harder.

Notice what is new or worse than usual

NHS guidance stresses that when behaviour change comes on suddenly, staff should think about health problems such as pain, constipation, infection, or medicine side effects rather than assuming it is simply the dementia. NICE also advises a structured assessment that checks for clinical causes such as pain or delirium before deciding how to manage distress.

Frontline staff do not need to diagnose every cause themselves, but they do need to notice changes early, check obvious factors, record clearly, and escalate in line with local policy. That is a major safety role in both residential and nursing care.

A practical reminder for nurses and team leaders

Before calling a behaviour "challenging", check for pain, illness, constipation, toileting need, medicine effects, and other physical causes. Sudden change should always make staff think about health problems first.