The CAUSEd problem-solving tool is designed to encourage caregivers and care professionals to understand the behaviours of persons living with dementia as a form of communication with their social and physical environments. In turn, caregivers and care professionals can identify the possible triggers for the behaviours, and minimize the impact of behaviours by developing and implementing support strategies.
Apply CAUSEd to Understand Behaviour Changes
CAUSEd is a problem-solving tool developed by Dementia Australia, to enable caregivers and care professionals to understand the changes in behaviour of persons living with dementia. Using an easy-to-remember acronym, CAUSEd (see list below for elaboration) guides users to see behaviour changes as responses to changes in the brain, and consider various factors that can be addressed in response to the behaviour.
The tool provides a systematic approach to:
• Identify the modifiable triggers for behaviour changes.
• Understand the unmet needs that persons living with dementia are communicating through their behaviours.
• Develop and implement support strategies to respond and meet the needs communicated, and minimize the impact of the behaviours.
As dementia progresses, it may become increasingly difficult for persons living with dementia to recognize and express their needs.
More often than not, the triggers for behavioural changes are often external to persons living with dementia, rather than an inevitable consequence of their dementia progression. These external triggers include problems in the social and physical environments that can be addressed and changed.
Despite limited evidence on effectiveness and significant evidence for potential adverse effects in older adults3, pharmacological treatments are often used.2 However, best-practice guidelines internationally recommend non-pharmacological approaches as first-line treatments for behaviours and symptoms related to dementia (BPSD).4,5
The CAUSEd problem-solving tool is a non-pharmacological approach that guides you to see beyond the behaviours and think about the causes in the following six aspects.6 The corresponding guiding questions also reflect that most of the triggers for the person’s behaviours can be addressed and modified using non-pharmacological strategies. Communication, Activity, Unwell/ Unmet Needs, Story, and Environment are factors that can be addressed or modified. While the dementia (with a lowercase d) cannot change, we can attempt to understand the person’s behaviour based on the dementia-related brain changes.
Madam Tan is a 78-year-old woman living with dementia, who has been recently admitted to the ward of the nursing home that you are working in. She uses a wheelchair and requires minimum to moderate assistance in her activities of daily living (ADLs).
On Madam Tan’s first morning at the home, you and your colleague have been assigned with the responsibility to assist Madam Tan in her showering. However, upon entering the bathroom, Madam Tan refused both of you to assist with her showering (behaviour: resistance to care). When you and your colleague attempted to continue with her care, she became increasingly agitated and eventually burst into tears (behaviour: emotional lability). She also began to push both of you away (behaviour: aggression) and thus immediately stopped with her care.
Using the CAUSEd approach to problem solve why Madam Tan was becoming distressed and not responding well to support with showering, here are some plausible areas of concern that may have triggered Madam Tan’s behaviour changes:
• Communication: Madam Tan usually wears a hearing aid and glasses, and was having difficulty hearing and understanding what was being asked of her.
• Activity: Madam Tan usually showers at night before going to bed, because this helps her to sleep better.
• Environment: Madam Tan is unfamiliar with the new environment (nursing home) and has never met you and your colleague before today, which caused her to feel very anxious.
After identifying the triggers using the CAUSEd approach, you can introduce helpful strategies to support a more positive experience for Madam Tan during showering. These strategies include:
• Ensuring Madam Tan is wearing her hearing aid and glasses before communicating with her.
• Changing the time of her shower to the evenings.
• Inviting Madam Tan to the shower and offering some choice. E.g., “Would you like to have your shower at 7pm or 8pm?”.
• Providing visual cues such as asking Madam Tan to hold her toiletries.
• Ensuring Madam Tan has an opportunity to develop rapport with you and your colleague before her shower. E.g., participate together in activities that Madam Tan enjoys, have meals together with her, and frequently make small talk with her.
• Providing support at an appropriate pace for Madam Tan.
If you would like to learn more about the CAUSEd problem-solving tool, you can go online, or attend the Foundations of Person-Centred Dementia Care course by Dementia Singapore, which provides more information on Behavioural Communication.
This course offered by Dementia Singapore is intended for front-line care staff and volunteers who would like to be equipped with a basic understanding of how to care for people living with dementia in a variety of settings. These settings include the family home, centre-based services, and residential care facilities.
Many thanks to Dementia Australia for granting the permission to adapt and reproduce this article on the CAUSEd problem-solving tool. The tool is developed by Alzheimer’s Australia Vic educators, Di Fitzgerald and Marina Cavill.
- O’Toole, G. (2017). CAUSEd: Effective problem solving to support well-being. Australian Journal of Dementia Care, 6(1), 15-16.
- Guideline Adaptation Committee, Clinical Practice. (2016). Clinical Practice Guidelines for Dementia in Australia: A step towards improving uptake of research findings in health- and aged-care settings. Australasian Journal on Ageing, 35(2), 86–89. doi: 10.1111/ajag.12330.
- Jessop, T., Harrison, F., Cations, M., Draper, B., Chenoweth, L., Hilmer, S., Westbury, J., Low, L. F., Heffernan, M., Sachdev, P., Close, J., Blennerhassett, J., Marinkovich, M., Shell, A., & Brodaty, H. (2017). Halting Antipsychotic Use in Long-Term care (HALT): A single-arm longitudinal study aiming to reduce inappropriate antipsychotic use in long-term care residents with behavioral and psychological symptoms of dementia. International Psychogeriatrics, 29(08), 1391–1403. doi: 10.1017/s1041610217000084
- Ministry of Health. (2013). MOH clinical practice guidelines on dementia. https://www.moh.gov.sg/docs/librariesprovider4/guidelines/dementia-10-jul-2013—booklet.pdf
- NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People. (2016). Clinical practice guidelines and principles of care for people with dementia: Recommednations. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/Dementia-Guideline-Recommendations-WEB-version.pdf
- Alzheimer’s Australia Vic. (2015). Annual report: The power of partnerships. https://www.dementia.org.au/sites/default/files/VIC/documents/AAV-2014-15-Annual-Report-FULL-FINANCIALS.pdf