Why Focus on Behavioral Expressions?

Behavioral symptoms generate more harmful consequences to patients and families than symptoms attributable to memory loss from cognitive decline”       — Professor Laura Gitlin

Behavioral expressions are considered to diminish the quality of life of people living with dementia (Samus et al., 2005). Specifically, these behaviors threaten the psychological and physical well-being of these individuals (Meghan et al., 2006). The impacts of these behavioral expressions on people experiencing them include more rapid progression of dementia, exacerbation of functional and cognitive deficits (Profenno & Tariot, 2004), mental health suffering, physical injuries, use of physical restraints, use of psychotropic medications (Lyketsos et al., 1999; Finkel, 1996) as well as increased dissatisfaction among other residents in long-term care homes (Maslow, 1994). Moreover, the behavioral expressions create difficulties in caring for residents with dementia and can place an enormous strain on formal direct care partners (Algase et al., 1997; Merrian et al., 1988). In fact, attempts to prevent behavioral expressions is often more distressing for care partners of people with dementia than addressing cognitive and functional deficits (Volicer, Hurley, & Blasi, 2003). Furthermore, behavioral expressions contribute significantly to health care costs (O’Brien, Shompe, and Caro, 2000) as well as to high costs due to increased use of psychotropic medications, hospitalizations, and emergency department visits (Finkel, 2000; Gedda & Rummans, 1999).

  • The term “Behavioral Expressions” was suggested by the National Dementia Initiative in a White Paper called Dementia Care: The Quality Chasm (2013).

Other person-directed terms that should be considered include “Expressive Behaviors” (Dr. Allen Power), “Reactive Behaviors” (Dr. Paul Raia), and “Responsive Behaviors” (Lisa Loiselle).

For the rationale for using these terms, see my letter to the editor of JAMDA:

Caspi, E. (2013). Time for change: Persons with dementia and “behavioral expressions,” not “behavior symptoms.” Journal of the American Medical Directors Association, 14(10), 768-769.