1 Understanding Challenging Behaviors Module 18 Geriatric Aide Curriculum NC Division of Health Service Regulation

2 Understanding Challenging Behaviors Objectives 1.Discuss key points and fundamental concepts in assisting older adults. 2. Recognize the 4 categories of triggers for challenging behaviors. 3.Develop an understanding of possible triggers. 4. Learn and implement problem-solving steps.

3 Understanding Challenging Behaviors Objectives 5.Recognize factors that associate ADLs with risky behaviors 6.Identify steps in knowing when to help a resident 7.Identify 3 ways to help a resident 8.Develop coping strategies for paranoid, suspicious and agitated behavior

4 Key Points in Assisting Older Adults Show respect and maintain resident’s dignity Maximize resident’s independence Encourage resident’s sense of control over own life Cultivate a good, day-to-day relationship

5 Fundamental Concepts in Assisting Older Adults Learned helplessness Powerlessness and loss of control –Death of a loved one –Loss of income –Loss of control over one’s body –Loss of independence

6 What Staff Can Do Sit down with the resident Ask the resident what is going on Acknowledge the resident’s frustration or irritation Resolve the problem together Establish a trusting relationship

7 Points to Remember Recognize factors that influence behavior Empathize with the resident’s feelings/needs Support losses and needs Prevent escalation by learning early signs Enhance resident’s involvement in self care Care about the resident’s needs & preferences Take time to interact with the resident

8 Perspective on Behaviors Behaviors that “Rub you the wrong way” Behaviors that put someone at risk

9 Stages of Working With Challenging Behaviors Novice –Behavior is deliberate Intermediate –Understand difference between risky and not risky Skilled –Accept, understand and adopt coping strategies

10 Triggers of Challenging Behaviors Related to physical and emotional health Related to the environment Related to task Related to communication

11 Triggers Related to Physical and Emotional Health Effects of medications Impaired vision or hearing Acute illness Chronic illness Dehydration Constipation Depression Physical discomfort

12 Triggers Related to the Environment Environment too large Too much clutter Excessive stimulation No orientation “cues” Poor sensory environment Unstructured environment Unfamiliar environment

13 Triggers Related to Task Task too complicated Too many steps Task not modified for increasing impairments Task unfamiliar

14 When Doing a Task Together Focus on familiar skills and tasks Give choices whenever possible Allow plenty of time for information to be processed Repeat instructions exactly the same way

15 When Doing a Task Together Break task into simple steps Modify steps as needed Sincere praise for success

16 Triggers Related to Communication Arguing with resident Ordering the resident Telling resident what he/she cannot do Sounding condescending Asking numerous questions Talking about resident in presence of the resident

17 Using Good Communication Skills Your approach –How you present yourself –Be calm, gentle, matter-of-fact –Be non-demanding, try humor –Begin your conversation socially

18 Things to Think About When Speaking Talk in area free of distractions Begin with orienting information Look directly at the resident Be at the resident’s eye level Speak slowly and clearly

19 Things to Think About When Speaking Use short, simple sentences Ask simple questions Use concrete terms, familiar words Keep tone of voice warm, pleasant Keep pitch of voice low

20 Problem Solving Keep a record describing the situation Review four categories of possible triggers Develop a list of strategies Try a strategy Reassure the resident

21 ADLs and Risky Behaviors

22 Factors Associated with ADLs and Risky Behaviors Cognitive –Identification –Sequencing Motor –Use of tools –Muscle coordination –Coordination of other functions –Initiation

23 Factors Associated with ADLs and Risky Behaviors Sensory –Hypersensitive to touch –Doesn’t feel right Emotional –Loss of control, independence –“Save face” –Invasion of personal space

24 The ART and SCIENCE of Helping The ART of knowing when to help The SCIENCE of knowing how to help

25 Knowing When to Help What’s happened in the past? What’s happening today? What do you expect to happen next?

26 What’s Happened in the Past? Know resident’s baseline ability –Abilities and needs –Level of cognitive loss

27 What’s Happening Today? Physical cues Verbal cues Emotional cues What you know

28 What Do You Expect to Happen Next? Anticipate and prepare Understand predicted disease progression Note how resident performs task Familiarize resident with equipment and types of assistive touch

29 Knowing How to Help Visual cues: –Facial expressions, signs, labels, pictures, gestures Verbal cues: –Preferred name, short & simple phrases, simple choices Tactile cues: –Handshake, hand holding, hand under hand

30 Putting It All Together Positive Physical Approach Resident’s level of ability Kind of help to use Monitor for response Pay attention to emotions

31 Paranoia and Suspiciousness Paranoia: An exaggerated distrust of others that is not based on fact. Suspiciousness: A state of being “worried or upset" about things in general and quite cautious.

32 Conditions Involving Paranoia, Suspiciousness, Delusions and/or Hallucinations Alzheimer’s disease Infections Medication Interactions Psychotic disorder

33 What Staff Can Do Helping Residents Who Accuse Others: Identify the problem –Take accusations seriously –Let resident know you care –Consider resident’s history or diagnosis –Watch resident in interactions with others

34 What Staff Can Do Helping Residents Who Accuse Others: Identify the problem (continued) –Notice if resident stops eating, becomes withdrawn –Listen and gather as much information as possible –Do not argue with the resident

35 What Staff Can Do Helping Residents Who Accuse Others: Use caring communication techniques –Don’t take the accusation personally –Show positive regard for the resident –Talk with colleagues, supervisor –Maintain perspective

36 What Staff Can Do Helping Residents Who Accuse Others: Use caring communication techniques –Use statements conveying helpfulness –Try to keep resident and others safe –Recognize that you are doing a good job

37 Angry, Agitated or Combative Behavior Physical or medical causes –Fatigue –Pain –Physical changes in brain –Medication side effects –Impaired vision, hearing –Hallucinations

38 Angry, Agitated or Combative Behavior Environmental causes –Sensory overload –Feeling lost, insecure, forgotten –Unfamiliar place, people, sounds –Lighting changes

39 Other Possible Triggers Response to caregiver’s impatience Resident scolded, contradicted, confronted Surprised by physical contact Change in schedule/routine Difficulty with simple tasks Activity perceived as childlike

40 What Staff Can Do Talk with nurse Simplify, simplify, simplify Be on the lookout for frustration Guide away from stressful situation Provide quiet times

41 What Staff Can Do Perform ADLs when resident is rested Check comfort of resident Avoid teaching Use distraction Make sure resident is comfortable Provide a consistent routine

42 What Staff Can Do Communicate directly with resident Share approaches with others Be aware of effects of shift changes Don’t take aggression personally Decrease your level of danger

43 Physical Safety Stand out of reach of the resident Leave the scene to prevent injury Call for help

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