ALL ABOUT BEHAVIORS 1

The New York Times April 11, 2005

The New York Times October 12, 2006

Objectives: Part One (III) Describe principles of communication Discuss behavior as communication Identify factors  behavioral communication Mass Senior Care Foundation Antipsychotic Initiative

Objectives: Part Two (IV) Recognize non-verbal communication of unmet need Describe common challenging behaviors Describe strategies to address Mass Senior Care Foundation Antipsychotic Initiative

About communication 10% is through words or speech 40% is through the tone of voice 50% is through body language Mass Senior Care Foundation Antipsychotic Initiative

About communication Try to understand Be open-minded Stand in the other’s shoes Mass Senior Care Foundation Antipsychotic Initiative

Communication obstacles Personal problems Emotional state Anger Anxiety Depression Paranoia Sensory deficits Cognitive deficits Hallucinations Thought disorder Mass Senior Care Foundation Antipsychotic Initiative

Communication obstacles Interferences Environmental noise Lack of privacy Lack of perceived power Mass Senior Care Foundation Antipsychotic Initiative

About Behavior All behavior has meaning Attempt to communicate Need or feeling Effect a change Start or stop Mass Senior Care Foundation Antipsychotic Initiative

Practices Staff Resident Family/Larg er community 11 Mass Senior Care Foundation Antipsychotic Initiative

About Behavior "What needs to change?" Environment My behavior or attitude The resident's I-care plan Mass Senior Care Foundation Antipsychotic Initiative

Understanding Behavior What is the communication? What needs to change? Is it a problem? Whose problem is it? Mine Resident’s Administrator Family Regulatory agency Mass Senior Care Foundation Antipsychotic Initiative

Institution-Behavior Relationships Clocks Assignments Restraints Management Mass Senior Care Foundation Antipsychotic Initiative

Your turn Mass Senior Care Foundation Antipsychotic Initiative

Common Behaviors Rummaging, Pillaging, Hoarding Wandering Irritability Delusions Hallucinations Agitation Lack of cooperation Paranoia Socially unaware behavior Aggression Sexual activity Accusatory behavior Anxiety Mass Senior Care Foundation Antipsychotic Initiative

Slides Mass Senior Care Foundation Antipsychotic Initiative

Brain-behavior relationships Right The big picture Visuospatial relationships Self-awareness Creativity Visual memory Mass Senior Care Foundation Antipsychotic Initiative

Brain-Behavior Relationships Left Language Emotional regulation Verbal memory Logic Sequencing Mass Senior Care Foundation Antipsychotic Initiative

Brain-Behavior Relationships Frontal Parietal Occipital Temporal Brain stem Hippocampus Amygdala Mass Senior Care Foundation Antipsychotic Initiative

*Frontal lobe = Chief Executive Initiation Self-monitoring Inhibition Judgment Mass Senior Care Foundation Antipsychotic Initiative

Temporal Lobe Memory Understanding language Organizing and sequencing Hearing Mass Senior Care Foundation Antipsychotic Initiative

Parietal Lobe Orientation Getting lost Apraxia Mass Senior Care Foundation Antipsychotic Initiative

Hippocampus Memory Amnesia Mass Senior Care Foundation Antipsychotic Initiative

*Amygdala Regulates emotions Fear Anger Apathy Paranoia Outbursts Mass Senior Care Foundation Antipsychotic Initiative

MODULE III Unmet Needs Building Observation Skills 26

Importance of language Mass Senior Care Foundation Antipsychotic Initiative

Agitation Slapping thighs Clapping Yelling Screaming Self-referred Something is wrong with me Do something! Mass Senior Care Foundation Antipsychotic Initiative

Aggression Hitting out Kicking Pinching Biting Threatening Swearing Other referred Something is wrong with you STOP! Leave me alone Mass Senior Care Foundation Antipsychotic Initiative

Agitation Aggression Dementia Delirium Stroke Developmental disability Brain injury Agitated depression Dementia Delirium Stroke Paranoia Developmental disability Brain injury Intoxication Delusions of persecution Mass Senior Care Foundation Antipsychotic Initiative

Agitation and Aggression Common causes Noisy environment Pain Constipation Discomfort Infection Drugs Hearing loss Boredom (agitation) Loneliness (agitation) Abrupt, tense or impatient staff (aggression) Frustration(aggression) Mass Senior Care Foundation Antipsychotic Initiative

Aggression FEAR Mass Senior Care Foundation Antipsychotic Initiative

Summary Behavior is communication Understanding guides intervention Goal is prevention Easier to change ourselves than others Mass Senior Care Foundation Antipsychotic Initiative

What do you see? Mass Senior Care Foundation Antipsychotic Initiative

What happened Scenario One Scenario Two Disinterest No eye contact Busy Frustration (  Anxiety) Threat Touch Respect Eye contact Full attention Comfort Accompanies Help to look Introduces pleasant event

Repetitive Questions What happens?