Understanding The GPEP Model Geropsychiatric Education Program (GPEP) Vancouver Coastal Health

Learning Objectives Identify four types of influences on behaviours: Identify four types of influences on behaviours: Psychiatric Psychiatric Physiological Physiological Psychosocial Psychosocial Environmental: social, physical environment Environmental: social, physical environment Discuss the GPEP Model as a tool for understanding behaviour and planning individualized care Discuss the GPEP Model as a tool for understanding behaviour and planning individualized care

Psychiatric Influences on Behaviour

Psychiatric Influences Dementia Dementia Depression Depression Delirium Delirium Other: Other: Schizophrenia Schizophrenia Bipolar Disorder Bipolar Disorder Personality disorder Personality disorder Obsessive Compulsive Disorder Obsessive Compulsive Disorder

Physical Influences on Behaviour

1. Aging: A Universal Process Affects everyone Affects everyone Occurs in every Occurs in every system of our body Individual – no fixed Individual – no fixed pattern pattern

2. Physical Illnesses and Behaviour Arthritis Diabetes Parkinson’s Disease Chronic Obstructive Pulmonary Disease Emphysema High Blood Pressure Visual disturbance….

Normal Cataracts

Normal Diabetic Retinopathy

Normal Glaucoma

Normal Macular Degeneration

3. Medications and Side Effects All medications have All medications have possible side-effects possible side-effects Your role: Your role: to notice if there is a sudden change in behaviour to notice if there is a sudden change in behaviour REMEMBER: role of medications in delirium REMEMBER: role of medications in delirium

4. Pain What percentage of elders in the community have significant pain? What percentage of elders in the community have significant pain? a. 10 – 25 % b. 45 – 60 % c. 70 – 85%

Why Elders May Not Report Pain Fear of being called a complainer Think no one would listen Think pain is a normal part of aging Cannot tell you because of dementia Fear of consequences May express pain differently

Psycho-Social Influences on Behaviour Who is this Person?

Psychosocial Influences Personal routines Personal routines Early life events Early life events Life roles/work history Life roles/work history Important relationships Important relationships Coping strategies Coping strategies Culture Culture Spiritual values/beliefs Spiritual values/beliefs Personality style… Personality style…

The Physical Environment’s Influence on Behaviour

How does the Physical Environment affect behaviour? Level of stimulation Private space Lighting / Glare Room temperature Signs & labels Poor colour contrast Safety concerns

The Social Environment’s Influence on Behaviour How OUR communication and approach affects the client/resident

Parts of OUR Communication Only 7-10% of our message is found in our WORDS Only 7-10% of our message is found in our WORDS Verbal communication – the actual words we say… Verbal communication – the actual words we say…

Parts of OUR Communication But…90% of our message is found in our NON-VERBALS But…90% of our message is found in our NON-VERBALS Non-verbal communication – how we say what we say: Non-verbal communication – how we say what we say: Tone Tone Volume Volume Body language… Body language…

Do WE have Good Listening Skills: Not interrupting Not interrupting Being non-judgmental Being non-judgmental Validating Validating Allowing for silence Allowing for silence Using supportive body language Using supportive body language Are we paying attention… Are we paying attention…

Understanding Responsive Behaviours

What is a Behaviour? Something someone is doing that you can see or hear Something someone is doing that you can see or hear Descriptive Descriptive Specific Specific Non-judgmental / not labeling Non-judgmental / not labeling

Understanding Behaviours Refusal, agitation, and aggression always has a cause/trigger: Refusal, agitation, and aggression always has a cause/trigger: Protecting oneself Protecting oneself Unmet needs Unmet needs Broken brain Broken brain When cognition and communication are impaired it is the way in which people with dementia tell us that something is wrong When cognition and communication are impaired it is the way in which people with dementia tell us that something is wrong Very often starts with anxiety Very often starts with anxiety Has a pattern Has a pattern

Tools to Describe Behaviours: 1. Identify the behaviour: Identification of Behaviours and Guidelines for Intervention* Identification of Behaviours and Guidelines for Intervention* 2. Document the Behaviour: Behaviour Pattern Record* Behaviour Pattern Record* 3. Care Planning: Behaviour Assessment Tool (BAT) Behaviour Assessment Tool (BAT) * Cohen-Mansfield, 2004

Tool to help with describing behaviour and classify types of behaviour IDENTIFICATION OF BEHAVIOURS & GUIDELINES FOR INTERVENTIONS Cohen-Mansfield

Behaviour Pattern Record

Care Strategies

Goals of Care Strategies The resident will: feel safe feel physically comfortable experience a sense of control experience optimal stress experience meaning and pleasure