1. BEHAVIOR MANAGEMENT

2. BEHAVIOR MANAGEMENT QUIZ
I. Residents who display moderate levels of dementia, will respond better when you present them with commands.
A demented resident often uses in place of talking if they are not able to express their needs.
It is important to get a resident's attention prior to engaging in any activity so they are aware of you. T I F
Discussing the resident with families produces two positive outcomes: 1. 2.
You must always give reality orientation to your demented residents T I F
Behavior monitoring is used to look for patterns in behavior. Two of the patterns we look for is and.
7. When dealing with an aggressive resident it is not a good idea to _
8. The five things to check for when resident is displaying agitated behavior 3. 4. 5.
The very first thing you should do when a resident shows sudden onset of agitated behavior is order psych meds. T I F if not, what is the first thing you should do? _
I 0. When resident is acting out in agitated manner, the most important thing for you to do is

3. OUTLINE FOR BEHAVIOR MANAGEMENT INSERVICE
GOOD NEWS/BAD NEWS
THE PROGRESSION OF DEMENTIA/ THE 4 A'S
HOW BEHAVIOR REPLACES VERBALIZATION
THE 5 POINT CHECK LIST
TALKING TO FAMILIES
USING YOUR IMAGINATION
YOUR APPROACH AND HOW YOU CAN PREVENT BEHAVIOR
MAKING BATHING A WIN-WIN SITUATION
DOCUMENTING
BEHAVIOR MONITORING
OUTLINE FOR BEHAVIOR MANAGEMENT INSERVICE

4. THE FOUR A'S OF ALZHEIMER'S DEMENTIA
The behaviors presented through the Four A's can at first, appear very confusing to us.
But once we understand what is happening in our loved one's brain that is causing these behaviors, we can begin to track and stage the disease process.
For most persons with any type of dementia, these are the order in which the A's will present themselves.
Amnesia
Aphasia
Agnosia
Apraxia

5. Quick Facts
1 in 10 over 65 have Alzheimer's Dementia and nearly half over 85 have AD
A person can live 3-20 years from onset of symptoms and at some time will require 24 hour care
Decline in ADL Abilities, impaired judgement, loss of language/communication skills, changes in mood and personality, anhedonia, hallucinations and delusions.

6. More about dementia
Remember, THIS IS A DISEASE. The problematic behaviors you are encountering are done purposefully.
It is usually when these behaviors begin that families decide they can no longer care for their loved ones.
We can eliminate much of the acting out behavior by making simple changes in OUR BEHAVIOR and the environment.

7. More ...
My purpose here is to teach you what triggers those unexpected problem behaviors and how to change the patient's routine to prevent them.

8. FATIGUE
People with brain disease tire very easily, because they have to concentrate so hard all the time. Try the following suggestions to prevent fatigue:
Give resident a rest period, either nap or quiet time
IF RESIDENT IS WAKING AT NIGHT DO NOT KEEP THEM UP ALL DAY. Forcing them to stay up all day can make the night waking worse and trigger behavior issues

9. FATIGUE
Get to know patient's best time of day. Use that time for baths, dentist, an things you need to do with the patient.
Allow for short activities. It is not a good idea to have these residents engage in complicated tasks.

10. CHANGE Have a routine for resident to follow in the day.
It is in the best interest of the resident to have surroundings stay the same, try to avoid room changes, activity changes, staff changes.
When decorating for the holidays it is best not to change the residents area too much. This may cause further confusion and frustration.

11. OVERWHELMING AND MISLEADING STIMULI
People with memory problems suffer the ass of ability to interpret what they see and hear properly.
Sensory perception may be distorted.
Crowded and loud rooms can be agitating.
If the resident begins complaining about people in their room who are not present, try turning of the TV, closing drapes, etc.

12. MISLEADING STIMULI ...
Understand the resident’s brain is ''playing tricks on them.'‘
Residents need to be reassured that:
They are SAFE
You have taken care of the problem
You understand that they are concerned and upset

13. LOSS OF MEANINGFUL ACTIVITY
Activities define who we are. When a resident is no longer able to engage in activities (work, drive, hobbies, etc.), depression and anxiety occur.
Have activity personnel ensure resident participates in some kind of replacement activity
Provide social and meaningful activity for the resident

14. LOSS OF MEANINGFUL ACTIVITY
If resident becomes angry or denies memory loss, do not press him/her to admit there is an issue:
anger and denial are all part of the grieving process when you experience loss.
Pet visits, gardening even in pots, and musical activities often provide a high degree of satisfaction.
Regular exercise, walking groups, ball toss, etc. will help maintain a positive mood.

15. CREATING TOO MUCH OF A DEMAND
DO NOT CORRECT PEOPLE WITH MEMORY PROBLEMS
Give tasks or instructions ONE step at a time.
Accept the patient's changing ability each day and hour, as the best the person can do right now.
If the resident becomes upset, try to distract rather than confront.
If that does not work, and the resident is safe, then walk away.
If the resident refuses a bath, has an outburst, leave for a while. They will likely forget, try again later

16. ILLNESS
If the resident is not feeling well, has pain, medication reaction, cold or infection, this can cause increased confusion and agitation.
Encourage fluids, and bed rest.
Ensure resident has lots of snacks if they are not eating well at this time

17. PERSONAL CARE
Many older adults become afraid of bathwater - noise, feeling cold, etc. are very scary. Our suggestions:
Remind resident of special occasion they must be clean for
Allow resident some choice ''now or after lunch?”
Know that patient's ''best time of day''

18. PERSONAL CARE
Associate patient event with care, i.e. chocolate, soothing music
Try not to have shower spray on resident's face
Use reward system, ''you really need to take a bath. When we are done, you can have a pop, cigarette, etc.

19. MADE-UP STORIES, REPEATED QUESTIONS, ETC
One of the most frustrating effects of memory loss is confabulation.
Do not argue as long as safety is not compromised.
You may need to talk with families when in doubt of facts.
Resident asks repeated questions because they,
have a poor sense of time
Are concerned about something else

20. VERBAL AGRESSION
Care should be taken to defuse verbal aggression before it escalates.
Most often, you will need to suspend your notion of what is right and wrong, the object is to diffuse the situation
ACTIVELY listen!
AGREEING – you do not have to give in, but you can acknowledge their feelings and put yourself in their position.
You can at least see their point of view

21. “I am sorry you think that” “It must be hard for you to deal with all of this. I am only trying to help you. How can I make it better?”
APOLOGIZING - you have not done anything wrong, and you should not have to apologize, BUT you are defusing an argument … You cannot argue with a person who is apologizing

22. “I do not know anything about this, tell me more
“I do not know anything about this, tell me more ...” “How could this have happened?”
PLAYING DUMB

23. PHYSICAL AGRESSION
When resident is aggressive, it is not time to get them dressed, insist on shower, etc.
Step back ... Suspend care until the crisis is over. Give your resident some time.
Use care in body language.
Always approach from the front
Don not clench fists
Do not stand with hands crossed or on your hips
Go down to the resident’s level but do not insist on eye contact

24. MORE PHYSICAL AGRESSION
If you need to speak, speak with a low, soft voice with clear directions. ''Give me the cane." ''Let me help you put the walker down.'‘
Walk away, leaving resident in a quite area, alone preferably (as long as you can ensure safety)
If there is a staff person who has a good rapport with the resident, enlist their help.
Ensure the safety of other residents.

25. My 2 Cents: DOCUMENT!
We can not extend our liability around the medications we use - all of which have significant side effects, to treat behaviors when they are not reported.
Be specific and concise. We don't need a long paragraph on a lengthy description, but we do need:
What happened before the incident. What took place that concerned you in short detail.
The nature of any physical or verbal aggression.
What you did to try to defuse the situation .
Whether or not it worked.

26. And .... Report the event to your supervisor/nurse, etc.
He/she will then report the concern to the Social Work department who in turn will alert Psychiatry to assess the resident the next time we round