1. Challenging Behaviors

2. Agitation…  Agitation is used to described diverse symptoms such as:  Irritability  Restlessness  Aggression  Screaming  Rummaging  Disinhibition  Resistance to care  Wandering  * Be specific when reporting concerns.

3. Urgent evaluation may be required in some situations.  Medical Issues  Abnormal Vital Signs  Heart rate 120  Systolic Blood pressure <90  Resp rate > 30  Fever  Other signs of serious underlying condition (i.e. stroke).  Psychiatric Symptoms  Escalating physically aggressive behavior.  Danger to self or others (intermittent or persistent).

4. Plan of Treatment for Problematic Behavior  ASK:  A:AntecedentsWhat are the antecedents?  B:BehaviorWhat is the behavior?  C:ConsequencesWhat are the consequences?

5. Some of the causes of problematic behavior  Untreated Pain  Fear  Frustration  Confusion  Inability to Express needs  Mood disorder  Discomfort  Seeking control  Personal History

6. General Management guidelines for persons with challenging behaviors.  Address pain and discomfort.  Minimize sleep disruption.  Encourage independence.  Provide activities.  Involve the patient differently in his or her care.  Maintain a structured daily routine in calm environment.  Use different approaches to bathing, feeding and other ADLs.

7. Examples Problem: Poor sleep or overnight wandering Cause: Resident may need to void Awakened by noise, light, or staff Daytime naps or sedentary during the day Approach: Scheduled toileting Indirect light Reduce noise Review sleep log/daytime routines Staff education

8. Example Problem: Combative when being bathed Cause: Anxiety/ Misinterpretation the event Cold or hot Modesty Movement of joints may cause pain Approach: Reassurance Flexible bathing method Same sex attendant Pain medication prior to bath

9. Example Problem: Agitated behavior during the day Cause: Pain or depression Environmental overstimulation Reaction to an action by family, other residents or caregivers Approach: Pain assessment Depression screening Observe for non specific signs of pain Monitor for what may be contributing to behavior

10. Example Problem: Inappropriate sexual advances Cause: Exaggeration of previous personality trait Drive for intimacy and love Approach: Separate from people he/she may have targeted Encourage loved ones to show physical affection when appropriate Educate staff regarding management Assign care to staff member unlikely to be targeted

11. Other Interventions: Music therapy Hand massage Aromatherapy Exercise