When Behavior Challenges: Responding to Behaviors Associated with Cognitive Loss. Objectives

Transcription

1 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss When Behavior hallenges: Responding to Behaviors Associated with ognitive oss by ois K. Evans, DNSc, RN, FAAN Viola MacInnes Professor o-director, Delaware Valley Geriatric Education enter Delaware Valley Geriatric Education enter Objectives With regard to older adults with dementia, direct care staff will be able to: Discuss behavior as a form of communication. Describe the role of cognitive impairment, life story, the environment and current situation in predicting and explaining behaviors. Use a range of assessment strategies to identify the meaning of behavior. Individualize care to older adults with dementia to prevent and respond to behaviors. Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-3

2 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Understanding and Responding to Behaviors in Dementia Delaware Valley Geriatric Education enter Behavior as ommunication A person with dementia communicates unmet needs through behavior Making sense of behavior is critical to meeting the person s needs All behavior is meaningful Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-4

3 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Understanding Behavior Behavior may be understood in the context of: person health status environment, and current situation Delaware Valley Geriatric Education enter Knowing the Person: he Key to Understanding are Patient as a person: life story cultural background past habits & usual behavior preferences & pleasures activities remaining abilities Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-5

4 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Behavioral Assessment: Reframing Reframing the way one perceives behavior is essential to plan individualized interventions Suspend judgment Avoid labeling ollect clues onduct behavioral assessment (use behavioral monitoring log) Delaware Valley Geriatric Education enter Wandering Definition: Moving about in an apparent aimless or disoriented fashion where the goal is either unobtainable as stated by the resident or unclear to the observer Frequency: 1 in 5 ambulatory, cognitively impaired nursing home residents MAY lead to unsafe situations or undue fatigue Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-6

5 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Discovering the Agenda o alleviate loneliness, isolation, boredom o seek safety in familiar surroundings o satisfy physical needs o relieve stress by walking o communicate a change in health status (if new behavior) Delaware Valley Geriatric Education enter Methods for Preventing Unsafe Wandering Behavior Provide safe environments for ambulation or movement Increase opportunities for social contacts Provide environmental stimulation Maintain functional capacity for self-care Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-7

6 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Individualized Responses to Wandering Behavior Attend to personal agenda Provide opportunity for meaningful work Implement protective interventions Make environment homelike Reduce exit cues, use visual barriers Delaware Valley Geriatric Education enter Self-Protective Behavior Sometimes these behaviors are viewed as aggressive or resisting care Definition: Psychomotor behaviors and vocalizations that may be an attempt to communicate and/or fulfill unmet needs for protection of self: A protective response Prevalence: about 50% in (verbal and/or physical) Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-8

7 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Self-Protective Behavior: Summary Pattern: occurs during day & during assistance with ADs/personal care, ESPEIAY BAHING Associated with use of psychoactive drugs/restraints Associated with functional disability and problems with communication Delaware Valley Geriatric Education enter Self-Protective Behavior Some may be related to neurological changes Most can be prevented/reduced Most of the time there is adequate warning, and precipitating factor can be identified Observation and knowing the resident is critical Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-9

8 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Goals for care Meeting the person s needs to: Feel safe Feel in control Feel comfortable Experience optimal stress Experience pleasure and satisfaction Delaware Valley Geriatric Education enter Individualized Strategies in Self-Protective Behavior o prevent/reduce the behavior: Environmental support alm approach ommunication and interpersonal strategies Use of remaining abilities Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-10

9 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Individualized Strategies for Minimizing Self-Protective Behavior When the behavior has already begun Distract/redirect activities Remove trigger Express your own fear, ask for feedback Use supportive stance Back off and re-approach later Do not shout, confront, reason, argue with, touch an already aggressive resident Have a facility/unit plan in place; train staff Delaware Valley Geriatric Education enter SOP Strategy for aregivers S - Slow Down - hink about what is happening O -Options P - Plan to have some time to yourself Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-11

10 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Noisemaking and Repetitive Vocalization (NRV) Definition: Excessively loud utterances, nonsensical sounds, screaming, moaning/groaning, cursing and verbal repetitiveness Prevalence: 25-41% in long term care Delaware Valley Geriatric Education enter ommon haracteristics in Persons with NRV Neurologic-cognitive impairment Sensory deprivation Psychological distress Discomfort/pain, fatigue Psychosis symptoms Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-12

11 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss What may trigger NRV? aregiver behaviors Environmental stimuli Delaware Valley Geriatric Education enter Assessment of NRV Describe the behavior isten to the vocalizations in context and try to understand the message Identify triggers Evaluate physical-mental status Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-13

12 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Interventions for NRV Activities (for the less cognitively impaired) omfort and environmental measures (for persons with advanced dementia) Social interaction Videotape of family members Music Delaware Valley Geriatric Education enter Facility Planning for Prevention of Self-Protective Behavior Example: BAHING ollect more information regarding bathing routines, environments, experiences of residents and caregivers Identify ways to normalize the bathing area and bathing experience: Homelike Incorporate other ways to meet need for cleanliness: owel bath vs. shower or tub Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-14

13 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Delaware Valley Geriatric Education enter Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-15

14 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Delaware Valley Geriatric Education enter Objectives Review With regard to older adults with dementia, can you now: Discuss behavior as a form of communication? Describe the role of cognitive impairment, life story, the environment and current situation in predicting and explaining behaviors? Use a range of assessment strategies to identify the meaning of behavior? Individualize care to older adults with dementia to prevent and respond to behaviors? Delaware Valley Geriatric Education enter for Delaware Valley Geriatric Education enter ab 3-16

15 Module Five: When Behavior hallenges: Responding to Behaviors Associated with ognitive oss Behavior Monitor og Specific Behavior to Document: Resident's Name: Room #: Date Exact time What happened? Where? Who else was around? What could be going on inside resident to cause it? What could be going on outside resident to cause it? What worked to help resident? for Delaware Valley Geriatric Education enter ab 3-17