DEMENTIA AND MANAGING BEHAVIORS

DEMENTIA AND MANAGING BEHAVIORS

Dementia is a general term that describes a group of similar symptoms caused by temporary or permanent damage to the brain or neurons. Memory loss Judgment Language Complex motor skills Impaired cognition

Reversible Dementias Irreversible Dementias Drug/Alcohol Interactions Thyroid Disease Tumors Malnutrition/Dehydration Infections Anemia Hypoglycemia Hypoxia NP Hydrocephalus Mental Illness Alzheimer s Disease Vascular (i.e. CVA) Lewy Body Parkinson s Disease FrontoTemporal Huntington s Disease Multiple Sclerosis TBI s Creutzfeldt-Jacob Disease AIDS Related

Confusion Anxiety Fear Loss of Control Irritability Delusions Hallucinations Depression REMEMBER..Just because a person with dementia can t remember things or effectively communicate needs, they still have emotions and feelings.

Individualized care is crucial for a person with dementia. Individualized care creates a consistent and safe environment. Today s dementia care is based around providing the individual with support and validation, not orientation to reality. There s no point in getting upset or getting the individual upset. Always meet people where they are to avoid behavioral escalation.

Body Position: Let s start with the basics! Position yourself at the same level. Bend or sit down. Do NOT stand or hover over a person. It is intimidating and scary. Puts you in a position of power over them. They can t focus on you and what you are saying if they are focused on fear or distraction.

Eye Contact Approach face-to-face. Make EYE CONTACT. Use the person s name. It is vital that they actually see you. Keep their attention focused on you. Always approach from the front. Approaching and speaking from the side or from behind can startle people with dementia.

Practical Approaches to Managing Dementia Behaviors Explain what you are going to do: Always allow extra time for processing. Explain what you are doing as you are doing it. Ex. I am going to take your blood pressure now. Dementia patients often exhibit paranoia. made worse in seemingly unsure/unsafe situations Remain calm and focused.

Speak In Simple Short Sentences Speak in short, direct sentences with only one idea to a sentence. It s best to focus on only one idea at a time.

Practical Approaches to Managing Dementia Behaviors Speak Calmly and Slowly Always speak in a calm manner with an upbeat tone of voice Even if you don t feel that way. People with dementia cannot process words as quickly as other people. Give them a chance to catch up to your words. Take a breath between each sentence. If you sound angry or agitated, they will often mirror that feeling back to you.

Practical Approaches to Managing Dementia Behaviors Avoid phrases likes Remember or I told you that already. Turn negatives into positives: For example- Let s go here instead of Don t go there. Always speak with respect and don t appear as if you are speaking down to a person with dementia.

Never argue with a person with dementia. Instead, validate feelings with phrases like I see that you are angry (sad, upset ). Let the person know they are not alone, then redirect to another thought. It sounds like you miss your mother. You must love her very much. Tell me about that time Then ask for one of their favorite stories about that person.

People with dementia need to rely on others to help communicate their needs. Every smile, frown, touch, tone or shoulder shrug means something. People with dementia can best process singlestep directions. Multi-faceted directions will often cause them to be come upset or frustrated. If the person becomes overly confused or frustrated, just come back to the task/item later on. Always look for non verbal cues as well.

Disinterested: Wandering/looking away Changing a subject Blankly staring at you Eating cake with a knife Pouring juice in their soup A Need to Keep Busy: Removing items from closet Stealing items Bringing things to you Moving things around Frowning: Dislike Frustrated Anxious Bathroom needs Pain Smiling: Happiness Security Comfort Trust

PHYSICAL BEHAVIORS Examples: Breaking things Biting Spitting Fighting Pushing Poor Impulse Control Throwing things Attacking Others

MANAGING PHYSICAL BEHAVIORS Listen to what the person is saying Eliminate or decrease stressful triggers Loud noises, television, clutter, crowded spaces, etc Reduce caffeine, sugar, junk food intake Ensure medication is given timely and appropriately Do not over stimulate Redirect to an enjoyable activity Direct to a familiar place (room with pictures of family) Offer to take a walk with the person STAY CALM DO NOT GET ANGRY Ask for help if needed.

MANAGING PHYSICAL BEHAVIORS Remember: Most behaviors have a trigger and do not just randomly occur: Be creative in how you manage behavior by really knowing and understanding your patients. What works today may NOT work tomorrow! Maintain a sense of humor and always keep calm. We cannot change the person but we can accommodate the situation: Ex. If the person insists on sleeping on the floor, ensure a safe and suitable arrangement for them.

MANAGING VERBAL BEHAVIORS Examples: Swearing Cursing Racial Slurs Screaming Yelling Threatening Arguing Management Stay Calm Do not raise your voice Redirect the person Take away from triggers Provide a safe activity Take the person for walk

WANDERING- WHY?? A new environment Escaping a noisy or busy place Loss of STM Forgetting where they were going Excess energy OR boredom Not enough/too much stimulation Searching for the past Lost items, lost family members Confusing night and day Long time habit Maybe person was a walker or a runner Agitation, discomfort, pain

MANAGING WANDERING Wandering is VERY common for people with dementia Regular assessment for pain and discomfort Assess medication effects and/or side effects Decrease causes for drowsiness Promote regular toileting Patient identifiers (bracelets, etc) Specialized environments for safety (locked units)

MANAGING WANDERING- TIPS Keep a log to determine any pattern or explanation for the wandering. Reduce objects that encourage wandering: Jackets Hats Umbrellas Purses/Handbags Relocate door locks and place alarms on doors (if allowable).

SUNDOWNER S SYNDROME Sundowner s Syndrome is the name given to the exacerbation of the typical symptoms of confusion and behaviors for an individual with dementia, which usually occur after sundown (late afternoon to early evening). Most often seen in Alzheimer's patients There is no concrete proof as to why sun downing occurs but there are some strong ideas.

POSSIBLE CAUSES FOR SUN DOWNING Hormonal imbalances Fatigue Anxiety of darkness A disturbed cardiac rhythm Medication imbalances Under stimulation during daytime hours Symptoms tend to be worse in winter seasonal affective disorder? Accumulation of sensory stimulation during the day.

MANAGING SUNDOWNER S Establish a daily routine with physical activity Control noise Use night lights Reduce fluid intake 2 hours before bed Ensure ample rest/monitor daytime napping Reduce stress Medication Supplements that help regulate sleep Melatonin, Vitamin E, Ginkgo Biloba Medications are NOT always the answer!

DON T DO THIS ARGUE REASON SHAME LECTURE SAY REMEMBER SAY I TOLD YOU SAY YOU CAN T COMMAND/DEMAND CONDECEND FORCE DO THIS INSTEAD AGREE DIVERT DISTRACT REASSURE REMINISCE REPEAT/REGROUP DO WHAT THEY CAN ASK/MODEL ENCOURAGE/PRAISE REINFORCE

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