Managing Challenging Behaviors of Dementia

Share and learn behavioral management skills (non-pharmacological approaches) for preventing and managing challenging behaviors.

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Behavior management is important in the person with dementia in order to maintain safety, improve their abilities to function, and improve the well being of themselves, their families, and their caregivers.

I found a very relevant article by Kohn and Surti (2008) that discusses negative behavior identification, evaluation, differential, and treatment with both pharmacologic and non-pharmacologic regimens.

I found the author's description of "explanatory models" very compelling including:

I just recently read an article called Clinical Considerations in End-Stage Dementia.
I thought this was very well written and discusses polypharmacy management and Geriatric Syndromes.

Check it out:   http://nurse-practitioners-and-physician-assistants.advanceweb.com/Conti...

Caring for patients with dementia can present real challenges to nursing students and novice nurses. One way to build their confidence in working with these patients is to offer them a standard way to approach each patient. The Positive Physical Approach incorporates current knowledge about the neuropsychology of dementia into a package that students and nurses of all levels can readily understand and practice. If practiced consistently, patients respond very positively to the students and nurses, making their experience more rewarding. Steps of Positive Physical Approach Step

 

Look at the links below for information about the VA programs where Oreon and Kendra work.

 

I have also included links to two evidence-based approaches to care for older adults with dementia:

Many of you probably already know that the Centers for Medicare and Medicaid Services have developed a very rich set of training modules on dementia.

If you're like me..you may find the sheer volume of the material a little overwhelming!

Happily for us...our colleagues at the North Carolina Centers for Medical Excellence (CCME)  have reviewed these materials, and prepared a tip sheets that may help.

The tip sheet summarizes:

I found an interesting curriculum that is being used for geriatric patients with dementia. It is called Gentle Persuasive Approaches and it originated in Ontario, Canada. The title of the article is: Moving Forward: Evaluating a Curriculum for Managing Responsive Behaviors in a Geriatric Psychiatry Inpatient Population.

 

I have recently been introduced to Music and Memory programs that have been undertaken in a number of long term care facilities.  The program involves the identification of  individualized play lists or "personalized music" for residents with dementia.   "Henry's story," http://www.youtube.com/watch?v=fyZQf0p73QM piqued my interest to learn more about the program and the evidence to date as to when and how it can be helpful.

I have recently been appointed to a National Advisory Group on development of a Uniform Curriculum on Alzheimer's Disease.

Part of the work involves reviewing an existing set of materials developed by a group in Minnesota called "Act on Alzheimer's"

Note that all of the materials can be used by anyone for free - -you just can't sell them!

Please consider reviewing some of these materials, and giving me your feedback on how you might use them in your own work.

What other content would you like to see developed?

Borbasi and colleagues (2010) write about a new model of NP-led care for people with dementia who exhibit challenging behaviors.  The authors explain how the Dementia Outreach Service, or DEMOS, model can be a cost effective way to help reduce aggressive behaviors among people with dementia living in long-term care facilities.

In order to qualify for DEMOS care the resident must be diagnosed with cognitive impairment/dementia plus at least one of five criteria:

One of the mainstays of care for people with dementia is making certain that their caregivers (both formal and informal) understand the basics of the disease, and how the disease influences behavior.

There are dozens of training programs available for purchase and for free.  It's worthwhile building a resource bank of educational materials you find helpful.

 

My current top 3 favorite sites include:

Note: this resource was provided by the Alzheimer's Association.

Steps to take for a person with dementia

Safety is important for everyone, but the need for a comprehensive safety plan is particularly important for a person with Alzheimer’s as the disease progresses.

Alzheimer’s disease causes a number of changes in the brain and body that may affect safety. Depending on the stage of the disease, these can include:

VA Innovates in Interprofessional Care of Older Adults with Challenging Behaviors

On August 23-24 the Mid-Atlantic Veterans Integrated Service Network (VISN-6) and the Durham Geriatric Research, Education and Clinical Center (GRECC) collaborated to offer a two ½-day workshop on Managing Challenging Behaviors in Older Adults.

En route to finding a video that would showcase, in a realistic manner, the challenges of advanced dementia, I came across this very compelling video and story.

Several years ago the Mid-Atlantic Veterans Integrated Service Network sponsored an interpofessional conference on managing challenging behaviors among Veterans with dementia and serious mental illness.

Here are links to the conference calendar and presentations.

http://coegne.nursing.duke.edu/content/managing-challenging-behaviors-older-adults