Careforce Homehealth Inc.

This module defines “problem” behaviors commonly seen and provides methods for assessing, preventing and dealing with difficult situations.

Resisting/fighting hands-on caregivers
Wandering and rummaging
Physical restlessness
Eating problems
Sleep disturbances
Disruptive yelling or moaning
Problematic sexual behavior/ disrobing

Causes

There are a variety of reasons that cause patients with Dementia to exhibit “problem” behaviors. Such reasons are outlined below:

  1. Alzheimer’s involves areas of the brain that control emotions and behavior. As a result, many clients exhibit increased volatility and are more prone to have behavior problems associated with aggressive and acting-out behaviors.
  2. The profound confusion caused by Dementia makes it difficult for clients to understand their surroundings and what is going on around them. When people are confused, they are more likely to feel anxious, afraid, suspicious, and/or angry, and they are much more likely to act out and exhibit problem behaviors.
  3. Clients with Dementia often cannot accurately indicate, describe, or otherwise verbalize their pain. They often express their pain indirectly through their emotions and behaviors. Many of the common behaviors exhibited by clients are actually very basic and reflexive responses to pain.
elderly woman with caregiver

Approach

Caregivers should apply the Dementia Care Philosophy when dealing with” problem” behaviors from clients. An outline is presented below:

  • Respect, compassion, and dignity must be upheld. Every person with Dementia is a unique individual and should be treated that way.
  • Caregivers should strive to develop close personal relationships with clients. Knowing the client helps in understanding that person and in anticipating their individual needs.
  • Using a sound Dementia Care Philosophy can diminish problem behaviors. The attitude and approach of the caregiver is critical. Using a “soft,” gentle, comforting approach can improve outcomes.
elderly woman with caregiver

Effective Approaches to Care

Comfort

Minimizing behavioral problems begins with good care. The knowledge, skills, techniques, and approach of the caregiver is significant. Critical to minimizing the occurrence of “problem” behaviors is focusing on the comfort of the patient. Dementia care can be called comfort care. Caregivers should help the person with Dementia to be as physically and emotionally comfortable as possible. Comfort includes the physical, sensory, emotional, environmental, social, and spiritual well-being of the individual.

The sense of confusion experienced by the client makes them more susceptible to physical and emotional discomfort. It may be challenging to assess and effectively enhance the comfort levels of the client since their communication skills are diminished by their Dementia (e.g. they may not be able to say that they are in pain).

  • People with Dementia who are comfortable exhibit less behavior problems:
  • Comfortable people don’t hit
  • Comfortable people don’t yell or scream
  • Comfortable people don’t moan or cry
  • Comfortable people don’t act agitated or distressed

Anticipate Needs

Caregivers should be proactive in addressing the needs of people with Dementia by anticipating their needs ahead of time, especially since people with Dementia may not be able to verbalize their needs. This requires the caregiver to know the client well, including subtle and nonverbal cues they exhibit.

To help clients to feel calm, comfortable and safe: - Ensure that you smile and are warm and friendly to the client.

  • Use pleasant voice tones and a gentle touch.
  • Use slow and calm reactions.
  • Have consistency in the environment - routine activities.
  • If the client gets upset, consider leaving him/her alone for a few minutes, giving them time to calm down before re-approaching.
  • Avoid arguing, correcting, confronting and other negative interactions.
  • Use prompts and cues, rather than challenging or directing the person.

Turning Negatives into Positives

It can be useful to engage the client in personally meaningful activities that draws their attention away from upsetting and distressing situations. Examples include:

  • Offer something to eat or drink.
  • Go for a walk; go outdoors.
  • Talk in a calm, soothing way.
  • Play music; sing a song.
  • Look at pictures.
  • Say a prayer; sing a hymn.
  • Pleasant exercise.
  • Reminiscing.

Below are further proposed strategies to deal with common problem behaviors:

  • Anticipate triggers- people/situations that trigger problem behaviors.
  • Allow and tolerate restlessness. Only use medications if client is uncomfortable or is endangering themselves or others.
  • Allow sleep wherever/whenever they like, no matter what time of day. Use soothing music and soothing touch.
  • Anticipate needs. Check for pain and treat any areas of discomfort (hunger, thirst, clothing, positioning, environment).
  • Push food and fluids. Maintain good bowel/bladder care.
  • Maximize mobility.
  • Preoccupy attention.

Effective Approaches to Care

Introduction

In this unit, you will learn that activities are the foundation of care. Every event, encounter or exchange is an activity. The scope of activities includes everyday interactions with staff, volunteers, relatives and other individuals. In this topic, you will learn how to determine which type of activity is best to suit your client at different times. You will examine activities that are suited to all forms of Alzheimer’s in particular. However these can be used for clients with other forms of dementia.

The activities that make up a client's daily experience should reflect as much as possible that person's preferred individual lifestyle, whilst enabling a sense of usefulness and success at their level of functioning. Alzheimer's disease is a progressive degenerative disease. The person with dementia has difficulty doing, or is unable to do, the things that he/she previously enjoyed doing. Cultivating activities with meaningful interactions for the person with memory loss is part of providing successful experiences.

Activities

The activities listed below are designed as part of the social model of care, or Activity Based Alzheimer’s Care (ABAC), where everything is deemed an activity.

They add variety to the person’s day. These activities promote interaction, encourage creativity, provide exercise and add quality of life to the person with Dementia. They include:

Personal care | Mealtime | Household tasks | Exercise | Social, Spiritual, Intellectual activities | Creative Games | Music | Hobbies

elderly man playing with board games

Benefits

Activities help maintain the independence and physical well-being of patients and enhance the quality of their lives, by providing them with mental stimulation and opportunities to engage in socialization.

The benefits of carrying out activities with patients with Dementia should not be underestimated. They allow carers to structure their time better and they make the best of the client's remaining abilities. They help to reduce undesirable behaviors such as anxiety, agitation and depression and help the patient to feel useful and needed.

Activities enhance sensory awareness and provide sensory calmness. Careworkers should incorporate a variety of activities into the daily routine of their clients.

elderly people at the park

Guidelines

The guidelines for choosing activities involves selecting activities that are interesting and that consider the uniqueness and interests of the person and their environment.

The caregiver will need to be flexible since the client may enjoy an activity one day and reject it the next day. You may never come across one activity that your client loves to do and will repeat countless times.

Part of providing care is about getting to know your client. It is a good idea to keep a diary detailing how they react to specific activities. Ask yourself: was that activity successful; why/why not? Try to find a variety of activities that your clients enjoy and rotate between them to keep the sessions enjoyable.

woman making some notes

Activities at Different Stages

Early Stage

Activities for the early stage of Dementia are used for socialization with caregivers, family and friends. These activities are extensions of the interests of the person and help to maintain their abilities and feelings of selfworth.

Throughout this stage of Dementia, it is important to provide real life activities similar to the background of the client. Try to incorporate household activities such as cooking, cleaning and decorating into the client's routine. Ensure that clients can listen to music, engage in physical activities, play games, express their creativity and are challenged mentally.

elderly couple playing some plants

Middle Stage

Activities for the middle/moderate stage of Dementia are modified to accommodate the current abilities and interests of the client. Clustering is important at this time, where patients of similar interests and abilities are gathered into smaller groups (6-8). However, it is important to avoid over-stimulation.

Try to simplify projects such as crafts, games, art, adaptive sports, in order to suit the client’s interests. Use music to evoke memories and interactions, to exercise to and just to have fun. Supervised arts and crafts such as knitting can be a great way to engage the mind during this stage of development.

woman preparing the food

Late Stage

When patients reach the advanced stage of Dementia, they will more than likely be in an assisted living environment. Advanced Dementia Palliative Care Activities should provide comfort, sensory enhancement and sensory calming activities. Seeing as advanced stage dementia results in death, the goals of advanced stage dementia palliative care should be to make the patient’s time in whatever environment they are as comfortable as possible.

To do so, try to anticipate and meet comfort needs such as hunger and thirst, proper positioning, continence issues, agitation and pain. Provide meaningful interactions with activities that focus on stimulating the resident’s senses (smell, touch, taste, hearing, vision (quality of life)).

Follow the steps outlined below to further create a positive environment for advanced level Dementia patients:

  1. Promote spirituality through the use of music, songs, scriptures and poems (quality of life).
  2. Utilize the resident’s life story to personalize care and interactions (dignity).
  3. Create a warm, homelike environment in each resident’s room and the general nursing unit (milieu).
woman with the female companion

Module 8B Summary

When communicating with a person with Dementia, you should: introduce yourself by name/association; validate responses and feelings verbally; use short simple sentences; ask primarily yes/no questions; allow time for responses; use word cues; try to guess what the person wants. In the early and for part of the middle stage of Dementia, verbal techniques may be used to calm and reassure the person. They allow you to redirect the person and to achieve a more positive interaction with them.

When communicating with a client, the goal is to avoid any situations likely to create anxiety or conflict, as both will cause them stress. Caregivers should be proactive by anticipating the client's needs ahead of time, especially since clients may not be able to verbalize their needs. The activities that make up a client's daily experience should reflect as much as possible that person's preferred individual preferences. They should enable a sense of usefulness and success at as normal a level of functioning as possible. Activities should help to maintain the independence and physical well-being of patients and enhance their quality of life, by providing them with mental stimulation and opportunities to engage in socialization.

The guidelines for choosing activities include selecting activities that are interesting, stimulating and consider the person's individuality and their environment. One person cannot administer care to the person with dementia. It takes a team. Caregivers need to be aware of the types of behaviors they are likely to encounter when working with clients who have Dementia. As a rule, don't intervene when a person with Dementia is exhibiting “problem” behavior, unless that behavior violates the rights of others or poses a risk to health and safety. Critical to minimizing the occurrence of “problem” behaviors, is focusing on the comfort of the client. Dementia care is comfort care. Caregivers should endeavor to make the client as physically and emotionally comfortable as possible.