Gerontology 130
Working with the Frail Elderly
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Gerontology 130 |
UNIT 6Coping with Behavioral Changes |
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Managing difficult behaviors requires that the caregiver be patient, creative, flexible, and forgiving. Perhaps the traits that help caregivers cope the most, is the ability to not take things personally and whenever feasible, to see the humor in all situations. Key to managing difficult behaviors is understanding that what works today, may not work tomorrow. As the disease progresses, solutions to previous problems may no longer work or may need to be adjusted. Difficult behaviors can include mood disorders, delusions or hallucinations, anxiety, resistance to bathing, insomnia, apathy and agitation, as well as wandering.
Although proper communication techniques can assist in handling difficult behaviors, there are other interventions that may be necessary as the dementia progresses. These interventions may include:
In the early stages in particular, individuals can be very combative and can to all outward appearances act and seem "normal". Families who notice slight changes in memory or behavior will often deny there is a problem; and may let the person live alone even when it is not safe to do so. In the early stages individuals may insist on driving or insist that they have taken a bath, when in reality they become lost when they drive or it has been a month since he/she has bathed. Disabling the car, exchanging car keys that do not fit into the ignition, and having a physician indicate that the person is no longer able to drive are all practical solutions. A person who resists bathing, may need a written reminder. Asking a person if they have bathed will often not be a solution, since the person with dementia cannot remember if they have bathed. The caregiver must take a gentle lead, and can fill the bathtub with warm water before the person gets into the bath. Purchasing a hand-held shower apparatus and sitting in the bath tub, can be less frightening then standing in a shower stall and gives the person with dementia a sense of control.
As dementia progresses, some people may suffer from mood disorders, depression, or anxiety. Other clients suffer from hallucinations or delusions. Still other individuals wander or become restless as the sun sets; commonly known as "sun-downers" syndrome. Most experts agree the way to cope with behavioral problems is to first try to analyze what might have triggered the behavior and then to change the environment in order to meet the person's need. One way to analyze what occurs is to use the "ABC" model of behavior analysis. (Mahoney, Volicer, Hurley, p. 142-143). This includes identifying the:
Excessive wandering for instance, may be triggered by a jacket or purse, indicating that it is "time to go to work". The consequence of that behavior might be anxiety or excessive worrying or wandering. Perhaps the person is wandering because they had a busy life-style and they may be bored at home. Keeping the individual involved in activities such as an appropriate level of exercise might help to alleviate the behavior. Another person may be triggered into wandering because they see the doorknob and are ready to leave. One way to prevent the person from wandering is to disguise the locks and distract his/her attention. If this does not work, enrolling a person in an adult day care setting that is locked and safe and allows the person to walk provides an outlet for anxiety and wandering.
Troubling behaviors cannot always be managed through activity planning or environmental changes. There are times when medications are appropriate. This is especially important if the individual is hallucinating, or extremely aggressive. Caregivers are often times reluctant to encourage their loved one to take medications for fear of making him/her groggy, sleepy, or listless. A proper level of medication can not only help to assure the safety of the caregiver but can provide peace of mind to those suffering from dementia as well. Medications for behavior management should be used when other strategies do not work.
Reference: Challenging Behaviors In Dementia (2000) Mahoney, Ellen; Volicer, Ladislav; Hurley, Ann. Health Professions Press, Baltimore, MD.
pp. 47-93 and 125-215, Management of Challenging Behaviors In Dementia (2000) Mahoney, Ellen; Volicer, Ladislav; Hurley, Ann. Health Professions Press, Baltimore, MD.
Review "Coping with Behavioral Problems" as told by Donna Coombe.
Donna Coombe is known as the "Sandwich" generation. She is sandwiched between taking care of her teenaged son as well as her father-in-law, step-parents, and biological parents. Her father-in-law initially lived within their home; however, his dementia disrupted the family dynamics, and progressed to the point that they were no longer able to care for him.
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Overcoming Difficult Behaviors · Transcript |
Opportunity for Reflection: Post 2 strategies that help individuals cope with difficult behavior on the WebBoard under Unit 6 Behavior.
At one point Donna Coombe indicates, "I am not a very manipulative person, but I learned how to be."
List at least two specific strategies that Donna Coombe implemented in order to help her cope with the fact that her father-in-law was not willing to bathe or change his clothes.
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