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Carers'
Corner |
Behavioral
Management in Persons with Dementia
A
number of behavior problems often accompany dementia. The severity of
the problems may differ from person to person and at different stages
of dementia, causing embarrassment and trouble to caregivers. A careful
and comprehensive evaluation of all possible contributing factors of the
behavioral problems will help the caregivers to manage these problems
more effectively.
Behavior analysis
Caregivers
can try to also see from the patient's perspective to analyze the reasons
for the behavior, and then assess the situation, set the goals and objectives,
and identify workable measures. For frequently occurring behavior, it
is helpful to record the behaviors, e.g. the intensity, frequency and
type of behaviors, so as to determine the ways to deal with the behavioral
problems.
Antecedent
: triggering factors for the behavior, including environment, person,
time, emotion and activities
Behavior : targeted behavior e.g. wandering and incontinence
Consequence : situation resulting from the behavior e.g. its effects on
others and its consequences for the person with dementia
Caregivers
need to accept the fact that the behavior is caused by the disease, and
that the person with dementia often cannot control the behavior. Caregivers
should be patient and caring and to encourage appropriate behavior. Successful
management of challenging behaviors in dementia is critical to the well-being
of older adults with dementia and their caregivers.
- Undesirable
or inappropriate behaviors are often reflection of the person's emotion,
intentions or expressive desires. They may be due to the following factors:
(a)
Factors related to environment
-
Environmental
influences, e.g. loud noise and excessive stimuli from the environment
may cause anxiety.
-
Large space, unfamiliar or new environment, may cause confusion and
anxiety.
(b)
Factors related to physical and emotional health
-
Persons
with dementia have difficulty in expressing physical discomfort, which
may induce emotional disturbance and agitation.
-
Drugs
can cause confusion and physical discomfort.
-
Symptoms
related to impaired vision or hearing may cause confusion.
-
Cognitive
decline may cause spatial disorientation of time, place and person.
(c)
Factors related to communication
- People
with dementia may have difficulty in receiving and understanding the
message during communication, which may lead to agitation and anger.
(d)
Factors related to task-induced stress
- When
they are no longer able to perform simple tasks such as bathing or grooming,
they may become withdrawn and frustrated easily.
Common challenging behaviors and coping strategies
Common
challenging behaviors include (a) wandering and/or pacing; (b) incontinence;
(c) repetitive behaviors such as words or actions; (d) suspicion
| Challenging
behavior |
Behavioral
management strategies |
| Wandering
and / or pacing |
-
Set
daily routine and avoid afternoon nap.
-
Engage
him/her in some meaningful activity during day time, e.g. exercise
and walks.
-
Engage
him/her in physical activity to work off excessive energy so
as to facilitate sleep.
-
Minimize
coffee / caffeine (e.g. soft drinks) intake.
-
Keep
updated personal information such as name, address, recent photos
and contact phone number for identification and contact of family
members in case of getting loss.
|
| Incontinence |
-
Consult
doctor for thorough medical examination to discover any possible
problems that may contribute to the incontinence.
-
Observe
carefully the toileting patterns and help him/her develop individualized
toilet schedules.
-
Reinforce
environmental cues such as labels or signage of the toilet.
-
Wear
simple clothing, e.g. trousers with elastic waistbands or velcro
tape instead of zippers or buttons.¡·X0P Maintain good personal
hygiene. Use adult diapers if needed.
|
| Repetitive
behavior ( words and actions) |
-
Engage
him/ her in simple, meaningful or favorite activity, e.g. folding
towels, preparing vegetables, etc.
-
Do
not be angry or scold the person with dementia. Respond to his/her
emotion. He/ she may simply need reassurance.
|
| Suspicion |
-
Avoid
arguing with him/her, or insisting on the truth, as he/ she
may not be able to understand the situation.
-
Be
empathetic to his/her problem. Different caregivers should use
a consistent approach in managing the behavior
|
Related topics
Dementia
Dementia
- Communication skills
Dementia-
Daily Living
Activity
Program for Persons with Dementia
Reference
:
Resource
Book on Psychosocial Health Promotion in the Elderly (Traditional
Chinese Only)
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