Nov 25, 2011

Reinforcement and Dementia Care

Everyone loves a good pat on the back or acknowledgment of a job well done. In fact, most people like to be around others who are generous in their support of us.

By P.K. Beville

P K Beville Reinforcement and Dementia Care
Positive Reinforcement is a behavior management technique used to encourage a desired response or performance. It affects our mood and resulting behavior.

The Virtual Dementia Tour™ (VDT) was designed to simulate what is known about the effects of dementia on a person. This simulation allows us to be sensitized to dementia and Alzheimer’s disease resulting in better care.
People with dementia struggle, at times painfully, to be a part of the world around them. Positive tone of voice, positive touch, offered often and sincerely, will make the difference in an environment rich in love and support.....

The goal of reinforcement in the VDT study was to determine its effect on keeping the participants involved and performing tasks during the tour, thus allowing us to see if it is likely that positive reinforcement could be a tool for managing the behavior and mood of people with dementia. At this juncture, there have been no studies to determine the effects of verbal and physical reinforcement on people with a cognitive decline.

During the VDT if a participant made a statement about giving up, sat down, tried to leave, or asked for help, they were touched on the arm and told, “You are doing great! You only have x number of tasks to go (the number of tasks that had not been completed). Look around the room and see if anything looks familiar to help you along.” No other help was given even if the participant responded with, “but I don’t remember any more”. This allowed us to observe the pure results of that one interaction on the participant.

In the study, 44% required reinforcement in order to continue. This means that almost half of the people that took the tour had to be reinforced. Since we will assume that those participants are normal, it is most likely that reinforcement for those with dementia will be much more. Without the reinforcement, the participants would have given up or become increasingly agitated. Think of how this applies to those we care for.

Of those needing reinforcement, 81% continued with the tasks after being encouraged and touched. Even more exciting, 99% stayed in the tour room until they were told that their time was up! The reinforcement calmed them down, refocused them, and motivated them to continue. One interesting point is that reinforcement occurred, on average, at about four minutes into the tasks. It is also important to note that the observer touched the participants when they were reinforced. Touch, in and of itself, is a form of reinforcement and in this case it helped to orient the person to the reinforcer (or caregiver).

The fact that reinforcement occurred after about 4 minutes into the tour, tells us that for the person with dementia, reinforcement needs to happen a great deal - not just a few times a day, but all day, during all situations. Because the dementia patient has short-term memory problems and an inability to focus, reinforcement will help bring clarity and decrease the chance that the person will become agitated or give up on small tasks.

After sending more than 180,000 caregivers through the VDT in 14 countries, this result continues to be the pattern. Many participants reported that having the reinforcement made them feel better but they would have liked even more help. Clearly, reinforcement is a key to managing this terrible disease. The long-term effect of using frequent verbal and touch reinforcement with dementia patients will be evidenced by a more adjusted and relaxed person. I would even go so far as to say, it can decrease depression if the symptoms are already present and possibly stave off depression altogether.

People with dementia struggle, at times painfully, to be a part of the world around them. Positive tone of voice, positive touch, offered often and sincerely, will make the difference in an environment rich in love and support.

P.K. Beville, M.S., is the founder of Second Wind Dreams(R) and Geriatric Specialists. She created the Virtual Dementia Tour, which is currently used in eldercare communities, Universities and by lawmakers in four countries. The Virtual Dementia Tour is a teaching tool that is used to help sensitize people to the plight of Dementia.

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