Apr 1, 2011

Challenging Behavior in Persons with Dementia

The ONLY Way to Deal with Challenging Behavior in Persons with Dementia IS "To PREVENT IT in the First Place".....

Alzheimer's Reading Room

Challenging Behavior in Persons with Dementia

Editor Note: This is not a full blown article by Judy Berry. Instead it is her comment to comments under the original article -- Joleen's Dad Out in the Cold -- What Should She Do?.

This issue: challenging and violent behavior of Alzheimer's patients is important to all Alzheimer's caregivers. This thread was initiated by the this article -- Nobody Wants Our Dad

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By Judy Berry
March, 2010

I have been working with this very vulnerable population, those with dementia and challenging/aggressive behavior, for the last 12 years.

After developing a model of specialized dementia care that has been successful in preventing the aggessive behavior in those that have had repeated discharges from other facilities and hospitalizations for behavior I have learned a few critical things I would like to share.

I'll start by saying I believe "NO One", the resident with the behavior, other residents, or staff should have to be subjected to violent behavior. We have learned that 90% of behavior can be contolled and/or eliminated by "pro-actively" Recognizing and Meeting the underlying need of the person displaying the behavior whether it be physical OR emotional.

There is a critical need for appropriate ratios of highly trained staff (and you are right when you say not everyone should work with people with dementia related behavior), but another huge piece often neglected in understaffed places is the ONGOING mentoring and support necessary to keep even the best trained staff on track and focusing on the emotional needs of the individual resident, and controlling their own non-verbal communication and reactions to that persons needs.

We learned that both professional and informal caregiver "perception" of what is actually going on in the minds of a person with advancing dementia has a direct correlation to how they treat the individual.

For instance, if they believe some of the readily available information that the "person" is no longer in there, or the "person" they knew is slowly disappearing before their eyes because of the effects on the brain, they are giving themselves permission to treat that person differently.

Talking about patients in front of them like they are not there, not paying attention to their personal dignity emotions and feelings, ignoring their behaviors; like calling out, crying, or just withdrawing etc, and not giving them choices are just a few of the things that frequently will happen if the caregiver has a misguided perception.

All these behaviors on the part of the caregivers will produce challenging behavior, but often well meaning caregivers are not even aware they are doing them.

I can truly empathize with Joleen and others when they talk about their pain and frustration when told "No place wants to take their loved one!" and the intense fear of what will become of them. I lived with that pain and uncertainty for 7 years with my own mom, just to see her succumb to the system that uses overmedication to make our loved ones compliant in their environment.

There are some medications that can be appropriate at times, in limited amounts to avert some of the anxiety our loved ones are experiencing with their disease. The problem has always been and still is, in my opinion, that we need to be asking ourselves and the prescribing physicians WHY are we using them, to reduce anxiety in the resident; or, to make life bearable for an understaffed facility that offers little in the way of training and "ONGOING staff support".

In the words of Jan Garard RN, Quality Improvement Coordinator and Trainer for MN Dept of Human Services,
The ONLY Way to Deal with Challenging Behavior in Persons with Dementia IS "To PREVENT IT in the First Place"


Judy BerryJudy Berry is the founder and CEO of Lakeview Ranch. Lakeview Ranch provides a unique model of specialized dementia care for those with aggressive behavior. The model focuses on prevention, rather than treatment to manage behavior. Judy is also the Executive Director and founder of the Dementia Care Foundation.

Original content Judy Berry, the Alzheimer's Reading Room