Managing Difficult Behaviors of Dementia (Short Version)

Managing Difficult Behaviors of Dementia:

Managing Difficult Behaviors of Dementia Alejandra Ceja-Aguilar Director of Education and Outreach

Alzheimer’s Disease (AD):

Is a progressive, fatal, brain disorder that gradually destroys brain cells and affects a person's memory, ability to learn, make judgments, communicate, and carry out basic activities of daily living. 360,000 new cases of Alzheimer’s disease each year Over 5.3 million Americans are living with Alzheimer’s Disease Alzheimer’s is the most common form of dementia and accounts for 70% of all cases Alzheimer’s Disease (AD)

AD on Neurons:

AD on Neurons

Slide 4:

Smaller overall Cortex shrivels Ventricles enlarge

Warning Signs of Alzheimer’s:

Memory loss Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative Warning Signs of Alzheimer’s

Dementia and AD:

Dementia and AD Memory loss Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative A series of symptoms including the loss of short-term memory and at least one of the following intellectual abilities serious enough to interfere with daily life: Language Impairment Motor -Memory Impairment Sensory -Memory Impairment

Prevalence of Difficult Behaviors:

90% of patients affected by Dementia experience Behavioral and Psychological Symptoms of Dementia (BPSD) that are severe enough to become a problem: Agitation (75%) Wandering (60%) Depression (50%) Psychosis (30%) (delusions, hallucinations, incoherence, and distorted perceptions of reality) Screaming and violence (20%) Prevalence of Difficult Behaviors

BPSD Symptom Clusters:

BPSD Symptom Clusters Pacing Repetitive actions Dressing/undressing Restless/anxious Hallucinations Delusions Misidentification Suspicious Agitation Physical aggression Verbal Aggression Aggressive Resistance Sad Tearful Hopeless Guilty Anxious Irritable/screaming Suicidal Withdrawn Lacks interest and Motivation Psychosis Depression Apathy Aggression Euphoria Pressured speech Irritable Mania

So How Do We Manage These Behaviors???:

So How Do We Manage These Behaviors??? Identify and Examine the Behavior Explore Potential Solutions Try Different Responses

1. Identify and Examine the Behavior:

What did he/she do? Did it hurt someone? What happened BEFORE and AFTER the behavior? When did this behavior start happening? What are the side effects of the medications he/she is currently taking? 1. Identify and Examine the Behavior

P.I.E.C.E.S:

Physical Intellectual (Cognitive) Emotional Capabilities Environmental Social P.I.E.C.E.S

2. Explore Potential Solutions:

What does he/she need? Have you explored your PIECES? Physical - Medications, alcohol, pain, infection, hydration, bowels, etc. Intellectual - loss of neurons leads to memory loss Emotional - Depression, Adjustment disorder, Grief, Isolation, etc. Capabilities - Loss of physical abilities, boredom, loss of independence Environmental - Increased sensitivity to light, temperature, sounds, smells, etc. Social - Coping strategy to changes in social network, relationships, and interactions with others 2. Explore Potential Solutions

3. Try Different Responses:

Keep your GOAL in mind. What will your new response be? What WAS the response? If it worked= congratulations! If it didn’t= go back to Step 1. 3. Try Different Responses

Behavior Maps:

Behavior Maps Time MON TUE WED 6am 7am 8am 9am 10a 11a 12p 1pm 2pm 3pm Time Behavior Response Solution 6am 7am 8am 9am 10a

General Supportive Strategies (Keep your PIECES in mind):

General Supportive Strategies (Keep your PIECES in mind) Stay Flexible, Patient, and Calm Respond to the emotion, not the behavior Don’t argue Use memory aids Acknowledge requests. Respond to them Find the cause of the behavior Consult a physician to identify any causes related to medications or illness Explore various solutions Don’t take the behavior personally TAKE CARE OF YOU.

Improve YOUR Communication :

Improve YOUR Communication Identify yourself-visually and physically Call the person by their name Use short, simple words and sentences Talk slowly and clearly Give 1-step directions Ask 1-question at a time Patiently wait for a response Pay attention to your non- verbals Don’t offer options that are not possible Repeat information or questions, slowly and clearly Avoid questions. Use statements. Avoid confusing expressions Place emphasis on key words Turn negatives into positives Offer visual cues Write things down for them Speak with Dignity

Agitation and Anxiety:

Provide the right environment Supervise activities Improve communication What is causing the anxiety? Listen to what they are “saying.” Reassure them. Validate their feelings. Involve them. Release energy. Get help Re-visit ALL medications Agitation and Anxiety

Psychosis/Confusion:

Stay calm Respond with a brief explanation that is consistent to where they are at Show photos. Share stories. Redirect. Duplicate lost items. Offers suggestions. Don’t scold. Don’t argue or try to convince them. Don’t take it personal. It’s the disease. Not the person. Psychosis/Confusion

Wandering:

Develop and stick to a routine full of activities, exercise, rest, and fun Inform others. Get help. Make the home safe. Install locks and alarms. Allow room for controlled wandering. Enroll in Safe Return with the Alzheimer’s Association Wandering

Trouble Sleeping:

Maintain an active schedule. Develop a bed-time routine. Calming sounds Calming smells Calming lighting Avoid stimulants. Trouble Sleeping

Repetition:

Look for a reason What is he/she trying to tell you? Turn the behavior into an activity Stay calm. Be patient. Repeat your answer. Redirect. Use memory aids Accept the behavior  Repetition

Bathtime:

Understand changes in perceptions Tub looks bottomless Room looks enclosed Sounds are enhanced Can’t recognize water Fear of falling Confusion Shyness- be patient Allow room for independence Consider hygiene history Maintain routine Respect privacy Bathtime

Dressing:

Allow independence Increase assistance only as needed Understand the disease can reduce inhibitions Let it go. Adapt clothing Prepare for incontinence Dressing

Taking Care of You:

Become a knowledgeable caregiver. Recognize warning signs of stress. Identify the stressor. Identify possible solutions. Implement a solution. Accept that there at things you CANNOT change and improve on those you CAN. Ask for help and Accept help. Make a physical, social, and emotional change in helping yourself. Give yourself permission to make mistakes. Taking Care of You

Southern Caregiver Resource Center:

Southern Caregiver Resource Center 3675 Ruffin Road, Suite 230 San Diego, CA 92123 (858) 268-4432 www.caregivercenter.org Alejandra Ceja-Aguilar aceja@caregivercenter.org