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Effective Interventions with Dementia and Difficult Behaviors
On the last track we discussed positive interaction techniques which can be used by the caregiver of an elderly person with Alzheimer’s. Included on this track are four basic rules for positive interactions. The four basic rules for positive interactions discussed on this track are stay pleasant, calm, and reassuring, help maintain self-esteem, use simple sentences, and use nonverbal clues.
On this track we will discuss managing difficult behaviors. This track will focus on analyzing behavior and managing behavior problems. In order for the caregiver to continue with an ongoing assessment of the patient’s Alzheimer’s and associated behavior, the following five steps may be useful when analyzing behavior.
These five steps regarding analyzing behavior are deciding if the behavior is a problem, what the problem really is, with whom the problem occurs, where the problem occurs, and when the problem occurs. As you listen to each step for analyzing behavior, consider the approaches used to manage specific behaviors. You might think of how you can adjust and apply the ideas to benefit your client.
5 Steps to Analyze Behavior
Step #1 - Is the Behavior a Problem?
Is the behavior harmful to anyone?
Step #2 What Is the Real Problem?
Maria stated, "He doesn’t even seem like he’s aware that the flowers are there when he starts pacing." Clearly, the basic problem was not that Ralph tramples the garden, but rather his pacing was the problem. I stated to Maria, "Ralph’s pacing is not a problem in itself. Can you find or create a different place for Ralph to pace? A place away from the garden, perhaps."
Other general approaches that can be used to decide what the problem really is include studying the problem and asking for someone else’s perspective. Do you agree that sometimes the root problem cannot be discovered in more complex situations? I have found that in cases regarding an undiscovered root problem, solutions can still be found by trying different approaches one by one.
Step #3 With Whom Does the Problem Occur?
Step #4 Where Does the Problem Occur?
Have you found that clients with Alzheimer’s commonly react this way to open areas? With Esther, glare, low light, wind, and temperature differences contributed to her sense of being in a strange place. I stated to Herb, "Esther cannot understand and adjust to an environment that is distressing her. Whenever possible, try to change the environment to suit her." As you listen to the environmental changes Herb utilized, decide if you can adapt them to allow the caregiver of your client to manage environmental problems.
Herb stated, "So Esther could feel safer outside, I painted the edges of the door bright yellow. I thought maybe she could see it more clearly that way. Sometimes I could point to the door and reassure her that we weren’t far from home. That didn’t work all the time, so I built an awning over the patio. Now Esther stays there when I garden. She likes it. I think having a roof over her head makes her feel more comfortable."
Think of your Esther. How could he or she benefit from caregiver management of the environment?
Step #5 When Does the Problem Occur?
Parker stated, "I stayed up, listening for any signs of her activity. It was pretty late when I heard her in there fooling around. Turns out she was rummaging through her drawers and closets all night, not sleeping. That’s why she didn’t want to bathe in the morning. She was too tired!"
I stated to Parker, "You may consider assessing Helen’s routine and adjusting it to suit her better. During the evenings, keep her routine consistent, don’t expect her to do anything difficult or stressful, and reassure her that everything is okay. Soothing music and easy activities she enjoys may help Helen." Do you agree that problems with clients may become worse if they have nothing to do? How could analyzing behavior benefit the caregiver of your client?
On this track we discussed analyzing behavior. In order for the caregiver to continue with an ongoing assessment of the patient’s dementia and associated behavior, the following five steps are useful when analyzing behavior.
These five steps regarding analyzing behavior are deciding if the behavior is a problem, what the problem really is, with whom the problem occurs, where the problem occurs, and when the problem occurs. Would playing this track in a session be beneficial for the care giver of a client of yours whose family member has been diagnosed with Alzheimer’s?
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