responsive behaviours

Alberta HCA Bridging Module 1: Responsive Behaviours of 21

Responsive Behaviours

Handout

1.2 Topics 1.3 Responsive behaviours 1.4 Aggressive behaviours 1.5 Client care 1.6 Changing philosophies 1.7 Specific strategies 1.8 Wandering 1.10 Hallucinations 1.11 Agitation & restlessness 1.12 Screaming 1.13 Sexual behaviours 1.14 Repetitive behaviours 1.15 Hoarding 1.16 Catastrophic reactions 1.17 Sundowning 1.19 Summary

Bridging Module 1: Dementia Care


Module 1: Dementia - Responsive Behaviours

1.1 Title

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1.2 Topics

Narration JILL: Hi … I’m Jill and with me is my colleague Carlos. Welcome to Module 1: Dementia Care. We will be your guides for this lesson on Responsive Behaviours. CARLOS: Hi Jill. So what topics will we be covering? JILL: We are going to describe common responsive behaviours in clients with dementia. Then we will discuss ways to prevent and manage aggressive client behaviours. Next, we explain about how to care for dementia clients who exhibit inappropriate responsive behaviors. The changing philosophies in caring for people with dementia will be examined. And finally, we will provide some very specific ways to deal with different types responsive behaviours. CARLOS: This all sounds like important stuff. Let’s begin. JILL: Okay.

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1.3 Responsive behaviours

Narration JILL: One of the most challenging parts of caring for a client who has been diagnosed with dementia is helping to manage the disruptive behaviours they sometimes demonstrate. A responsive behaviour is a socially inappropriate behaviour or response to a normal interaction or situation. CARLOS: So as I understand it, these behaviours are not reflective of the usual personality of the person, but are due to the damage that has been caused to the brain by the progression of dementia. JILL: Yes, that’s correct Carlos. Responsive behaviours are the actions, words, and gestures that are an action or expression of the client in response to unmet needs in their personal, social or physical environment. The client may be experiencing stress, pain, illness, fatigue, fear, discomfort or boredom. For example, pain may be expressed as aggression because the person cannot verbally express their pain to the caregivers. CARLOS: Identifying these causes or “triggers” of responsive behaviours in clients is important. Once we know what these are, we can take steps to try and remove or minimize these stresses that cause the inappropriate behaviours.

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1.4 Aggressive behaviours

Narration JILL: One frequent response behaviour is aggression. Aggression is behaviour that is not only disruptive to others, it can also compromise the safety of the client, caregivers and others residing in the same environment. We must understand how an aggressive response begins; the contributing factors to the response; the consequences of the aggressive response; and the best ways to support the client. This is critical to maintain the safety of the client, yourself, and others. CARLOS: One effective approach to managing aggressive behaviours is the “ABCD” approach. It is a method of understanding how the responsive behaviour occurred; what effects it has on the client and those caring for them; and how to care for the clients responding in an aggressive manner. JILL: Let’s describe the “ABCD” approach. “A” represents the antecedent or activating trigger that caused the aggressive response, for example hunger or pain. CARLOS: The “B” stands for the type of aggressive behaviour, for example shouting or swearing, punching or slapping. JILL: The “C” represents the consequences to the aggressive response. The consequences affect the client, the caregivers, and perhaps other clients or family members. CARLOS: The “D” stands for the decision made to decrease the behaviour and debrief, or share the experience with others to avoid another incident.

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1.5 Client care

Narration JILL: Learning how to manage clients when they are experiencing responsive behaviours is challenging and stressful. It requires an understanding of who the client is as a person. When considering strategies to reduce responsive behaviour, client safety must always be the priority. CARLOS: As dementia progresses, responsive behaviours may become more severe or disappear or new ones may begin. Strategies to manage responsive behaviour can change and new strategies have to be tried. JILL: Providing a safe environment, anticipating client needs, being creative with solutions, and sharing your knowledge with the other team members are the most effective ways to manage responsive behaviours in clients diagnosed with dementia.

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1.6 Changing philosophies

Narration CARLOS: Jill, I understand that over time there has been a change in philosophy on how to care for clients with dementia. JILL: Yes, there has. At one time, the philosophy was to continually keep clients oriented to time, place and person. This was an approach borrowed from care of clients with mental health diagnosis. While this approach is helpful for persons receiving psychiatric treatment, it is not very effective for clients with dementia. CARLOS: Why not? JILL: In reality, it is often very upsetting for a client with a diagnosis of dementia to be reminded what year it is, or that she is no longer a young girl or a new wife! So the current recommended approach is to join the client in the reality he or she is living in right now. CARLOS: Hmmm, interesting. But I can see how this would be a lot less stressful for the client.

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1.7 Specific strategies

Narration JILL: For the remainder of this lesson, we are going to focus on specific strategies for dealing with different types of responsive behaviours. Here is the list. CARLOS: So, let’s see. We are going to discuss ways that health care aides should deal with … wandering … hallucinations and delusions … agitation and restlessness … screaming … socially unacceptable sexual behaviours … repetitive behaviours … hoarding … catastrophic reactions and sundowning. JILL: Yep!

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1.8 Wandering

Narration JILL: Let’s begin with a client who frequently wanders around. CARLOS: You should begin by learning the patterns of wandering for each client and share this information with other staff or family members. JILL: An important thing to do for a wandering client is to ensure their safety. For example, make sure the client is mobile enough to walk longer distances. Provide an open space such as long hallways, outdoor paths to encourage “safe” wandering while being supervised. CARLOS: It is probably also a good idea to place chairs along hallways or walkways to provide the wandering client a place to rest. JILL: I agree.

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1.9 Wandering

Narration JILL: And here are a few more ways to deal with wandering clients. For clients who may wander into unsafe areas, placing a dark mat, dark tape on the floor, or mirrors on the wall can create a perceptual barrier to prevent clients from going to places where they shouldn’t be. CARLOS: Music may limit the wandering to an area for a period of time. If the client enjoys the music, he is likely to stay in the area where he can hear it. JILL: Regular exercise may decrease wandering. CARLOS: Encourage the client to speak, and listen to what she or he has to say. JILL: Distract the client by involving him or her in an activity that they enjoy. CARLOS: These are some effective ways to deal with a dementia client who likes to wander.

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1.10 Hallucinations

Narration JILL: Our next responsive behaviour is hallucinations and delusions. CARLOS: Accept the hallucination or delusion as the client’s reality. Do NOT attempt to convince the client the hallucination or delusion is not real! JILL: Distract the client from the hallucination or delusion by redirecting them to an activity that they enjoy. HOWEVER, if the hallucination or delusion brings pleasant emotions to the client, do not try and redirect them. Let them enjoy the experience! CARLOS: Interesting.

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1.11 Agitation

Narration CARLOS: Our next responsive behaviour is agitation and restlessness. Listen to the client if he is expressing his frustrations. Determine the causes that trigger agitation and restlessness. Try to eliminate or minimize the triggers. Jill: Be aware of your response to the client’s restlessness. Stay calm and reassure the client that you are there to help and comfort them. When the client becomes calmer, redirect them to an activity that maintains their calm response.

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1.12 Screaming

Narration JILL: Next, is what to do if a client is screaming. The first thing to do is to determine whether the client is experiencing pain. If they are, then implement care strategies to relieve the pain. Reposition the client. Keep the client comfortable – not too warm or too cold. CARLOS: Another option is to distract the client. This can be done by playing music the client enjoys and that calms them. You can also have a conversation with the client about their interests, hobbies, family, traditions and holidays.

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1.13 Sexual behaviours

Narration CARLOS: Our next challenging behaviour is socially unacceptable sexual behaviours. JILL: Try distracting the client with other activities. In a matter-of-fact way, set boundaries with the client. If the client is touching you inappropriately, gently move the hands, and distract them with conversation.

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1.14 Repetitive behaviours

Narration JILL: For repetitive behaviours, consider ways to comfort and provide security to the client. If the repetition is an action, try to provide an activity that addresses that action. For example, if the client is always wringing her hands, try to provide an activity that the client can do with her hands such as sorting items, folding socks or hand towels.

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1.15 Hoarding

Narration JILL: For hoarding types of behaviour, remove only unnecessary items and leave the remainder of items in a safe place such as out of the way of walking paths, stoves or heaters. Removing all items can cause the client to become scared or upset that his items are missing. CARLOS: You can also engage the client in recreational and social activities to distract him from hoarding. Ensure that the client has enough to eat at meals and snacks so that he does not feel it necessary to hoard food. JILL: Good point.

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1.16 Catastrophic reactions

Narration CARLO: Our next responsive behaviour is catastrophic reactions. If this happens, allow the client more personal space during the responsive behaviours. Keep your hands at your sides when approaching the client. JILL: Speak calmly and slowly. Give the client time to understand that you are trying to help. Find out what the client needs or what caused the reaction. CARLOS: Do not touch the client until he or she has become calmer. Then use touch to reassure and comfort them.

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1.17 Sundowning

Narration JILL: And our last topic is sundowning. Sundowning is a symptom of Alzheimer's disease and other forms of dementia. It's also known as “late-day confusion.” If someone has dementia, their confusion and agitation may get worse in the late afternoon and evening. CARLOS: The first thing to do is to see if the behaviour is caused by discomfort such as hunger, pain or need to use the toilet. JILL: Allow time for rest and naps between activities. Avoid making appointments such as bathing or other potential stressful activities in the late afternoon or evening. CARLOS: Prevent over-stimulation from television or radio. This can lead to increased confusion. JILL: Provide adequate lighting to lessen shadows when it begins to get dark. CARLOS: A rocking chair can provide stimulation while having a calming effect.

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1.18 Sundowning

Narration JILL: Continuing with sundowning … Brisk walks or other forms of physical activity throughout the day may reduce restlessness or the need to wander later. CARLOS: Keep the client active and distracted when sundowning may occur. For example have them help prepare the meals and set the table. JILL: Allow the client quiet time if this helps decrease the agitation. Maintain a regular eating and sleep schedule as much as possible. CARLOS: Familiar routines may help the client feel more secure. This can include readying the home for evening such as closing the curtains or turning on the lights. Bedtime routines that include warm milk and soft music may also be helpful.

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1.19 Summary

Narration JILL: Well, that brings us to the end of this lesson on responsive behaviours. CARLOS: Yes, we provided a considerable amount of information. This included a discussion of the challenge of providing care to clients diagnosed with dementia. We explained some general ways to deal with clients who exhibit inappropriate behaviours. And finally we spent time providing some very specific ways you can deal with the different types of responsive behaviours. JILL: We hope you found this lesson informative and useful. It should enable you to provide better care for your clients with dementia. I’m Jill, along with Carlos, saying goodbye for now. CARLOS: Bye.

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1.21 The End

Narration No narration, only music.

responsive behaviours

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