Behavior management planning for problem behaviors in dementia: A practical model.

Abstract

Psychologists are often sought out by families or nursing home staff to develop intervention strategies for behavior problems in dementia patients. This article describes a systematic approach, or practical model, for developing these strategies. Variables that may contribute to behavior problems include comfort needs, assaultiveness, anger, patient's perceptions, activity involvement, triggers, patterns of escalation, personal history, caregiver interaction styles, and level of cognitive functioning. Each variable of this model is described in terms of key team members, relevant team dynamics, assessment, and intervention strategies.Psychologists are being increasingly called on to help develop intervention strategies for behavior problems in dementia patients (Nordhus, VandenBos, Berg, & Fromholt, 1998). The need for psychological intervention begins with the realization that "The dementias are the most commonly found psychiatric syndromes in the nursing home with a prevalence of 67 to 78 percent" (Grossberg & Solomon, 1993, p. 35). The behavior problems of dementia patients constitute a disproportionate part of the caregiving burden. As a result, the management of these behavior problems is primarily left to nursing assistants, who often have little or no formal training in working with behavioral problems (Liptzen, 1992). Given these considerations, the need for involvement of psychologists becomes clear. This article describes a practical model that psychologists can use to guide their assessment and intervention efforts directed toward behavior problems in dementia patients.It may be initially tempting to look for specific approaches to specific problems. For example, one may ask how to manage assaultiveness, wandering, disruptive vocalizations, or inappropriate sexual behavior. Indeed, a number of authors have offered recommendations to manage specific behavior problems. These strategies tend to be either behavioral, environmental, or some combination of these techniques (e.g.,

The moderating effect of aggressive problem behaviors in the generation of more positive attitudes toward nursing home residents

“…These finding suggest that it is vital for psychologists, who are often central in negotiating treatment team dynamics (Hillman, 2000;Slone & Gleason, 1999), give appropriate recognition to staff members who work with aggressive patients. These findings also suggest that staff members' self-identification as a helper and healer is more important than previously believed.…”

“…The present study suggests that distribution of this information should be explored further as a possible time and costeffective intervention for maintaining more neutral staff attitudes toward more non-aggressive nursing home residents. The social history information also could be used to help understand the genesis of problem behaviors in order to develop alternative activities for elderly patients with dementia (Slone & Gleason, 1999) and reduce the incidence of problem behaviors (Rovner et al, 1992). Thus, the utility of psychologists' roles in long-term care can again be highlighted and strengthened.…”

“…) Aggressive problem behaviors, including kicking, punching and biting, appear to occur more often when a patient suffers from dementia, or when daily routines are altered (Hillman, 2000;Jackson, Spector & Rabins, 1997). The ability of staff members to individualize or empathize with residents who display aggressive behavior appears limited (Everitt et al, 1991); staff members have been found to avoid those patients Downloaded by [Akdeniz Universitesi] at 21:05 25 December 2014 (Hu, Huang, & Cartwright, 1986;Slone & Gleason, 1999).…”

“…Due to the high levels of stress associated with caregiving (e.g., Slone & Gleason, 1999), the frequent turn-over among nursing home employees, and society's general devaluation of care-giving, it would seem obvious that nursing home staff members, as well as their patients, would benefit from psychological intervention (Abeles et al, 1998;Hillman, 2000.) The distribution of patients' life history information to nursing home staff members is one such intervention that has shown promise in generating more positive attitudes toward nursing home patients themselves.…”

A Team Effort for Treating Depression in Dementia

“…Slone and Gleason (1999) describe the critical role that the dynamics of the caregiving team have on the success or failure of intervention efforts. Despite the impact team dynamics can have on treatment outcomes for people with dementia, teamwork issues often seem to be overlooked.…”