Difficult behaviour and dementia in nursing homes: five cases of psychosocial intervention

Abstract

Psychosocial interventions in five people, who presented with uncooperative and difficult behaviour at mealtimes and during assistance with self-care tasks, are described. In four cases, a single case experimental design was used. The results are discussed in the context of 'rementia' and a broadly defined functional analytic perspective to assessment and intervention. In contrast to the standard neurogenicdisease paradigm, a person-centred holistic model of dementia is proposed for the understanding and amelioration of distress in people with dementia who are seen as difficult or 'challenging'.

Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT)

“…Some interventions include part of the underlying understanding of the concept of person-centered care -for example, life story work (Moniz Cook et al, 2003;McKeown et al, 2010). Other interventions include different individualized care aspects and/or multi-method interventions (Sloane et al, 2004;Chenoweth et al, 2009;Dilley and Geboy, 2010;McCormack et al, 2010;Palese et al, 2010).…”

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

“…The closest approximation is a well-established range of techniques known as 'functional analysis' (see Functional analysis-based interventions), which has been used in a number of single case studies or case series. [66][67][68][69] Our second challenge was to devise a means to engage staff in a way that they perceive as relevant to their working experience and with sufficient power to change or expand the way they perceive and respond to behaviour they find challenging. There are preliminary studies of successful interactive online programs using actors to simulate common behaviours in context followed by demonstration of how effective responses can be achieved.…”

“…In addition, it was also not possible to implement our original plan to build into the action-planning cycle an iterative process that would enable staff to refine and modify a resident's action plan based on their findings from trying out the first set of actions. According to the principles of a functional analysis approach to understanding behaviour, 1 and our modelling of this in clinical practice, 13,68,69 an iterative 'detective' approach to problem-solving is usually required. Nor did our time scale allow staff to receive assistance from the specialist dementia care therapist to target the range of multiple behaviours, as often there are a number of behaviours that cause distress for the person living with dementia and those supporting them.…”

“…Cases were derived from the clinical situation in which some cases have been documented in the literature. 1,13,68,69,98 Learners were guided through interactive video-clips, resources that are relevant to the person with dementia, such as life story information or case notes, audio-clips on views of others within the care context, and then provided with structured feedback to set their observations of the person's CB in the context of 'causation'. 49 The learning focused on guiding staff to use 'why' questions 63 to consider the potentially multiple causes for what they had observed about the person and the behaviour in the vignette.…”

Emerging Technologies for Monitoring Behavioural and Psychological Symptoms of Dementia

“…The literature [39] [40][41] on monitoring of agitation and aggression in patients with dementia has focused on the use of Scale to assess Observed Agitation in Persons with Dementia of the Alzheimer Type (SOAPD) [42]. The SOAPD rates the following aspects of agitated behaviours:…”