Approaches, Activities and Interventions in Response to Behaviors of People with Alzheimers and Senile Dementia

APPROACHES, ACTIVITIES AND INTERVENTIONS
IN RESPONSE TO BEHAVIORS OF PEOPLE WITH ALZHEIMERS AND SENILE DEMENTIA
Carly Hellen, Rush Alzheimer's Disease Center
 

IN GENERAL:
 Research the presence of antecedent to the behavior; what was happening prior to the onset of the behavior
 Look for environmental elements that cause do contribute to the behaviors; surroundings, noise, activity, people, etc..
 Try to determine the reason for the behavior, if possible
Have all staff responded the same manner when addressing behaviors
 Share in successful approaches, activities, interventions with all staff, put information in prominent place on care plan
 Don't over reacted to residents behavior; don't use words or tone voice that scold, punishes, chastises, etc.

to further identify possible approaches and interventions...
VERBAL ANXIETY (FEELING LOST, SCARED, I DON'T KNOW WHAT TO DO)
 Approach slowly
 Redirect to object, activity, prop, conversation
 Use touch in a gentle, reassuring way
 Take residents to the most familiar setting on unit to sit in relaxed and feel more secure
 Reassure with familiar props, locations, activities, etc.
 Involve resident in positive peer relationships, perhaps with someone who needs to reassure or nurture someone else
 If asking what's wrong, use validation to listen for the reason underlying the anxiety, then try to resolve
 Involving normalization activities resident is capable of doing
 Allow residents to sit in area where staff are working to feel he or she isn't alone

REPETITIVE CALLING OUT; YELLING, SCREAMING
 Use slow, rhythmic music, lifelong favorite music.
 Use refreshments
 Give resident a busy box, scrap book, props to occupy attention and interest
 Spend one on one time in quiet, and non-distracting area; use soft voice so that perhaps resident will have to stop yelling to hear you
 Use the resident's name and look directly at him or her in trying to calmly breakthrough
 Assess whether the resident is in pain, discomfort, has a need that can be met
 Assess whether something or someone in environment is causing the behavior
 Try to involved in singing instead

VERBAL ANGER; ABUSIVE LANGUAGE
 Distract and redirect
 Introduce singing instead
 Introduce a "favorite" of the resident; activity, music, food, person
 Involve in craft or physical activity were anger could be expressed in nonverbal manner
 Involve in social settings that clearly cue the use of manners or appropriate social skills
 Do not react with shock, schooling, anger, parental tone

EXPRESSION OR DISPLAY OF SADNESS; DEPRESSION
 Use validation therapy techniques to find a reason behind the behavior, don't ask "why"?
 Involve in or use something from residents lifetime that has offered enjoyment or comfort
 Do and say things that make the resident feel of value or special
 Involve in activities that you are certain residents can be successful in doing; give genuine praise
 Acknowledge and accept what the resident is expressing
 Use music: sad music may help you release feelings; happy may offer distraction
 Use something to offer comfort to, to cuddle, pat, tactile stimulation

SHORT ATTENTION SPAN; EASILY DISTRACTED
 Break the activity into short sections
 Use a lifelong, normalization, familiar activities
 Use of props, pictures, materials to assist in holding resident's attention
 "Roving" activities; take the activity to where the resident is on the unit, rather than time to keep the residents attention in an activity group or area
 Use of resident "jobs"/ roles in activity; making it important to stay involved
 Put out materials and allow or assist resident in going from "station to station"
 Manual activities; task oriented activities; tactility stimulating materials
 Seat in group or at a table or in an area in a way that the resident faces the fewest number of distractions
 Change activity, approach, tone of voice that you notice resident is losing interest
 As you notice increase in distractability, ask resident a question or give one on one to regain interest
 Inter-generational activities
 Good mixture of passive to active activities

WANDERING, PACING
 Involve in physical or movement activities
 Set up a "wandering trail" with interesting things to stop look at and/or do long away
 Normalization activities: sorting jewelry or stocks; tying laces; untying or unknotting socks; sorting and folding laundry; sweeping; testing
 Use activities that can occur while walking
 Set up "comfort" areas (chair, pillows, couch, music playing, things to look at) that draw resident in to rest
 Dancing
 Involve in a roaming choir or rhythm band while walking

ELOPING (PURPOSEFUL ACTIONS TO LEAVE AREA OR BUILDING)
 Walk with the resident using a non-directed conversation to distract or calm resident
 Setup planned walking activities
 Involve resident in tasks of the unit- making beds; sweeping, pushing cart with staff
 Disguise the unit's exits
 Assess times of day this happens; look for environmental cues -such a staff leaving to go home-and eliminate
 Involve in activity prior to this time of day
 Involve in activities that match the reason the resident has to leave-cooking, work, childcare

REPETITIVE PHYSICAL MOVEMENTS
 Activities that naturally involve repetitive movements-sanding, dusting, stuffing
 Rhythms band; dancing; movement to music; exercise
 Work oriented repetitive activities: sorting, stapling, stamping, cutting, folding

PHYSICAL COMBATIVENESS, AGGRESSION
 Remove resident from the situation to calm, quiet area without making a big deal about it
 Massage. Stroke or hold residents hand, it he or she will allow. Brushing hair
Dancing, singing, rhythmic music, clapping, marching
 Physical activity with gross motor movements, and safe props, if any; walking; ball activities
 Repetitive manual activities like crumpling or tearing newspaper for stuffing
 Give the resident something safe-non breakable-to hold
 Find ways in which the resident could have some element of control in the situation
 Normalization or repetitive activities that can be done alone
 Give the resident some space; Decreased stimuli in the environment
 Use of smells or foods that are soothing or comforting

RUMMAGING; PILLAGING; HOARDING
 Therapeutic "purses", bags, etc. filled with belonging that the resident can keep
Redirection
 Display items that can safely be picked up and taken by the resident; pegboard with collection of hats on, jewelry that belongs to the unit
 Don't simply take something away from the residents; "trade" it for acceptable item
 When coming into a resident's room to check their hiding places, ask "I've lost my ______________: I'd like to look for it here. Please help me look for it."

SUNDOWNING
 Adjust activity in staff schedules providing more things to do and staff to intervene at this time of day
 Use refreshments at this time today
 Have staff be very conscious and careful about the way in which they leave the unit at this time of day
 Suggest family visits at this time, if possible
 Use normalization and helping types of activities
 Consider a psychosocial group to address through group techniques/ relaxation techniques

INAPPROPRIATE SEXUAL BEHAVIORS
 Redirect attention to other things
 Seek family's knowledge about cause of behavior, give support to family, especially to spouse or resident
 Provide private area for more appropriate behavior

STRIPPING
 Use clothes with closures that aren't easily accessible to resident
 Try variety of types of clothing to determine whether resident will leave some types on
 Give resident things to do/ manipulate with hands; tactile stimulation props, busy box, board, apron, pillow
 Don't scold; calmly redress resident

CATASTROPHIC REACTION

: Identify the stressor(s) can eliminate or reduce as much as possible; take preventative action :
 Identify resident's "symptoms" leading up to reaction, and intervene at that time
 Use a consistent approach whenever dealing with catastrophic behavior
 Use enough-but not too many-staff to intervene in as calm a way as possible
 Determine successful ways to redirect residents and communicate these to all of the staff working with the patient