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