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    AD Network News

    By Carly Hellen, Rush Alzheimer's Disease Center
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    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
       



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