Main image courtesy of Medium.
As a nurse or CNA who works with elderly residents, chances are you’ve encountered some challenging or inappropriate behavior from your patients. Many seniors who are struggling with dementia or other cognitive impairment issues engage in behavior that may not make a lot of sense to staff.
However, you’re committed to the care of these individuals, which is why it’s so essential that you’re able to recognize and respond to these kinds of situations. One of the best ways to ensure you’re ready to give the care they need is to have the appropriate training with courses in behavior management from Mariposa Training.
In this guide for nurses and CNAs, the topics we’re going to cover include:
- Why residents might in engage in inappropriate social behavior
- Types of inappropriate social behavior common in dementia patients
- The underlying causes of inappropriate behavior
- How nurses and CNAs can offer their best care
Why Do Residents Engage in Inappropriate Social Behavior?
Understanding why residents with dementia use this type of behavior
Residents with dementia may engage in inappropriate social behavior because they have an unfilled need. Image courtesy of CNA Online Course.
No matter if you work in a hospital, nursing home, or other senior facility, as a geriatric nurse or CNA, part of your daily routine involves the care of dementia patients. Although not always the case, oftentimes dementia patients can exhibit challenging or inappropriate social behaviors during their day to day lives in a nursing care facility. As the disease progresses, patients can develop symptoms such as aggression, resistance, hallucinations, and even delusions that can make engaging with them and assisting them in their daily needs stressful for caregivers. But why do dementia patients exhibit these kinds of challenging social behaviors?
Many times patients are engaging in inappropriate social behaviors because:
- They cannot ask for what they need. Dementia patients sometimes are dealing with issues such as pain, fatigue, or even boredom and cannot ask for what they need. This typically occurs when they have lost the ability to verbally communicate or formulate logical thoughts.
In order to try and get through to caregivers, they may engage in what we view as inappropriate types of social behavior. Unmet needs can be the reason that dementia patients may appear to get increasingly aggressive or resistant to care.
- It is their only way of communicating. For many patients, aggressive or difficult behavior is their only way of communicating. As the disease progresses, the patient loses their cognitive abilities, and can be confused or stressed out about what is happening around them. To them, this type of behavior is the only way they can express what they’re feeling, or ask for what they need.
These types of behaviors can also be the result of triggers (change, stress, fatigue, pain), which is why it’s important for nursing facility staff to pay attention and notice what might be causing the challenging behavior. Patients are trying to communicate something when they act in this way, and it’s the job of caregivers to figure out how to meet their needs.
What Are the Common Inappropriate Social Behaviors in Dementia Patients?
Learn how to identify inappropriate social behaviors in senior residents
The first step to helping patients with challenging behaviors is to recognize that it is a symptom of deeper concern. Image courtesy of All Allied Health Schools.
In order to provide the best care you can to senior patients with dementia, it’s crucial to be able to identify challenging social behaviors. Once you can recognize some of the common types of behaviors in dementia patients, you will be better prepared to help. Remember, there’s always a reason behind the difficult social behavior of residents in your care. Once you start to recognize some of the common behaviors, you can determine what the actual problem is and find ways to appropriately address it.
Using a root cause analysis is one of the most beneficial ways for staff to discover what the real issue is with their patients, and find the correct ways to address the problem.
Resisting care
Many dementia patients engage in resistance to care when they become frustrated or confused. This can also occur when something suddenly changes in their daily routine or to their environment, making it appear less familiar. Although the resistance to care may appear suddenly one day, chances are it could also be the result of something that’s been building up for a while.
If your patient seems to be uninterested in receiving care, it’s important to take the time to ask them if something is bothering them or if they’re in any pain. Even if they cannot form a logical reason why they’re exhibiting a resistance to care, you can always note why this may have occurred.
Was there a trigger such as a change of routine? Do they need to be examined by a doctor in case something is wrong? These are all good questions to ask in order to get to the root of what’s causing the resistance or agitation.
Abusive language
An additional form of agitation is the use of abusive language when you’re trying to engage with a patient with dementia. Many times the person using the abusive language has never used that type of language in the past, but with dementia, this is a common symptom. Abusive language can be caused by triggers, just like the other types of inappropriate social behavior. Common triggers that can cause abusive language from a patient towards a caregiver or family member visiting include:
- Changes in routine
- Overstimulation
- Unfamiliar place or people
- Feelings of being patronized
Although these are not the only triggers, they can lead to abusive or foul language in your senior resident. As the disease progresses, many dementia patients struggle to find the right words, and become even more frustrated that they can’t get their needs met.
Foul language and name calling are difficult to hear, but it’s important to again understand all this behavior stems from an unmet need that they are unable to verbalize to caregivers. Take notice of whether or not this type of language happens after one of the common triggers. Once this is taken into consideration, it may be easier to avoid that trigger in the future.
Wandering and exit seeking
Wandering and exit seeking can also be challenging behaviors nurses and CNAs will encounter in a nursing facility with dementia patients. While there are a variety of reasons why a resident may feel the need to wander—they’re looking for someone, feel that they need to be somewhere, or are simply trying to relieve boredom—wandering should be addressed.
If you have residents that are engaging in wandering or exit seeking behaviors, this could be because they are worried or frustrated and trying to communicate that to the staff.
Socially inappropriate sexual behavior
Socially inappropriate sexual behavior may also occur in patients with dementia. When this happens, it is because residents no longer are in control of their responses, are disoriented, or they are trying to communicate that they may have an unmet need— such as needing to use the restroom. While this type of behavior can make staff and other visitors uncomfortable, it is important to understand how to effectively distract and redirect their attention to another type of activity.
Hoarding
Sometimes you might have dementia patients that start to hoard a variety of items. This may be done because they’re afraid they’ll run out, or it may make them feel more in control. This type of behavior is typically the result of a need to feel safer and more secure, and holding onto a specific type of item makes them feel that way. Hoarding should be a sign to nurses and CNAs to investigate what could really be at the root of this behavior—does the resident need to feel more secure? Are they actively engaged in activities? Or do they need a more positive source of comfort?
Attention seeking
When delivering care to different residents in a senior living facility or nursing facility, there may be patients with varying degrees of cognitive abilities. Sometimes dementia patients may use attention seeking behaviors in order to try and have their needs met. It’s important that as a caregiver, you start to understand this “language.” While yelling or crying will get the attention of a caregiver, the resident may not be able to fully communicate what is really wrong.
As with all other challenging social behaviors, it’s important for staff to recognize what is really going on, as they’re just a symptom and not the root cause. In order to better understand how to help, let’s discuss a little more about the major underlying causes of these difficult behaviors.
Underlying Causes of Inappropriate Behavior
Getting at the root of the problem behavior with dementia patients
A little investigating into challenging social behaviors could reveal what’s really going on with a dementia patient. Image courtesy of University of St. Augustine.
Learning how to understand what a resident is trying to “say” in their behavioral language is the key to meeting their needs. There are four types of antecedents that can be at the root of challenging social behavior with dementia patients.
Human factor
When analyzing the reason for difficult behavior in dementia patients, sometimes it can be because of something that is directly affecting the well-being or health of the resident. They could be resisting care or shouting abusive language to staff members because they are:
- In pain
- Fatigued
- Dealing with a change in medication
- Have an undiagnosed issue
- Are dehydrated
- Are feeling scared or dealing with loss of control
Any one of these human factor antecedents could be the real reason behind the challenging behaviors.
Environmental
Change can be difficult for dementia patients, especially when their environment changes. Sometimes their challenging social behaviors can be the result of:
- Less than perfect levels of stimulation, either too much or too little
- Changing light levels
- The temperature of their room or during everyday activities such as bathing and eating
Situational
At times the trigger for inappropriate social behaviors can be situational, and dependent on factors like:
- Perceived lack of personal space
- Fear of touching or contact
- Change in routine, surroundings, or staff
Delivery of care
And finally, residents with dementia may also engage in disruptive or difficult behavior because they are not receiving the care they need—and their needs are going unmet. This can occur when:
- They are not treated with respect
- Do not have their needs met in time
- There is a change in their daily routine or usual caregivers
- Residents are asked to do things beyond their capabilities
It is the job of the staff at the nursing care facility to ensure when challenging social behavior occurs, they ask the “why” questions in order to get at the root cause, which will fall under one of these antecedents.
Don’t Treat the Symptoms, Treat the Cause - What Nurses and CNAs Can Do
Staff training in inappropriate behavior of dementia residents is essential to get at the root of the problem
Recognizing challenging behavior is just the first step when it comes to helping meet the needs of dementia patients. Staff such as nurses and CNAs are in a unique position since they interact with the residents on a daily basis. With training and experience, they can learn to see what these kinds of behaviors are—symptoms of an unaddressed issue. Staff can help address these concerns when they act according to a plan.
- Understand the language of the impaired residents
First, you’ll need to understand the “language” of the dementia residents. Sometimes that language is inappropriate social behavior such as wandering, foul words, or lashing out. As a caregiver to impaired patients, you know that this behavior is a symptom of dementia, and is not indicative of what the patient may actually be trying to express.
- Identify, address, and prevent
Once the behavior is identified, it’s time to ask why this is occurring. This will help get you to the right antecedent that is likely causing the problem. In order to get to the root cause, you’ll need to step back and continue to ask why the resident has acted in this way,
- Track behaviors
It’s also important to track this as a part of a comprehensive behavioral management plan. If you start to notice patterns of what triggers certain behaviors, this is a useful way to address the root cause of them, instead of the symptoms. Having a way to document when, where, and why the behavior occurred may be able to prevent future occurrences.
Although inappropriate social behavior can happen with dementia residents, there are ways nurses and CNAs can help get to the root of the issue, and help fulfill the needs of their residents.
