GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS
- Build a POSITIVE, TRUSTUNG RELATIONSHIP. You are familiar and you are SAFE
- Use effective verbal and nonverbal communication techniques.
- Encourage independence in the person. Try to help the resident build a sense of control and competence over his/her life.
- Avoid “why” questions.
- Avoid arguing, yes/no battles, rational or logical explanations, and debates.
- Re-direct questions to save the resident grief and reduce problem behaviors (i.e., validation therapy).
- Redirect or divert the resident’s attention to a positive topic, activity, or object.
- When a behavior requires intervention, act quickly with positive techniques and activities.
Dementia related behaviors: Non-pharmacologic responses and interventions.
❖ Wandering/Pacing
- Movement with or without a purpose or goal
- Interventions:
- Distraction/diversion
- Use signs for cueing
- Maintain a safe area to pace
- Monitor fatigue
- Create purposeful activity such as rummage or sensory stimulation kits.
- Create interesting places to move toward.
- Consider a change in body temperature. Go outside in a safe internal space. Walk/Wheel with resident. Drink something cold or hot. Wash hands in cold water etc.
❖ Rummaging/Pillaging
- Searching, looking at
- Interventions:
- Provide safe objects to touch, hold, manipulate. The more familiar the objects, the better.
- Invite residents to take objects from one place to another.
- Is the environment or something in it new?
- Ensure personal items have resident names in place.
- Support a resident’s interest in organizing and repositioning items.
❖ Anxiety/Agitation
- AEB: inappropriate verbal, vocal or physical activity
- Interventions:
- Avoid frequent changes
- Decrease crowds or loud noises
- Recognize what can create overwhelming feelings for a resident.
- Watch for signs in advance of mood changes and distract or remove person from the stressful situation to a calmer space.
- Recognize anniversary events or response to family leaving.
❖ Catastrophic Reaction
- Exaggerated or over-reaction to an incident demonstrated by sudden mood change, uncontrolled crying, agitation, and restlessness, anger - with or without violence.
- Interventions:
- Anticipate stressors
- Use positive statements
- Distraction/diversion
- Failure-free activities
- Respond to the emotion
- Use exercise through meaningful, movement based activities to reduce stress
❖ Combativeness/Aggression
- Physical striking out (hitting) due to a fear, anger, misinterpretation, or challenges
- Interventions:
- Check residents sleep and fatigue level. Has resident slept well in the past 48 hours?
- Ensure resident is physically comfortable.
- Respond, distract to avoid further aggression
- Move and speak slowly, remind resident who you are; do not threaten
❖ Sun downing
- Increased behaviors (pacing, confusion, yelling, restlessness, etc.) that occur mid to late afternoon and evening, possibly due to circadian rhythm, physical, emotional exhaustion or dehydration
- Interventions:
- Simplify approaches and environment
- Rule out PAIN or lack of sleep
- Take the resident outdoors – exposure to sunlight
- Encourage fluids
- Rest periods after lunch
- Involve in a quiet activity
❖ Screaming, yelling, calling
- Expressions of fear, or losing control
- Interventions:
- Check hearing and vision?
- Evaluate for pain?
- Distract, divert (use music, folding towels, etc.)
- Use touch, if appropriate
- Try turning on a light
❖ Repeated movement
- Using hands or fingers to take apart or pull at things or hitting or wiping surfaces, or chewing, clapping etc.
- Interventions:
- Side effects or medication?
- Give resident something to hold
- Provide resident with music of choice and personal earphones. Perhaps the behavior is self-stimulating.
❖ Layering or stripping off clothes
- Dressing/undressing of clothes in inappropriate places or times.
- Interventions:
- Gently assist the resident to put on a robe or clothes
- Keep clothes accessible for resident to change between.
- Assess whether resident is hot, cold or simply uncomfortable in the garment.
- Evaluate for soiled undergarments.
❖ Socially Inappropriate Sexual Behavior
- Sexual activity involving socially inappropriate language, public exposure, offensive and/or misunderstood gestures.
- Interventions:
- Remain cam; don’t overreact, argue, scold or laugh
- Ignore language and behavior, distract or divert
- Assist resident to private space
- Evaluate whether behavior is a side effect of medication.
❖ Demanding or accusing
- Wants everything done immediately or cannot remember where possessions are located
- Interventions:
- Use caring calm voice
- Assist to find missing items
- Use food or tasks to distract
❖ Hallucinations and Delusions
- Hallucinations: sensory experiences (hearing, seeing, tasting, smelling, feeling) not experienced by anyone else
- Delusions: persistent incorrect beliefs (“you’re not my daughter”)
- Interventions:
- Check hearing, vision, hearing aids, glasses
- Modify environment to eliminate causes
- If harmless, let go and distract with tasks
- Remember that it is real to the resident
- Don’t take it personally
❖ Withdrawal and Apathy
- Sadness or depression - surroundings and people
- Blank look of sadness
- Absence of expression
- Retreating to room
- Interventions:
- Anticipate and avoid problem situations
- Encourage positive situations
- Reassure resident that he/she will be cared for as long as necessary
- Do not force participation
- Help resident to feel safe and secure.
