Working with Clients with Dementia
Behavior Traits of Clients with Dementia
Caregivers need to be aware of what types of behaviors they may encounter when working with clients who have been diagnosed with dementia.
This unit defines “problem” behaviors commonly seen in the clients with dementia and provides methods for assessing, preventing and dealing with difficult situations.
Common behaviors are outlined below:
Resisting/fighting hands-on caregivers
Wandering and rummaging
Disruptive yelling or moaning
Problematic sexual behavior/ disrobing
If careworkers are aware of the behavior they can expect from client- they will be better equipped to mentally and physically deal with it!
Why Behaviors Occur
There are often a variety of reasons that cause patients with dementia to exhibit “problem” behaviors. Such reasons are outlined below:
Effects on the Brain
Alzheimer’s involves areas of the brain that control emotions and behavior.
The Brain and Behavior
As a result, many clients exhibit increased volatility, and are more prone to have behavior problems associated with aggressive and acting out behaviors.
The profound confusion caused by dementia makes it difficult for clients to understand their surroundings and what is going on around them.
When people are confused they are more likely to feel anxious, afraid, suspicious, and/or angry, and they are much more likely to act out and exhibit problem behaviors.
Clients with dementia often cannot accurately indicate, describe, or otherwise verbalize their pain. They often express their pain indirectly through their emotions and behaviors.
Many of the common behaviors exhibited by clients are actually very basic and reflexive responses to pain.
The Dementia Care Philosophy as it Applies to Behavior
Caregivers need to always apply the Dementia Care Philosophy (covered previously in the course) when dealing with ”problem” behaviors from clients.
A reminder of the Dementia Care Philosophy is outlined below:
Respect, compassion, and dignity must be maintained at all times.
Individuality. Every person with dementia is a unique individual, and must be treated that way.
Caregivers should strive to develop close personal relationships with clients with dementia. Knowing the client helps in understanding that person and in anticipating his/her needs.
Using a sound Dementia Care Philosophy greatly diminishes problems behaviors. The attitude and approach of the caregiver are critical. Use a “soft,” gentle, comforting approach at all times.
Key Principles of Intervention
Never intervene when a person with dementia is exhibiting “problem” behavior unless one of the following applies:
The behavior significantly violates the rights of others.
The behavior poses a significant threat to someone’s health or safety.
Only when it is necessary to intervene, be sure that you do so in a manner that does not does endanger any of your clients or co-workers.
Follow the guidelines set by the priorities available by clicking the attached icon.
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When it IS necessary to intervene, keep in mind these priorities:
Safety:The first priority is insuring that the client is SAFE.
Comfort: Maximize comfort at all times and in all ways. When client are comfortable, they are less likely to exhibit behavior problems.
Behavior as Communication: People with dementia communicate through their behavior. With this in mind, caregivers should assume that behavior problems represent a message in which the client is telling the caregiver that something is wrong and needs fixing.
Clarity: When residents truly understand what is going on, they are less likely to be confused or afraid. A goal is to make the environment, especially caregiving situations, as clear as possible.
Unmet needs: When their needs are not being met, clients often exhibit behavior problems. Caregivers should anticipate and address all needs. This is much easier to do when the caregiver comes to know the client very well.
“Soft Approach”: Use a soft voice, soft actions, soft expressions, and soft touch. Smile and maintain a warm demeanor. Go slow. Talk using short, simple, concrete words/sentences. Go one-step-at-a-time. Always be gentle, kind, apologetic, and respectful. Never correct or confront. When a person with dementia gets upset, back off, re-establish rapport, engage/distract, then re-approach. Or simply leave and come back later.
Prevention – Maximizing Comfort
Preventing behavior problems starts with good care. The knowledge, skills, techniques, and approaches of caregivers are all critical factors in the cause and treatment of behavior problems.
Critical to minimizing the occurrence of “problem” behavior is focusing on comfort. Dementia care is comfort care. Caregivers should always strive to make the person with dementia as physically and emotionally comfortable as possible.
The goal of caring for people with dementia is to maximize their comfort.
Comfort is a multifaceted concept that includes the physical, sensory, emotional, environmental, social, and spiritual well-being of the individual.
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Below are tips to help ensure a client enjoys maximum comfort
The sense of confusion experienced by the client makes them far more susceptible to physical and emotional discomfort.
It may be challenging to assess and effectively enhance the comfort levels of the client since their communication skills are diminished by their dementia (e.g., they may not be able to say that they are in pain).
People with dementia who are comfortable exhibit less behavior problems.
Comfortable people don’t hit
Comfortable people don’t yell or scream
Comfortable people don’t moan or cry
Comfortable people don’t act agitated or distressed
Maximum comfort is achieved through good caregiving. People with dementia who are well cared for exhibit far fewer behavior problems than those who are not well cared for.
The “soft” approach is designed to maximize comfort during care situations and all interpersonal interactions/relations.
Prevention – Anticipating Needs
Caregivers should be proactive in addressing the needs of people with dementia by anticipating those needs ahead of time, especially since people with dementia often require a great deal of care and may not be able to verbalize their needs.
This requires the caregiver to know the client extremely well, including all the subtle, highly individual nonverbal cues the client exhibits to communicate his/her needs.
Carergivers should also aim to maintain a dementia-friendly environment that is safe, comfortable, and at the appropriate level of stimulation.
They should also maintain a philosophy of respect, dignity, compassion, and individuality at all times.
Intervention - Caregiver Approach
The caregiver’s response to behavior problems has an enormous impact on whether or not the behaviors will diminish or escalate. Therefore, the caregiver’s approach is a significant factor in what happens to a behavior.
When caregivers have to intervene, it is recommended that they use the “soft approach”, designed to help clients feel calm, comfortable, and safe,outlined below:
Ensure that you smile and are warm and friendly toward the client. Use pleasant voice tones and a gentle touch.
Use slow and calm reactions. Have consistency in environment, routine, activities, and caregiving approaches.
If the client gets upset, consider leaving him/her alone for a few minutes, giving him/her time to calm down, before re-approaching.
Avoid arguing, correcting, confronting, or other negative interactions. Use prompts and cues, rather than challenging or directing.
Intervention - Caregiver Approach (Continued)
When using the caregiver approach it can useful to engage the client in a personally meaningful fashion that draws their attention away from the upset and distress of the situation. Examples include:
Offer something to eat or drink
Go for a walk; go outdoors
Talk in a calm, soothing way
Play music; sing a song
Look at pictures
Say a prayer; sing a hymn
Figure 1. A walk outdoors can be a good way to calm and centre a client
Dealing With Common Behaviors
Below are a range of proposed strategies to deal with common behaviors that carers experience when working with patients diagnosed with dementia:
Maintain compassionate dementia care philosophy at all times. Use the “soft” approach to avoid triggering combative responses.
Back off, apologize, act “soft”, engage and distract attention away from upsets when a client gets upset or combative. Re-approach with the “soft” approach once the client calms down.
Assaultive towards Peers and Caregivers
Look for people/situations that consistently trigger assaults and strive to change those triggers. Look for early warning signs and intervene before they escalate.
Use the “soft” approach while engaging and distract attention away from upsets.
Allow and tolerate restlessness. Maintain a soothing, low- stimulation environment. Only consider medications if client is uncomfortable or is endangering themselves or others.
Do caregiving “on the run”, including eating (if necessary). Allow sleep wherever/whenever they like, no matter what time of day or night if the situation allows. Use soothing music and soothing touch.
Anticipate needs. Check for pain and treat any and all possible areas of discomfort (e.g., hunger, thirst, clothing, positioning, environment, etc.). Push food and fluids and good bowel/bladder care.
Maximize mobility. Maintain a soothing environment. Preoccupy attention. Keep stimulation low and soothing, but don’t isolate.
Allow the client to sleep according to their own individual sleep patterns and schedules, including during nighttime hours (whenever the situation will allow).
Avoid using tranquilizers for sleep unless absolutely necessary. Don’t try to keep the client awake all day in order to get them to sleep at night (will cause “sundowning”).
END of UNIT
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