Lesson 15: Managing Behaviors and Symptoms


Attention

At times, when we are in the presence of someone who is acting out, we may feel like this!

When dealing with acting out behavior, we cannot refuse to hear, refuse to see, nor refuse to say something!


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify ways in which BPSD may be managed

Teaching

Read Chapter 9 in Cohen & Eisdorfer

BPSD

The collection of "issues" that arise as a result of Alzheimer's and/or Dementia is known as "BPSD" or Behavioral and Psychological Symptoms of Dementia.

These symptoms range widely in terms of type and severity, and they change over time. They manifest a great deal of distress and anxiety among caregivers, the patients themselves, and professionals.

The major goal of "Management" is to create a safe and comfortable living environment for everyone involved. To this end, there is much that we can do.

Psychological Symptoms

  • Delusions and Hallucinations
  • Misidentifications
  • Depression
  • Anxiety
  • Apathy

Behavioral Symptoms

  • Violence and Physical Aggression
  • Wandering
  • Agitation
  • Inappropriate Sexual Behavior

Working with Family Members and Caregivers (including other professionals)

What the field of Mental Health brings to the situation is a deep understanding of cultural factors associated with the expectations of aging.

When we think of aging person we rarely come up with the picture painted by the symptomatology indicated above. In addition, based upon individual cultural expectations, some of these behaviors may be quite upsetting.

Some of the cultural aspects of aging we contend with when we are working with others include:

  • Beliefs about aging and the role of older people
  • Beliefs about memory changes with aging
  • Religious beliefs and cultural norms
  • Size and location of racial/ethnic communities
  • Availability of family and other caregivers
  • Perceived burden
  • Availability and accessibility of culturally appropriate health care services

Our role may be to help everyone orient towards these factors and needs in managing the care of individuals who are manifesting these symptoms.

We may, for example:

  • Teach family members about the disease and how it progresses
  • Provide materials to dispel myths associated with aging and memory
  • Identify cultural and religious needs in a family to caregivers and decision makers
  • Help professionals understand the limited availability of some family members
  • Help caregivers identify and contend with the real burden of caring for another individual

Managing Behaviors

As with any problem solving situation, we go through a set of steps to address behavior management issues.

  1. Identify the problem and the symptoms (it is very important to identify WHO this is a problem for...it is a problem for the patient, or for the caregiver, or the staff, or the facility...???)
  2. Prioritize the problems (address the most important for safety and comfort FIRST)
  3. Gather detailed information (the more detail about incidents we can gather the better we can identify antecedent factors and other solutions)
  4. Identify consequences (identify what typically happens when a behavior occurs...often behaviors are functional...they manifest as inappropriate ways to meet legitimate needs...for instance, an inappropriate sexual comment or action may be a request for companionship)
  5. Develop a specific plan (Plans give all parties specific directions as to what they are going to DO if the behavior happens...this provides a consistent message to the patient and empowers everyone involved with their responsibilities)
  6. Work with everyone involved to develop PREVENTION strategies
  7. Find ways to praise everyone involved...this work is CHALLENGING and it is often filled with failed attempts
  8. Evaluate and Modify the plan as needed
  9. Pharmacological interventions MAY be indicated, but may not deal with all of the behaviors
  10. Sexual related behaviors need to be approached directly and frankly with sensitivity to cultural differences among all involved.

Some of the ways in which we can modify environments in order to reduce some behaviors (in general) include:

  • Structure in the environment to SHOW that people are safe
  • Stimulating activities (but not TOO stimulating!)
  • Involving patients in their care (no matter how "absent" they may seem)
  • Avoiding day time napping
  • Early evening activities (to address "sundowner syndrome")
  • Minimize noise
  • Consistent times for bed, meals, activity, etc.
  • Maintain lighting
  • Provide adequate for ADLs based on the person's functional abilities
  • ACCEPT THE REALITY THAT THEY ARE PRESENTING...any delusions and hallucinations are REAL for these people...you cannot argue them out of it and it is better to PLAY ALONG and then see if you can DISTRACT them into another action.

Assessment

Lesson 15 Discussion

Reflect on any situation that you may have been in when someone acted inappropriately. Did you respond well? Were you surprised? How do you think the situation was handled? What might you do differently next time?