Lesson 15: Managing Behaviors and Symptoms


Attention

At times, when we are in the presence of someone who exhibiting behavioral challeges (physical or verbal) we may feel concerned or wondering what our role might be in managing those behaviors!


Learning Outcomes

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

  • Identify ways in which Behavioral and Psychological Symptoms of Dementia (BPSD) may be managed

Teaching

Behavioral and Psychological Symptoms of Dementia - BPSD

The collection of behavioral 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 behavior 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

The psychological symptoms might present themselves as:

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

Behavioral Symptoms

The behavioral symptoms might present themselves as:

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

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. Is it a problem for the patient/client, 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/clients 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 activities of daily living (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.
  • This app is called the BPSD Guide. It lists physical behavioral symptoms, psychological symptoms, psychotic symptoms and disihibited behaviors. Look through the types of behaviors and as you drill down into the topics you will find lists of symptoms, ways to assess, interventions to use and clinical scenarios.

    The app is free. It will ask you on first entry if you want to particpate in a research study involving the use of the app. You should select Opt-out to not be including in the research study.


Assessment

Lesson 15 Discussion

Using the BSPD Guide iPad App listed in the lesson:

1) Go into the app and select one of the four behavior or symptom categories.

2) Read about the symptoms, contributing factors, diagnosis, assessment tools, conclusions, precautions, interventions and the clinical scenario.

3) Share your thoughts about your selcted behavior or symptom and what you learned about what it might look like and how to manage it.