Dementia care
experiences such as pain, hunger, thirst, tiredness, loneliness, and boredom might result in irritability or agitation, especially if the person cannot meet their own needs or communicate about these to care providers. At other times, the person may
experience symptoms that result from neurological and clinical changes occurring as part of the illness. A person with dementia may experience depressed mood or develop psychosis, which refers to a change in mental state with an altered sense of reality, experiencing hallucinations, which is seeing and hearing things that are not real, or presenting with delusions, which are fixed, false beliefs. People with dementia may, for instance, believe that people are stealing from or persecuting them, which may make them defensive towards others. While misinterpretation of experiences such as misplacing personal belongings may contribute to these symptoms, they may also be primary symptoms of neurocognitive change. People with dementia are also vulnerable to changes in mental state when they become medically unwell, such as with a urinary tract infection, for example. At these times, the person might present with delirium, causing increased confusion and agitation that influences their behaviour.
Assessment is the key to understanding changed behaviours Aged care providers must understand BPSD and be able to support the workforce in responding with knowledge, skill,
Having terminology that enables clear communication so that contributing factors can be understood and supported is helpful
and resilience that is grounded in a compassionate person-centred approach. A thorough assessment is vital to insightfully supporting a person experiencing BPSD. Assessment requires time and critical reflection about what may contribute to a person’s changed behaviour to address underlying causes rather than superficially targeting observed behaviours.
It is essential to consider intrinsic (within the body) triggers for behaviour change. These may include the disruptions in brain circuitry caused by dementia, acute or chronic medical conditions, pain, mood changes, and unmet needs, including simple physical needs, such as hunger and thirst, or more relational and occupational issues, such as the need for meaningful activity and personal connection. Another intrinsic factor to consider is the person’s history and personality. Understanding the person’s life story may explain particular responses. For instance, a history of personal trauma may account for anxiety or defensiveness. Identification with a cultural or professional background may account for preferences or expectations in how others relate to the
person. A person may have lived with a particular mental health condition. When working with a person with dementia, there is no substitute for knowing their story and developing a care plan around this. Extrinsic (outside the body) triggers can also cause behaviour change. Extrinsic factors may include environmental factors, such as inadequate space, overcrowding, noise, and the behaviour of others living in the same environment. Notably, the approach of care staff is also a critical factor that may contribute to a person’s behaviour. Not surprisingly, a person with dementia may become agitated or defensive if care staff rush because of a task-oriented approach or when staff speak in a way that is not patient and easily understandable. A practical approach to assessment
is the ABC model. This approach helps care providers consider the antecedents to changed behaviour, considering the intrinsic and extrinsic factors that may have triggered the behaviour. It prompts carers to evaluate the behaviour, asking what happened and how the person interacted with their environment. Finally, it focuses on the consequences of the behaviour, considering the impact of the behaviour on other people and the care environment. Carefully documenting observations, including the nature of behaviours, their frequency and the effect of strategies or treatments used to respond to them, empowers care providers to understand better what is happening for the person with dementia and develop a care plan that, over time, reduces their experience of BPSD.8
Case Study 1: Assessing Meera Meera is a 75-year-old woman living with Alzheimer’s disease. She also has osteoarthritis and diabetes. Meera can no longer communicate using whole sentences but instead uses repeated words and sounds. She becomes distressed when care staff assist her with personal hygiene, appearing frightened and becoming physically defensive. Staff feel stressed by Meera’s response and have been using four people to attend to her care needs. Care staff undertake a comprehensive assessment to identify contributing factors to Meera’s distress. They recognise that she experiences pain when staff touch her while delivering personal care. They realise she does not like being rushed and becomes anxious if the room is crowded and care staff speak at once. Care staff dig into her
May 2023
www.thecarehomeenvironment.com 19
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44
