By Kim Warchol, OTR/L, DCCT

(Page 3 of 5)

 

Component 3: Dementia Capable Behavior Management.

The caregiver must know how to reduce the prevalence of negative behaviors. This begins with knowing that the vast majority of negative behaviors expressed by a person with Alzheimer’s/dementia have a reason or trigger and that behavior is most often simply a communication of an unmet need. Typical reasons for a negative behavior may be unmanaged pain, loss of control, fear, or boredom. The caregiver must have the ability to observe the situation and behavior to try to discover the trigger. A good approach to behavior analysisis the use of the “w” questions. Ask, “who” is present during the behavior, “what” is occurring, and “where” and “when” is the behavior occurring? This may show a pattern that leads to identification of the behavior trigger. For example, a young child may always have a behavior meltdown during a stressful day in which there was more than the usual activity that led to missing a nap. The parent observed that every time the morning nap was missed, the child had a tantrum or was very resistive and cranky in the afternoon. Similarly, I have found that those with moderate/severe dementia “sundown” more often or more severely when the stress of the day was higher than usual. Once the causes of the stress were addressed, the sundowning ceased or was greatly reduced. Therefore, if the behavior is not causing an emergency situation, it is important for caregivers to take time and look for patterns that lead to identification of the likely reasons behind the behavior. When the trigger is addressed, it can reduce or completely eliminate the negative behavior.

As mentioned above, dementia capable care is not unlike child care as many of the basic principles of child care apply to care for elders with Alzheimer’s/ dementia. For example, for children (and for those with Alzheimer’s/dementia), it is the caregiver that must change the world for the child to feel and be successful. In child care, the guide as to what and how much to adapt is the child’s age. In the case of Alzheimer’s/ dementia care, the guide is the stage of dementia the person is functioning within. Of course, there are many differences because we would never treat an adult like a child. Also, an elder has a history that deserves respect and an elder may feel shame in a way a child would not. While honoring these differences, it is very helpful to think about the many similarities. For example, a child at the age of two could participate in washing their face and brushing their teeth with much support and guidance from Mom or Dad. Mom or Dad will innately “adapt the activity to the just right challenge level” to facilitate a successful functional and emotional experience for that young child.

The following lists some of the adaptations the parent might make:

• Only have the items on the counter that are needed to brush their teeth or wash their face as anything else may become a distraction

• Simplify communication by giving a simple one step direction such as “put the brush under the water” while simultaneously guiding the child’s hand through the motion

 

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