ENSURING QUALITY CARE
WORKING WITH CHALLENGING BEHAVIOR • Overview of dementia types • Overview of challenging behaviors • Creating alternatives to medications and restraints September 2019 Safety, Oversight and Quality Unit 2
DEMENTIA September 2019 Safety, Oversight and Quality Unit 3
PURPOSE AND KEY TERMS • Challenging behaviors The purpose of this section is to assist the learner in acquiring • Behavioral symptoms basic understanding of types of • Delirium dementia, how care needs change • Dementia as a resident with dementia changes and what to expect when • Depression caring for a resident with dementia. September 2019 Safety, Oversight and Quality Unit 4
OBJECTIVES The learner will be able to: Define the different types of dementia Explain causes of dementia and identify the most common form of dementia Describe behavioral symptoms associated with dementia Give examples of reversible causes of dementia Give examples of the types of care needs of residents with dementia and how the care needs will change for the resident September 2019 Safety, Oversight and Quality Unit 5
INTRODUCTION Challenging behaviors are those behaviors that affect the health and safety of either the resident or others. • Challenging behaviors can include: • Wandering • Hitting or biting • Verbal aggression that causes others to react in a physically harmful way • Challenging behaviors do not include: • Arguing • Cussing or name calling • Being picky • Incontinence • Having a negative attitude or difficult personality September 2019 Safety, Oversight and Quality Unit 6
INTRODUCTION Understanding the causes of challenging behaviors can be useful in understanding the person. • Challenging behaviors can be the result of a: • Unmet need – not being able to appropriately identify the need • Medical Condition • Psychiatric Condition • Dementia, depression and delirium frequently result in challenging behaviors: • It is important to understand the symptoms of dementia, depression and delirium September 2019 Safety, Oversight and Quality Unit 7
INTRODUCTION CONTINUED Behavior is a form of communication: • Challenging behaviors often result when a basic need has not been met • A person may be conveying many needs through challenging behavior Often, resident behaviors are a problem for others but not for the resident: • A resident who eats his food with his fingers may be a problem for you because you are not comfortable observing this • However, it more than likely is not a problem for the resident as long as they are getting enough to eat and a balanced diet September 2019 Safety, Oversight and Quality Unit 8
INTRODUCTION CONTINUED • A resident who repeatedly sings or hums the same two lines of a song can be “annoying” but is not considered a challenging behavior • A resident who smears fecal matter on their bed or clothing when trying to take their brief off may be an inconvenience because there is extra work involved in cleaning it up • When looking at behaviors ask yourself, “is this my problem or is it a problem for the resident?” • Can the behavior be mitigated through a behavior support plan or interventions to prevent the behavior from escalating? • If a resident’s behaviors become a health or safety issue for the entire household it must be addressed. September 2019 Safety, Oversight and Quality Unit 9
INTRODUCTION CONTINUED One of the most important things you must do is to develop a relationship with the resident. The better you know the resident the better you will understand their needs and the way that they communicate. You may also find the behavioral symptoms are not a problem at all because you know what they mean. September 2019 Safety, Oversight and Quality Unit 10
REVIEW OF DEMENTIA TYPES Dementia is defined as “the loss of intellectual function (thinking, remembering and reasoning) so severe that it interferes with an individual’s daily functioning and eventually results in death.” • Most of the behavior symptoms that confront caregivers occur with residents who have dementia. • Dementia is a broad term that describes a group of symptoms. September 2019 Safety, Oversight and Quality Unit 11
REVIEW OF DEMENTIA TYPES CONTINUED Symptoms of dementia: • Memory loss • Disorientation • Personality changes • Inability to carry out normal activities of daily living (ADL’s) • Thinking and reasoning difficulties • Dementia can have a variety of causes – the most common cause is known as Alzheimer’s disease September 2019 Safety, Oversight and Quality Unit 12
REVERSIBLE CAUSES Sometimes a resident’s behavior will change suddenly. This generally is not a sudden onset of dementia but is “delirium”. Delirium most commonly is caused by an infection, medication reaction/ interactions, illness, or dehydration. Dementia is not reversible but delirium can be quickly reversed by treating the cause. When reporting the behavior changes to the physician or nurse, it is important to explain that the behaviors are new to the resident. September 2019 Safety, Oversight and Quality Unit 13
REVERSIBLE CAUSES CONTINUED Reversible Causes of dementia: • Drug toxicity • Infection • Depression • Metabolic and endocrine disorders • Vision and hearing problems • Nutritional problems • Tumors and trauma • Blood circulation complications September 2019 Safety, Oversight and Quality Unit 14
DEPRESSION Depression can also cause confusion and behavior changes in older adults: • You may observe the resident has lost interest in eating, loses weight (a younger resident may eat more and gain weight), sleeps poorly or sleeps much of the time, and has little interest in activities • The resident may have multiple complaints of physical problems and may talk about death • They may be confused and disoriented September 2019 Safety, Oversight and Quality Unit 15
DEPRESSION CONTINUED Short-term depression is a normal reaction to loss and grief: • When residents leave their own homes to live in an AFH, they will grieve the loss of their home and independence. • Chronic depression does not get better without treatment and can be life- threatening. • Contact the physician, nurse or mental health professional to report this type of depression as the resident may need an antidepressant medication and/or mental health therapy. September 2019 Safety, Oversight and Quality Unit 16
MEDICATIONS Medication reactions/interactions can cause behavior symptoms: • Ask the pharmacist to review their medications to be sure the behavior isn’t the result of medication reaction or interaction • After trying to change or work with the behaviors, you may want to ask an RN or mental health professional to assess the resident – they can help you determine alternative measures • Contacting the physician for a medication or physical restraint order should be the last thing that you do September 2019 Safety, Oversight and Quality Unit 17
MEDICATIONS CONTINUED Find out as much as you can about the individual’s behaviors. If possible, work with the resident’s family and/or others who are significant in the resident’s life. They may be able to provide valuable information including their history and patterns of daily living activities. If you have gathered information about the resident’s past work, volunteer and social activities you may find a way to work with the challenging behavior. September 2019 Safety, Oversight and Quality Unit 18
DISCUSSION/QUESTIONS Safety, Oversight and Quality Unit September 2019
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