Principles of Behavior Management with Dementia Patients

There are many sound, proven approaches for managing problem behaviors in nursing homes and other settings, especially those behavior problems resulting from dementia. Of course, psychotropic medications are usually the treatment of choice for these, which can be very effective when judiciously monitored and adjusted as necessary. However, there are non-medication, milieu-oriented approaches that are equally effective whatever the setting, and should also be considered, especially to maintain compliance with OBRA laws, and to avoid unnecessary medications.

This CoHealth blog – and upcoming blogs – will present a series of behavior management principles for use by paid and unpaid caregivers. These principles are formulated around the impairments in cognitive, behavioral, and interpersonal functioning that accompany dementia, and recognize that the most effective interventions incorporate an understanding of why the person is behaving the way he is. Once we understand the various losses that occur with a dementing illness, we have a better appreciation of how to minimize the triggers or causes of these behaviors, and how to de-escalate the problem after it has occurred. For example, the deficits in language expressiveness and comprehension, the inability to learn new information, and the difficulty in processing complex communication all will contribute to problematic behaviors.

The first principle has to do with creating a calm and reassuring environment. The dementia person is reacting to his environment, so to the extent that we can control the environment, we can also control the person’s behavior. First of all, we need to be sure it is not over-stimulating. We cannot have too much going on in these settings, or present more stimulation than the person handle, such as a loud television, radio, and overhead PA system - all on at the same time.  Excessive stimuli create anxiety and restlessness in the individual because the dementia patient has difficulty processing complex information, and filtering out unwanted or unnecessary sounds. So, with excessive stimulation we create the setting, the opportunity, and the risk for rising agitation and the potential for behavior problems. The more secure and safe the individual feels, the less anxiety he experiences, and the less anxiety, the less chance of a behavior outburst.   Principle number one, then, is to create a milieu or environment that does not over-tax the individual's ability to process all that he is sensing thru visual or auditory channels.

There is also a risk of too little stimulation being available so the patient does not become too disconnected from his world, but the priority here is for structured, familiar, and reassuring communication. This will be addressed in an upcoming blog.

If interested in learning more about this topic see my online course on Behavior Management, including Prevention of Aggressive Behavior and De-escalation Techniques at CoHealth.org.