Principles of Behavior Management and Avoiding Over-stimulation with Dementia – Principle 7

Understanding the changes in mental or cognitive functioning that come with dementia gives caregivers effective approaches to reduce or avoid behavior problems. These behavioral approaches can minimize emotional flare-ups, power struggles, and physical outbursts. Ideally, these approaches can also reduce the amount of psychoactive medications that are needed.

This is another CoHealth blog on caring for individuals with dementia, whether they are residing in nursing homes, residential and assisted living settings, or in their own homes. An important principle in behavior management is to use isolation when the person becomes agitated due to over-stimulation, and move him to another room or setting that is less stressful and less stimulating. This can frequently occur in residential settings, where the level of activity and programming can be too stressful and demanding for the impaired resident to comprehend and process. Dementia produces a difficulty in processing incoming information, generally both auditory and visual information, and too much stimulation can lead to agitation, restlessness and irritability. A related principle is to be on the lookout for what are called precursor behaviors, or signs of an imminent outburst. These include rocking, pacing, clenched fists, or flushed face, all of which suggest more serious problems are on their way. Stay attuned and intervene quickly in the face of these precursor behaviors, and more serious outbursts can be avoided. When settled down again, the person can return back to the activity.

The more behavioral interventions we have in our caregiving repertoire, the more we can minimize potential problems and the more we can focus on the positive experiences of these individuals under our care. More approaches can be found in the CoHealth website's online courses, such as behavior management, understanding and differentiating depression, dementia, and delirium, and helping families with nursing home placement.

Principles of Behavior Management with Dementia – Principle No. 2

This is a second in a series about managing problem behaviors with older adults due to dementing illnesses, whether residing in nursing homes, independent or assisted living facilities, or their own homes. There are many sound, proven approaches for managing these problem behaviors. Psychotropic medications are one choice, but other approaches that are milieu or environmentally-based can complement the psychoactive interventions, and may allow for a reduction or elimination of the drugs altogether.

These caregiving approaches are formulated around the impairments that come with dementia, especially in the areas of cognitive, behavioral, and interpersonal functioning. These approaches recognize that the most effective interventions incorporate an understanding of why the person is behaving the way he is. For example, this blog discusses the need for consistency in all interactions and routines with these individuals, whenever possible. Because the dementia patient is unable to learn and process new information, it becomes necessary to rely on previously learned knowledge and information as much as possible. In long term care settings, this means providing familiar caregivers, familiar rooms for activities and seating arrangements in the dining room, and familiar roommates. Anything that is being provided for this individual should be the same, predictable and consistent as possible. In private homes, meal times, preferred seating locations, and even dressing and hygiene activities should be consistent from one day to the next.

When there are changes in routine, as with new caregivers, or changes in a schedule, roommates, or meal times, those familiar to the person should take extra time to explain the change, as unimportant as it may seem. Without the explanation and extra structuring of the event, we can tax the person’s feelings of security and safety, something that can easily lead to increases in anxiety and agitation. Even when we might think a little change of pace might be enjoyable or refreshing, the person whose neurons in the brain are not firing normally will likely not appreciate the unfamiliar change. And she may become more distressed by it.

As we better understand the various losses that occur with a dementing illness, we can minimize the triggers or causes of these behaviors, and how to de-escalate the problem after it has occurred. For more insights into these issues, see my online courses on differentiating among depression, dementia, and delirium and on managing problem behaviors in dementia patients, and families facing Alzheimer's disease.