Dealing with Difficult Behaviors

Communiction

 

What is a person trying to communicate through behavior? 
Experts say that all types of behavior are forms of communication.  Behavior problems surface for many reasons. If you can identify the reason for the behavior, you can know better how to handle it.         
 
 Common causes of behavior problems  

  • Fatigue  

  • Medications  

  • Frustration  

  • Dementia / Alzheimer’s / Other Brain Disorders  

  • Established Behavior Patterns  

  • Outside Conflicts  

  • Desire for Attention (children especially)   

 
Many times, dysfunctional behavior increases at the end of the day as stress builds and the person becomes tired. Pacing and wandering are clues that tension and anxiety are building. Certain stressors can trigger agitated behaviors.  Ignoring agitation behaviors is one of the worst things you can do. Try to discover the problem that is prompting the behavior, and fix the problem if you can. 

 

Common triggers of agitation behavior in clients with dementia 
  Fatigue  

  • Sudden or frequent changes in environment.

  • Sameness and routine help to minimize stress.  

  • Responses to overwhelming environmental stimuli.

  • Excessive noise, commotion, or people can trigger agitation behavior. Large group activities can be disturbing.  Excessive demands. Caregivers and family must accept the fact that the dementia client has lost and continues to lose mental functions. Pushing these clients to improve their capabilities will only cause stress.  

 

 

Dealing with challenging behavior is never easy. Caring for a client with dementia, Alzheimer’s, and other brain disorders poses many problems for caregivers. Keep an open mind and be patient. 
 

 

Suggestions for dealing with common behavior problems 
 Angry/agitated behavior 

  • Determine whether medications are causing adverse side effects.  

  • Reduce caffeine intake.

  • In severe cases, and as a last resort, medication may be prescribed to keep a dementia client calm.

  • Reduce outside noise, clutter, or number of persons in the room. Keep objects and furniture in the same places.

  • Help the confused person by making calendars and clocks available.  

  • Familiar objects and photographs may offer a sense of security and remind of pleasant memories.

  • Gentle soothing music, reading, or walks may help an agitated client.

  • Do not try to restrain a client during an outburst.

  • Keep dangerous objects out of reach.

  • Acknowledge the client’s anger over the loss of control in his/her life. Say that you understand the person’s frustration.

  • Distract with a snack or an activity.  

  • Limit choices. Instead of asking, “What would you like for lunch, soup or a sandwich?”  Say, “Here’s a sandwich.”  

  • Allow them to forget the troubling incident. Confronting a confused person may increase anxiety. 

Repetitive phrases and actions 

Avoid reminding the client that he/she just repeated the same phrase or asked the same question. Ignoring the repeated phrase or question may work in some cases.

  • Agitated behavior or pulling at clothing may indicate a need to use the bathroom.

  • Do not discuss plans until immediately prior to an event.  

 

Paranoia 
Explain to family members that suspicious accusations are part of the illness.

  • Check out paranoid behaviors with the client’s doctor.

  • If the dementia client says money or an object is missing, assist him in locating it. Avoid arguing. Try to learn his/her favorite hiding places.

 

Wandering and pacing 

  • A person who paces incessantly may burn off too many calories. Also, pacing may turn into wandering. Provide inviting places for the pacer to sit and relax.  

  • Locking a client in his room or restraining him in a chair is inappropriate. Implement activities and adjust the environment to relieve agitation.

  • Put away items such as coats, purses, or eyeglasses. Some clients with dementia will not wander without taking certain personal articles with them. If they can't find them, they won't leave.

  • Provide for regular exercise and rest to minimize restlessness.

  • Dark-colored mats placed in front of doors may prevent the client from stepping outside. Black or dark blue areas may look like holes in the ground to a client with dementia, prompting the person to avoid the area. 

 
Hoarding or gathering 

 • Provide the client with a safe place where he/she can store items, such as a canvas bag. 
 

Incontinence 
 Assist client to bathroom every two hours (or ask family members to do so).

  • Limit fluid intake in the evening before bedtime.

  • Place a commode at the bedside at night.

  • Use signs to indicate which door leads to the bathroom.  

Sleep disturbance or nighttime agitation 

  • Make sure the living quarters are safe—put away dangerous items and lock the kitchen door.

  • Try soothing music.

  • Keep the curtains closed to shut out darkness.

  • If hallucinations are a problem, keep the room well lit to decrease shadow effects that can be confusing. Remove shadowy lighting, televisions, dolls, etc.

  • Use medications as a last resort.  

  •  Maintain eye contact to help keep attention.

  • Use short simple sentences.

  • Avoid negative sentences such as “Don’t go outside.” Instead say, “Stay inside.”

  • Speak slowly and clearly.

  • Encourage the client to talk about familiar places, interests, and past experiences. 

 

A simplified approach to managing agitation behaviors is to modify the environment.  

Adjusting the person’s surroundings or activities can help. Some simple, basic interventions can be used to ease agitation behaviors.   
 
Music therapy.
Some studies have proved that playing calming music can lead to a decrease in agitation. Music may be played during meals, bath, or relaxation. 
 
Exercise and movement. Light chair exercises can help to maintain function of limbs and decrease problem behaviors.  
 
Activities.
Look for activities that the client enjoyed in the past.  
 
Socialization. Human interaction is essential for people with Alzheimer’s disease. Large groups are out, but a volunteer can converse, reminisce, or engage in activities with a client. Sometimes videos are good for clients with advanced dementia because they mimic a conversation or a sing-along. 

Behavioral problems especially common in children 
 Children misbehave for many reasons. They may be seeking attention, or act out because they are lonely or frustrated. They may be scared. There may be conflict with family or caregivers. Because children mirror their parents' behavior, established behavior patterns developed at home will be used wherever they are. 
 
Adults expect children to do as they are told the first time. However, many children require several requests before they comply. Children will learn that there is no reason to comply unless positive reinforcement is provided. Negative consequences following compliance only reinforce noncompliant behavior.  Negative consequences may bring about a temporary change in behavior but will not change attitudes. Negative consequences such as writing sentences 50 times, sitting in time out, or verbal correction will worsen the negative attitude that underlies the misbehavior unless negative consequences are combined with positive reinforcement once the child complies. 
 
As children grow, positive behavior is maintained because the child has developed an internal value system, knowing the difference between right and wrong. In the long run, children behave properly because they want to, not because they are forced. As one grows into adulthood, positive behavior is not maintained through threats of punishment. Adults have learned positive attitudes on which they base their behavior. 
 
Suggestions
 

  • Let the child know when a behavior is not acceptable. In order to stop the behavior, a time-out may be necessary. Then when he behaves in an acceptable manner, use positive reinforcement.

  • Stay cool and calm. Don’t lecture or embarrass him.

  • Stress that his behavior is the problem, not his personality.

  • Help him to identify acceptable behavior in place of the problem behavior.

  • Sometimes it is appropriate to give the child a choice. “You have a choice. You may sit at this table and eat quietly, or you may go to your room without lunch. It is your choice.”

  • Help the child learn that even though they are angry, they cannot express that anger by hurting others. Encourage children to put feelings into words. When children fear their safety or their self-esteem is threatened, they replace powerlessness with aggression.

  • Allow abused children to make choices. A predictable environment is essential for abused children. Inform them of daily routines and let them know when changes will occur. They strive for attention, so give them positive attention for improvements or accomplishments.  

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