Concordia Home Care and Nursing Services LLC   Concordia Health Mobile Lab

Concordia Edvantage Training Academy                  Concordia Luxury Home

Mon-Fri: 9AM to 5PM

Behavior Management

Behavior Management

LEARNING OBJECTIVES
Participants will be able to:
• List causes of behavior problems
• State common triggers of agitation behavior
• Make changes in the environment to reduce agitation behavior
• Implement ways to overcome behavior problems

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 handle the problem better.

Common causes of behavior problems include:
• Fatigue
• Medications
• Frustration
• Dementia/Alzheimer’s/other brain disorders
• Established behavior patterns
• Anxiety
• Depression
• Pain

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 patients with dementia
Fatigue. Sudden or frequent changes in the 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.
Pain. Increasing pain may trigger agitation. Observe the patient for facial grimaces, avoiding moving extremities, guarding or moving away from touching area all these are signs of pain.
• Excessive demands. Caregivers and family must accept the fact that the dementia patient has lost and continues to lose mental functions. Pushing these patients to improve their capabilities will only cause stress.

Dealing with challenging behavior is never easy. Caring for a patient with dementia, Alzheimer’s, or other brain disorders poses many problems for caregivers. Keep an open mind and be patient. If one strategy doesn’t work, try another.

Dealing With Common Behavior Problems

Angry/agitated behavior
• Determine whether medications are causing adverse side effects.
• Observe patients to see if they have any pain.
• Reduce caffeine intake.
• In severe cases, and as a last resort, medication may be prescribed to keep a dementia patient calm.
• Reduce outside noise, clutter, or the 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 a reminder of pleasant memories.
• Gentle music, reading, or walks may help an agitated patient.
• Do not try to restrain a patient during an outburst.
• Keep dangerous objects out of reach.
• Acknowledge the patient’s anger over the loss of control in his or her life. Say that you understand the person’s frustration.
• Distract with a snack or an activity.
• Eliminate choices. Instead of asking, “What would you like for lunch? Soup or a sandwich?” say, “Here’s a sandwich.”
• Allow the person to forget the troubling incident. Confronting a confused person may increase anxiety.

Repetitive phrases and actions
• Avoid reminding the patient that he or 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 patient’s doctor.
• If the dementia patient says money or an object is missing, assist him or her in locating it. Avoid arguing. Try to learn his or 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 patients in their rooms or restraining them in a chair is inappropriate. Implement activities and adjust the environment to relieve agitation.
• Put away items such as coats, purses, or eyeglasses. Some patients with dementia will not wander without taking certain personal articles with them. If they can’t find them, they won’t leave.
• Provide regular exercise and rest to minimize restlessness.
• Dark-colored mats placed in front of doors may prevent the patient from stepping outside. Black or dark blue areas may look like holes in the ground to a patient with dementia, prompting the person to avoid the area.

Hoarding or gathering
• Provide the patient with a safe place where he or she can store items, such as a canvas bag.

Incontinence
• Assist patient to the 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.

Communication
• 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 patient to talk about familiar places, interests, and past experiences. 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, baths, or relaxation.
• Exercise and movement. Light chair exercises can help to maintain the function of limbs and decrease problem behaviors.
• Activities. Look for activities that the patient enjoyed in the past.
• Socialization. Human interaction is essential for people with Alzheimer’s disease. Large groups won’t be effective, but a volunteer can converse, reminisce, or engage in activities with a patient. Sometimes videos are good for patients with advanced dementia because the video can mimic a conversation or a sing-along.

Modifying the environment is a simplified approach to managing agitation behaviors.

Behavioral Problems Especially Common in Children

Children misbehave for many reasons. They may be seeking attention or acting out because they are lonely or frustrated. They may be scared. There may be a conflict with family or caregivers. Since 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 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 the child behaves in an acceptable manner, use positive reinforcement.
• Stay cool and calm. Don’t lecture or embarrass the child.
• Stress that the child’s behavior is the problem, not his personality.
• Help the child identify acceptable behavior in place of the problem behavior.
• Sometimes it is appropriate to give the child a choice. Say, “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 children learn that even though they may be angry, they cannot express that anger by hurting others. Encourage them to put their feelings into words. When children fear for their safety, or when 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 reinforcement for improvements or accomplishments.