Management of Challenging Behavior in Elderly People

Patient living in the nursing homes with diagnosis of dementia experience Disruptive behavior. According to Burton et al. (2015) more than 44 million people have dementia. Dementia affects memory, thinking and social abilities. These symptoms severely interfere with daily functioning of the patient. Approximately 90% of dementia patients demonstrate psychological and behavioral symptoms such as anxiety, agitation, depression, hallucination, delusion, and aggression (Chen et al., 2014). Behavioral and psychological symptoms of dementia (BPSD) are a varied group of non-cognitive symptoms affecting demented patients. These symptoms are delusion, hallucination, agitation, anxiety, euphoria, disinhibition, night-time behavioral disturbances

Challenging behaviours are often extremely stressful, which presents managing problems with dementia people as well as their care givers. In general, 80% individuals with dementia most often express the signs of challenging behaviours (McKay2008). The common behavioural disturbances associated with dementia include hallucinations delusions, sleep problems, sundowning, aggression, agitation, wandering, and communication challenges (Zwijsen et al 2014).

• Every individual, including individuals with dementia, has their unique life history, lifestyle, culture and preferences, including their likes, dislikes, hobbies and interests, which makes an individualised approach in care necessary.

These strategies may help with relieving distress, agitation and challenging behaviours. Strategies when dealing with dementia patients may include, “introduce yourself at each encounter, use touch as appropriate, try to determine the cause of the behaviour and then try to reduce or eliminate it. These behaviours may be caused by boredom, which you would try and use activities as a distraction, Pain which we3 will try non-pharmacological treatment first e.g.: heat packs, Anxiety where we will use reassurance and diversion. Often using a soft approach such as smiling, pleasant voice tones while talking calmly in short sentences will help defuse a situation.

There are many types of dementia, causing many different symptoms and treatments, it may take time to find the appropriate treatment/medication to suit the individual.

This assignment will explore the effect of the long term condition dementia. It will focus on a service user who has recently been admitted onto an assessment ward and their family. It will explore the nurse’s role and how they will support and manage the patient’s illness. The Nursing and Midwifery Council (NMC) (2015) state that individual’s rights to confidentiality must be respected at all times, therefore all names mentioned in this assignment have been changed to maintain confidentiality.

Side-effects such as sedation, falls and extrapyramidal signs are well-known, and more recent work indicates that neuroleptic treatment of dementia leads to reduced well-being and quality of life (Ballard et al, 2001) and may even accelerate cognitive decline (McShane et al, 1997).

Unit-4, Q3. Explain how negative beliefs, values and misunderstandings can affect a person's attitude towards people with dementia. Unit-4, Q4. Explain how positive beliefs and values can affect a person's attitude towards a people with dementia. Unit-4, Q5. Describe the steps you can take to ensure a person with dementia feels valued , included and able to engage in daily life. Unit-4, Q6. Describe the practices that could make a person with dementia feel excluded. Unit-4, Q7. Explain why it is important to include individuals with dementia in all aspects of their care. Unit-4, Q8. Describe how an older person's experience of dementia may be different to a younger person who develops dementia. Unit-4, Q9. Mr Singh is a 75 year old gentleman who moved to England from India when he was in his 30s. Mr Singh is a practicing Sikh. He does speak English but because of his dementia he has reverted to only speaking in Punjabi. Describe the steps you could take to gain knowledge and understanding of Mr Singh's needs and preferences. Unit-4, Q10. Sophie is a 39 year old lady who has Down's syndrome. She has also developed dementia which is progressing quite quickly. Sophie has been admitted to a care facility which specialises in supporting people who have learning disabilities and also have dementia. Describe the knowledge and understanding that the staff would need in order to work in a person-centred way with Sophie.

The way a person is behaving is usually a good indicator of what they are trying to communicate, especially if they have difficulty expressing their feelings with words. Body language will also provide clues. People wish to be heard and validated and the way they behave may indicate how they are feeling. so a person presenting as angry may be feeling frustrated. People presenting as sad may be experiencing vivid memories of a past event that seems very real and current to

Challenging behaviour can be explored in every client group however the client group explored here is older adults within informal care. Due to the Data Protection Act 1998 the name of the older adult involved in the care has been changed to Client X. Why challenging behaviour occurs can be explored and explained through many different avenues such as through the use of psychological theories and situational factors that can effect behaviour.

Horgas et al. (2009) is an in-depth examination of the various factors that can be used to report pain within these specific groups of patients. The journal is from the American Geriatrics Society, and thus is clearly peer-reviewed. It is a thorough examination into how dementia patients report their own pain, as well as how their pain can be observed within actual practice. The data was then coded according to the American Hospital Formulary Service System (Horgas et al 2009). This clearly shows that the research supports evidence-based practices for it uses real observations from patients actually being in the field today in combination with commonly held patterns from prior research.

To achieve effective and excellence care on dementia, biological, psychological and social approach to dementia has to consider because it provides an understanding to people with dementia and help improved health practice, treatment and support for better dementia care (Bowers & Downs, 2008). Biological approach tackles the disease process of dementia, the cause of brain injury and the changes in behavior pattern of dementia sufferers. On the other hand, psychological approach to dementia involved the sufferer’s reaction to the injury, how they accept it and deal the situation. It also covers the effect of the disease process on their communication and action in relation to others. Particularly, people with dementia, mostly feel embarrassed and depressed by their brain injury. They are often angry, agitated and frightened because of the disease but maybe it also means seeking help to avoid embarrassment and disgrace. Dementia care in social domain explains the right of the person with dementia to enjoy and experience significant social interaction. Friendly environment and venues with sociable care provider that makes them comfortable and feels worthy is the focus. In addition, social identities of the people with dementia should be valued and social

As we have seen, treatment of schizophrenia with antipsychotic drugs can have impressive results in terms of decreasing active symptoms, although it does nothing to alleviate negative symptoms or to improve cognitive functioning. Unfortunately, this kind of treatment has the drawback of extremely serious and even fatal side-effects. Newer generation atypical antipsychotics offer more hope, as they can treat both active and negative symptoms, and also improve cognitive functioning. Moreover, they have fewer side-effects. However, treatment is complicated by the fact that results are unpredictable; and in addition the side-effects that they do have can be very serious, such as diabetes, which in itself is life-threatening. However, as the potential side-effects are known, the physician has leeway to choose a drug which is a good match for the patient’s clinical profile. Then, once the patient’s symptoms have been much alleviated with an appropriate newer generation atypical antipsychotic, the patient should be able to also benefit from a range of psychotherapeutic interventions. It is argued that this is the best treatment regime to choose, as it is likely to result in the greatest improvement in quality of life, coupled with the lowest risk of potentially devastating side-effects, or of death. This is likely to be better than utilizing cognitive behavioral therapy, the results of which are not reliably known – although research has certainly shown that it is less efficacious

During my first clinical rotation as a nursing student, I was assigned to care for several older adults suffering from dementia. Although all of my patients ranged in severity from mild to severe progression of dementia, they all experienced moments of agitation, anxiety, or disturbed behaviors related to their disease. It occurred to me after careful review of several patient charts that despite often being prescribed pharmaceutical regimes for other comorbidities, these patients were rarely prescribed medications, besides those to control anxiety, specifically targeted at treating their progressing dementia. Through some research I discovered that the significant number of individuals affected with dementia is a growing public health concern in part due to the current limited ability of pharmaceutical treatments to treat the disease (Samson, Clement, Narme, Schiaratura, & Ehrle, 2015). This revelation began my interest in current nonpharmacological treatments being implemented in controlling adverse behaviors and feelings in patients diagnosed with dementia.

2. The purpose of this study is to evaluate the efficacy and safety of low dose risperidone in treating psychosis of Alzheimer’s disease (AD) and mixed dementia (MD) in a subset of nursing-home residents who had dementia and aggression and who were participating in a randomized placebo-controlled trail of risperidone for aggression.