In addition to the information we provided about inappropriate sexual behavior in last week’s tidbit, Dr. Elizabeth Galik, one of the investigators on our study, has written an article on this topic for Bottom Line Health. You can read it online here:
This week, we’d like to discuss how to approach a resident with challenging behaviors in a way that can result in more positive interactions between the caregiver and resident. For example, if a resident scratches, swears or tries to hit a nursing assistant while she is helping the resident with morning care, how does that experience affect her? How will she approach her next encounter with the resident later in the day?
First, we as caregivers should be mindful that people with the dementia are exhibiting these challenging behaviors because of their disease. By not taking their angry words or actions towards us personally, we can objectively think about effective ways to react to their behavior that can result in increased expressions of wellbeing by the resident. Here are some ideas to help:
Before approaching a resident that you know can be challenging based on past experiences, take a deep breath and acknowledge your feelings. Are you angry? Anxious? Frustrated? If you enter the resident’s room while projecting these feelings, the resident will often pick up on them and respond accordingly. Try to “reset” yourself before you approach the resident and start with a clean emotional slate.
Put aside your expectations of what the resident will do. These expectations can turn into self-fulfilling prophecies.
Take a moment to put yourself in the shoes of the resident. Are they scared? Frustrated? Sad? In pain? If they aren’t able to articulate their feelings verbally, they will do this through their behavior. Try to figure out what they may be trying to communicate.
Remember the TMT-TMT rule: Too Much Talk and Too Much Touch by the caregiver can sometimes over-stimulate and agitate a resident. In these cases, a simple gesture and silent cuing may suffice. Also be aware of your body language. Standing over a resident can result in a “fight or flight” response. How would you feel if someone stood over you and tried to shove a toothbrush in your mouth?
Now, smile and take a few minutes to sit eye-to-eye with the resident (not standing over him), and talk about something you know the person enjoys….sports, upcoming holidays, weather, pets, etc. Starting with some brief moments of calm can have a positive impact on the rest of your visit and help establish trust.
You may have heard something similar to this before—while you cannot control the behavior of a person, you CAN control your response to it. Keep this in mind this week and see if this changes the way you interact with some of your residents.
Here’s a short and sweet—and very practical—tidbit that one of our intervention nurses shared:
In the past when staff have exhausted all approaches/interventions to stop or decrease a resident with combative behavior, I have cut a pool noodle in half or thirds and had the resident hold it in each hand. I’ve also given the resident gum to chew in order prevent biting the staff.
We hope you all had a chance to spend at least a little time outside over the July 4th holiday. Did your residents?
Fresh air and sunshine can do wonders for people’s spirits, especially for people with dementia. Research has shown that when people can freely use outdoor areas, agitation and aggression reduce, independence is promoted, and memory recall is more likely to occur. An outdoor space or garden gives people the chance to be physically active, feel unrestrained, be more in touch with nature, socialize, and do meaningful activities (like plant flowers) that make them feel at home. It can also help maximize sleep duration for residents who have trouble sleeping through the night.
And while indoor household tasks like folding laundry and sweeping floors can help engage residents in meaningful activity, this can work outside too! Have residents help sweep leaves and dirt off the deck or patio, pick up sticks, fill the bird feeder, and plant or water the flowers. There are lots of outdoor games too…horseshoes, beanbag toss, walking races, and beach ball volleyball to name a few.
What can you do this week to get more residents outside?
Resisting care, sometimes called combative with care, is a common behavior that is different from agitation or aggression. A person who is resisting care may pull away, attempt to leave or become agitated or aggressive during care activities. An example of a person resisting care may be saying “stop that, leave me alone!” and pulling away from staff during a specific care activity such as bathing. It is thought that resistance occurs because the person does not understand the care activity and sees this as an invasion of their personal space or a threat to their safety.
How to approach the resident:
Assume a non-threatening posture: smile and speak in a pleasant tone of voice, keep arms open (not crossed), conduct care at the resident’s eye level and from the side.
Don’t stand over the resident
Slow down care and ensure you are communicating clearly and explaining the task in a step-by-step process.
Do not use “baby talk” (elder speak) when delivering care.
General strategies to reduce care resistance:
Encourage the person with dementia to do as much for themselves as they can. Put objects necessary for the task within their field of vision so they are more easily located and remove objects that are unnecessary or distracting.
Identify long-standing habits and adjust routines accordingly. For example, if the resident is used to doing oral care at the sink, take them to the bathroom to complete this part of their care.
Consider whether the activity may be uncomfortable or painful and consider pain treatment before the activity.