Managing Difficult Behaviors I Thomas Magnuson, M.D. Right hand Professor Department of Psychiatry UNMCSlide 2
Objectives Identify regular practices connected with dementia Look at different methodologies used to help with these practices Delineate flow thoughts on non-pharmacologic medicines for these practicesSlide 3
Demographics Dementia 360,000 new instances of Alzheimer\'s malady every yr. More than 5.1 million with dementia in the USA in 2007 15-20% of all more than 65 Alliance for Aging Research Home Page: Alzheimer\'s Association Alzheimer\'s Disease Facts and Figures 2007Slide 4
Demographics Nursing Homes Over 1.5 million in nursing homes 80% have psychiatric analyses 80-90% of those are dementias 50-90% of maniacal nursing home occupants will have issue practices created by subjective impedanceSlide 5
Demographics of Behavioral Problems in Dementia www.cihi.caSlide 6
Impact half of nursing home attendants have been physically mishandled by a patient in the previous year 48% have endured psychological mistreatment by a patient www.cihi.ca Findings from the 2005 National Survey of the Work and Health of Nurses (Ottawa:Statistics Canada, 2006)Slide 8
Types of Behavioral Problems Agitation General fretfulness Near-consistent, no signals noted Specific anxiety Such as with dressing, showering, sustaining Disruptive vocalizations Yelling, addressing, swearing Disrobing Hoarding/taking Especially new onset with the dementia Wandering/pacing 20%Slide 9
Types of Behavioral Problems Other than Agitation Aggression Towards self, inhabitants or staff Focused or irregular Hypersexuality Verbal, physical or both Resistance/rebelliousness (30%) With prescriptions, suppers, cares Sleep troubles Up throughout the night, snoozing throughout the day Fragmented restSlide 10
What makes a conduct an issue? Brokenness Changes in the everyday working of the inhabitant and associates because of the conduct Aggression towards others so extreme that it puts their situation in peril by hurting others or themselves Disruptive vocalizations so serious that their security is at danger from the forceful companions Generalized anxiety so significant it prompts a fall and hip break in an occupant with step issuesSlide 11
What makes a conduct an issue? "Antipsychotic medications are normally used to treat a portion of the behavioral inconveniences of dementia, including delirium." But, "the issues basic the requirement for such solutions, behavioral issues, for example, animosity and fomentation, are genuine, and the other options to antipsychotics are limited." Nevertheless, "[m]any specialists feel behavioral intercessions ought to be attempted in the first place, and antipsychotics utilized if all else fails, \'when the conduct or the psychiatric indications are truly crazy, and creating complete misery for the individual experiencing Alzheimer\'s, as well as for parental figures all around them,\'" said Maria Carrillo of the Alzheimer\'s Association.Slide 12
What makes a conduct an issue? The CONTEXT of the conduct is regularly what makes it an issue At a physically little nursing home a man who strolls continually might pace though at a bigger office they are "strolling the lobbies" No men, likely no hypersexuality Frail inhabitant implies little risk of harm to others if forceful Non-consistence with multivitamin versus insulin Continued mild-mannered talking versus hollering versusSlide 13
What makes a conduct an issue? Brokenness and Context More Calls if: Physical side effects coordinated towards others Verbal side effects coordinated towards others Fewer calls if: The occupant talks all the time yet never raises their voice The inhabitant rests an excessive amount of The inhabitant is excessively frail, making it impossible to hurt anybody when they are forceful These practices can be symptomatic of the same needs as the more troublesome practicesSlide 14
Context The initial phase in tending to a conduct is to distinguish the connection of the conduct Mr. Smith is an awful driver. How is he a terrible driver? Mr. Smith is having behavioral issues What is the conduct? At the point when is it happening? Where is it happening? What happens previously, then after the fact the conduct? Exasperating elements? Moderating elements? What happens as an aftereffect of the conduct?Slide 15
Approach to Behavioral Problems Is it new or old? Starting the previous evening or been there since they moved in six months prior? Intense onset makes one more worried around a therapeutic etiology If it has tailed them from office to office you may need to adjust Assess on the off chance that this is an indication of an unmet need, a restorative issue, or a psychiatric issue.Slide 16
Approach to Behavioral Problems Unmet need? Hunger, thirst, portability, help of agony, fatigue, forlornness A natural trigger? Overstimulation/Understimulation Particular individuals Light levels Roommate, moved roomsSlide 17
Could it be 2 o to a restorative cause? New indications? New agony from a break UTI, hyponatremia, parchedness Exacerbation of old side effects? COPD-related Worsening congestive heart disappointment hypoxia may seem like tension Medications? Opiates, muscle relaxants Chemotherapy Antidepressants, antipsychotics, benzodiazepinesSlide 18
Behavior issues increment with wooziness and despondencySlide 19
Is it because of a psychiatric issue? Temperament 20-half of every single hysterical patient will endure with wretchedness Mania can likewise happen as a consequence of dementia half of all nursing home patients have some kind of discouragement Anxiety 25-40% of insane patients will show uneasiness Psychosis Delusions and mental trips are basic in dementia 25-45% of every deranged patient will encounter psychosisSlide 20
Behavioral Problems REMEMBER: The patient can just have inspirations attributed to them just in the event that they have enough intellectual limit left to have an intention,Slide 21
THEREFORE: Apathetic individuals are not attempting to chafe you by taking more time to do ADLs Forgetful individuals would prefer not to lead you on a wild goose pursue when they can\'t recollect where they put their dentures Frightened patients with no knowledge into their circumstance are not attempting to hurt you, they are attempting to safeguard themselves.Slide 22
Behavioral Problems Patients are in nursing homes for a reason Which essentially neuropsychiatric (dementia), yet Historically, most nursing homes grasped therapeutic caregiving, not psychiatric caregiving Many NH laborers have been prepared in restorative, not psychiatric, situations Better data and guideline is currently accessible about psychiatric issues in the nursing home When the worldview of psychiatric consideration is grasped, the way the parental figures take a gander at patients changes significantly This methodology is presently expected in long haul care situationsSlide 23
Why Not Just Give Them A Pill? Frequently it doesn\'t work Antipsychotics in dementias furnish unobtrusive advantage Same with state of mind stabilizers, antidepressants Often used to treat behavioral indications, yet there is no FDA-endorsed operator for this issue Some behavioral issues don\'t react well to drugs Wandering/pacing Restlessness/squirming Poor self consideration Disrobing Pulling/picking at dressings, gadgets Hoarding/takingSlide 24
General Strategies Not each intercession works with each inhabitant Not each mediation works each time The key is adaptability Often the earth triggers the conduct Look around to see what is going on the unitSlide 25
General Strategies Minimize ecological change Stability is crucial Limit number of parental figures Reward guardians that function admirably with an occupant Videotape effective staff amid troublesome experiences to teach other staff Minimize the quantity of room changes Structure breeds change Addition of solutions inside the initial 4 weeks after an adjustment in environment not prone to be useful.Slide 26
Control the measure of incitement Too much regularly sets off patients Shift change, lounge area, exercises, brilliant lights The extra large flat screen television, warmth and cooling ventsSlide 27
Control the measure of incitement Too little can prompt sentiments of Isolation Loneliness Desire to be the place the activity is!Slide 28
Just the right incitement… ..Slide 29
Or is it accurate to say that this is better?Slide 30
Enhance correspondence Residents with dementia have aphasias Use visual signs to impart Slow, short clear guidelines Booklets with visual signals for toileting, dressing, washing, eatingSlide 31
Enhance correspondence Many occupants are tangible hindered Loss of hearing-methodology from the front, don\'t expect they hear your tranquil welcome from behind Assistive listening gadgets can improve correspondence Visually weakened declare your name every time, let them know what you will do before you touch themSlide 32
Do not hustle the patient Give them five seconds to react Break an undertaking into little parts One direction given at onceSlide 33
Let\'s Go to the Bathroom. Stand up Turn Walk Turn I\'m going to help you with your jeans. Sit I will sit tight for you to wrap up.Slide 34
Calming Interludes Outside-Sunshine Walks, smolders vitality, mitigates nervousness plantingSlide 35
Water steaming shower, shower, Water wellspringsSlide 36
Auditory Enhancements Music-sing an aches, karaokeSlide 37
Enhanced environment Comfortable family room Aquarium AviarySlide 38
Things that you can Modify without a remedySlide 39
Where to get more data UNMC Geriatrics Website http://www.unmc.edu/nebgec/Long Term Care Mental Health Forum http://ltcmentalhealth.forumcircle.comSlide 40
Post Quiz Question 1 Which of the accompanying markers are reliable with useless practices? Animosity towards others so serious that it puts their situation in danger by hurting others or themselves Disruptive vocalizations so extraordinary that their wellbeing is at danger from the forceful associates Generalized eagerness so significant it prompts a fall and hip crack in an occupant with
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