Lyn Geboy, PhD (left) and Beth Meyer-Arnold, RN, MS (right)
A couple of us from Best Alzheimer’s Products attended the The 2013 National Adult Day Services Conference in Louisville, KY. Conferences are always busy for us, but I did manage to attend one of the breakout sessions, and found it very informative. I really like meeting conference attendees and sharing our activities with them. I also get new insights and perspectives every time. This alone can make these professional conferences worthwhile for us.
I attended Person-Centered Approaches to Challenging Behaviors, given by Beth Meyer-Arnold and Lyn Geboy. Person centered care is something we have always advocated, but I was still able to learn a lot about creating an environment that is truly person centered.
Behavior is Communication
The 60 minute talk explaining the concept and practice of person centered care began with a premise that behavior is communication: furthermore, behavior is purposeful communication. Obvious if we think about it, but we often forget. To a degree, all of us use behavior to communicate, but a person with Alzheimer’s disease is losing the more common ways of sharing thoughts and ideas, or expressing needs and emotions. As a disease like Alzheimer’s progresses, behavior becomes the most available and perhaps the only means of communication available.
Don’t Label Behavior!
Challenging behavior is one of those typical symptoms of dementia. Aggression, wandering, anxiety, sun-downing; these are just some of the labels we use to describe what we often see in people with cognitive and memory disorders. Don’t label behavior! Labeling is judging, and will change how you interpret the behavior. When we say “aggression” we think “hostility”, but that’s usually not the case. What is causing someone to act in a way that we interpret as aggressive may be a reaction to an unfamiliar setting, or to a loud or confusing noise. Once you discover and remove the cause, the behavior often disappears.
Labeling Can Prevent You From Looking For a Cause
To say about someone who has dementia that he is “just being difficult” because he is flailing his arms and making loud noises can stop you from looking for the cause of the behavior, can blind you to what he or she is trying to communicate. Aberrant behavior like this is often caused by pain or discomfort. Finding and removing the cause of the pain can alleviate the behavior.
Develop a Process to Find the Cause of Difficult Behavior
This process should probably start with a thorough examination by a nurse. It could be something as simple as a small cut that has become infected, or it might be more severe. Bernice1 was once displaying extreme behavior in her assisted living facility that went on for some time until we discovered that she had broken her hip! If a simple exam doesn’t turn up anything, try Extra-Strength Tylenol as a diagnostic tool. If the behavior disappears, it was likely caused by pain, and a visit to the doctor for a more thorough examination is probably in order.
There is not any FDA Approved Medication to Treat Dementia-Related Behavior
Another point that was made and should be remembered: as a way of controlling behavior, “drugs are not the answer!” No medication has been FDA approved to treat dementia-related behavior. There is little evidence that any drug is effective, and the probable side effects are just not worth the risk.
- Read more about the benefit of activities and non-pharmaceutical therapies at Best Alzheimer’s Products : Activities for Alzheimer’s Disease.
- Read more about why we need to consider quality of life issues and spend more time and money researching alternative therapies for people currently living with Alzheimer’s or dementia on Mayo Clinic’s Blog: Plan needs to embrace Alzheimer’s quality of life issues.
A more thorough account of person centered care can be found in Person-Centered Care: Tools for Transformation, available from Attainment Company.
1Bernice (the reason we started Best Alzheimer’s Products) was a close family friend who didn’t have any surviving family at the time she was diagnosed with Alzheimer’s. Holly, my wife, was her primary caregiver.