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*(The degree of complication of a patient's clinical course due to depression varies by stage of illness; depression is usually a more significant complication early in disease course.)
Behavior Inappropriate or impulsive sexual behavior
Common Patient or Event-Related Factors
Non-Pharmacologic Intervention
References
Dementia-related decreased judgment and lack of social awareness
Do not overreact or confront; respond calmly and firmly; distract and redirect
Misinterpreting caregiver's interaction as having sexual overtones
Educate caregivers
Do not give mixed sexual message (double entendres and innuendos - even in jest); avoid nonverbal messages; distract while performing personal care or bathing
Ballard & Poer, 1993 Ballard, 1996
Uncomfortable-too warm, clothing too tight; need to void, genital irritation
Check room temperature; assist with comfortable weather-appropriate clothing; ensure that elimination needs are met; examine for groin rash, perineal skin problems, stool impaction
Need for attention, affection, intimacy
Increase or meet basic need for touch and warmth; model appropriate touch; offer soothing objects (such as dolls or stuffed animals); provide hand or back massage
Behavior Resistance to personal care (e.g. resisting help with bathing, personal hygiene, dressing, or grooming)
Common Patient or Event-Related Factors
Non-Pharmacologic Intervention
References
Caregivers rushed
Adjust timing of baths, wounds care, dental hygiene, etc. to times of maximal staff availability
Physical or emotional discomfort
Treat physical condition as able, e.g. pain medication if necessary
Adjust bath environment, e.g. temperature of room ,water, may need to void whirlpool for some patients
Preserve modesty, privacy
Potts, Ritchie & Kass, 1996
Bossenmaier & McLachlan 1991
Sloane et al., 1995
Apraxia-patient cannot remember how to perform tasks
Patient cannot understand or follow instructions
Patient afraid of doing task
Simple set-up, cueing or demonstration of task, unhurried assistance, easy-on clothing
One-step at a time directions in an unhurried tone
Reassure, distract with music
When necessary and possible you may need to defer task to a later time.
Vogelpohl, Beck, Heacock & Mercer, 1996
Unclear cause but clear agitation during personal care
*Snoezelen
Brown, Jones, Volicier-lookup ref RDL...
*Snoezelen therapy combines soft lighting, gentle music, tactile surfaces, and essential oils to stimulate the sense of older adults with dementia in a comfortable, safe environment.
Behavior Sleep Disturbance
Common Patient or Event-Related Factors
Non-Pharmacologic Intervention
References
Agitation... "sun-downing" when it occurs in the early evening
Medical evaluation (infection and medication effects are common)
Someone is really taking something from person
Check out validity of situation
Combined, disturbed sensory and cognitive abilities e.g. decreased hearing, decreased or altered vision or color perception.
Distraction Respond to resident's feeling... do not argue or correct perception
Carlson, Fleming, Smith & Evans 1995
Forgot where objects were placed
Offer to help find; have more than one of same object available (e.g. purse, wallet); have a list where objects should be placed; learn favorite hiding places
Misinterpreting who people are, suspicious of their intentions
Introduce self and role routinely; draw on old memory, connections; do not argue
Change in environment or routine
Reassure, familiarize; set and follow a routine as much as possible
Social isolation
Encourage and provide familiar social opportunities
Behavior Wandering
Common Patient or Event-Related Factors
Non-Pharmacologic Intervention
References
Past history of using physical activity to relieve stress
Provide secure walking path, exercise program
Holmberg, 1997
Restless, bored
Increase activities scheduled
Individualize programs
Teri, 1992
Toileting need
Institute toileting schedule
Signs or pictures on bathroom door
"Visible toilet" toilet to center of room
Harr, 1995, ch 2
Stress, noise, activity level
Reduce excess stimulation
Lost-looking for someone or something familiar
Provide familiar objects, signs, pictures. Offer to help find objects or place: reassure
Medication side effect
Monitor, reduce or discontinue medication
Environmental stimuli - exit signs; people leaving
Remove or camouflage environmental stimuli; ID or alarm bracelets
Creation date: Jun 25, 2008 3:34pm Last modified date: Jun 10, 2009 7:27pm Last visit date: Sep 2, 2023 1:17pm
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