Interpreting and Responding to ‘Difficult Behaviors’

By: Jonathon Evans MD

From: Provider September 2012

Summary: All resident “behaviors that others find so distressing are the resident’s attempt to communicate, says Jonathan Evans, MD. “The challenge for us is trying to figure out what they’re saying.”

Dr Evans says his “main interest is in trying to improve dementia care without medications.” He states “I’m not trying to indict the medications, but it’s more gratifying to figure out what people are trying to say through their behavior and help them get what they want. And we don’t have to worry about side effects.”

Evans has identified some broad rules to keep in mind when trying to determine what resident communications may be about.

· First, seek to understand. Try to understand what the person is reacting to: “Most behaviors are in response to something.”

· Multiple causes. Any given behavior may have multiple causes. For example, take wandering. Wandering might mean someone is lost, bored, wanting to exit a stressful situation, or has to go to the bathroom.

· Aggression indicates interpersonal conflict. Behaviors that involve aggression “represent conflict between the resident and usually the human in the environment,” say Evans. “What’s going on is the individual with dementia by definition has problems comprehending and reasoning, and they misperceive certain actions by people in their environment as a threat to them.”

· Is the distress theirs …or others? Another rule for care givers is to determine whether the behavior is due to the individual being in distress, or is it just discomfiting to other people.”

· Keep a log, and look for patterns. When did the behavior start? What was present? What was that person doing? Write out what happened in as much detail as possible each time an incident occurs. Over time that “typically leads to insights that help caregivers figure out what people are misperceiving and responding negatively to,” Evans says.

· Other tips. Caregivers should identify themselves when approaching the resident. Tell the person “what you’re going to do before you start doing it. That often allays people’s fears,” Talk to people at eye level. Break tasks into a single step at a time, rather than do multiple things at once.

These are the kinds of things that doctors aren’t taught, and often, neither are nurses or C.N.As.