Symptoms of Dementia
Repetitive behavior- people with dementia may say or ask anything same over and over again. Repetitive behavior also occurs when they are unsettled and unsettled. Here are some of the examples of repetetive behavior it includes tapping, rubbing hands asking questions, making same noise, it can be very irritating for some carers and family with people living with dementia. It is usually caused by anxiety separation from loved one cauising consistent asking for their loved one or side effects of medications such us particularly repetitive movement, inability to express needs, trying to express emotion too many unfamiliar objects or sounds and sights that causing anxiety. The best thing to cope with this behavior was asked them to have a walk like in the garden, don’t tell them that they have already asked the same question, use calm voice when approaching them, and when they can still read, use signs like we “we will have and eat the afternoon tea at around 15:30 pm.
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Wandering- wandering is the major priority , it is the most common form of disruption with people with dementia. It is also due to forgetfulness and frequent need for stimulation. It is common cause of tension and anxiety for the carer and the people with dementia is the wandering. It can also triggers with medication which causes restlessness and unfamiliar environment assistant to find their way around plenty of reassurance may lessen the problem or if the person bored sad or lonely. It includes to keep the need and make the person safe allowing them some independence and choice can also be challenging for them, this can be resolve depending on several factors involving and including neighborhood environment, personality of the carer plus the coping mechanism. The coping strategy was encourage exercise such as walking, gardening or stacking wood and also provide good exercise and some interest give meaning ful activities such as folding clothes. Consider electronic buzzer, chimes, bell above door or a pressure sensitive mat if the person way out.Ensure gates are lock and also ensure she/he carries that can identify him/her. If unable to find within an hour let the police know and when the demented being found notify the police.
Sundowning- it increased confusion and restkessness in person with dementia. It is means progression of dementia and it occurs more frequently during middle stage of alzheimers. People with dementia will become more confused restless or insecure in the late afternoon or early in the evening. They get worse after a change in routine, they become more demanding, become upset and disorientated, attention span during this time is limited they became impulsive they may feel see things that are unreal. The causes is there is a psychological or physiological function during tge day or each day that can increased confusion that leads to agitated behaviors. They become anxious going home and even finding mothers which indicate they need safety and security protection. If surrounding becomes worst early afternoon rest is recommended, offer a drink and do not restrain make them feel safe.
Aggressive behavior- it can be due to verbal abuse like physical violence bitting or even scratching. It may trigger may be because of changes in the brain misunderstanding of messages being sent by the carers. It is also causes and lead to emotional harms to others or threatens. It can be reactive it can be overt and secretive. Environmental factors such as noise feeling of failure frustration and poor ineffective communication by staff, talking loudly being bossy, threatening tone and body language can trigger behavior. The coping mechanism involves use gentle approach, remove the person from trigger, smile, use distraction such listening to music, avoid confrontation which may worsen aggressive behavior.
Rummaging- rummaging means to search thoroughly by handling turning over or disarranging contents, it also means searching thoroughly. People with dementia intrude into other private spaces and rummage when they are lost searching for purposeful activity, it triggers when the person is feeling of being unfamiliar in surroundings. It may be searching for a purposeful activity. The coping strategy is provide picture of something familiar on the door provide distraction, provide things or objects which can connect a person with their past, provide rummaging box or draw full of familiar items. Have an area or room provide client to rummage.
Hoarding- people with dementia may search and find for something they may believe that is missing and they do hoarding and hoard things to collect them for safe keeping.It is a persistent difficulty discarding or parting or possessing because need to save them. A person with this experience distress thought of getting rid of items. It influence and triggers the behavior everytime they may feel insolated and they may feel neglected so hoarding is a common response to this. It can also triggers memories on the past like her sister is tooking her things. The person with this type of behavior has a fear of fear or loss.
Catastrophic behavior- it is behavioral and emotional response in a situation which create a stress to people with dementia. It is a caused for a person with dementia and situation its beyond the person’s ability to comprehend. Trigger can lead to too much inform,ation, feeling of insecurity, changes of routine and environment, too much stimuli and unfamiliar noises can be a factor. The coping mechanism is use gentle, calm, slow speech, smiling and touch theraphy may be used , removed the person from the stimuli, and document if dituation may be avoided in the future.
Changes in the Brain
Changes that taken place in the brain and affect person memory mood and behavior it also depends on what part of the brain has being affected. Plaques and tangles stop communicating between nerve cell and caused them to die. It can trigger challenging behavior such as sundowning hoarding, aggressive catastrophic rummaging wandering etc. anger and agression are often directed to a family member because they are closest. The behavior is out of person’s control and they may be frightened by it they need assurance eventho it doesn’t show that way.
Communication style of others- as dementia progress ability to communicate decreased and decline in language is lost that leads to frustration and anxiety. If they cant understand what people or carers saying this may cause them to act as a challemnging including aggression. Aggressive behavior may be a person’s way meeting the need attempt to communicate and can result of unmet outcome need.
Approach by other people- Never ever approach from behind it can trigger challenging behavior, do not be loud and bossy cause it might upset the client and can make them feel angry and frustrated, different carers with different approach or changes in routine can trigger challenging behavior.
Loss of choice- Other people may think people with dementia can not longer do thimgs for themselves and leave them out of decision that affect them. This cause frustrated to people with dementia it can cause angry because they are not being listened and they are being ignored, the person may loose confidence if there is a loss of choice including their ADL;s, activities and meals. They can become stress and have anxiety if they don’t have choice.
Environment- The environment may not meet their needs or may be overstimulating too hot or too cold, noisy or bright can trigger their behavior, too much agitation but less stimulation can lead to boredom frustration and apathy.
Sensory issues- Impaired vision and hearing can misinterpret sight and sounds in this it can trigger behavior issues. Poor eyesight and loss hearing may lead to anxiety, frustration and communication difficulty.
Anxiety- Anxiety causes inability to carry out activity o daily living. Inability to understand words around them , inability to perform previous ability and anxiety can be due to multiple factor causing frustration which caused sense of loss.
Cultural factors- In other instances client feels that they are not being understood. Dementia person may revert on their own language, become angry, anxious, and frustrated when other doesn’t understand what they are saying.
Service limitation- Services may not be person centered in health changes they are not noted and reported properly. Carers and meals may not be on time which can greatly affecting the client behavior not enough staff on duty which client routines may change due to lack of staff that leads to challenging behavior.
Physical health changes- An inability to communicate any pain or health problems may lead to anxiety and feeling of helpless. Infection, pain and constipation may lead to delirium. There may be pain illness infection or physical discomfort including being constipated or thirsty or from sitting for too long.
Medication- Some medication can increase agitation and confusion new meds can lead to changes in behavior, side effects for taking too many medication may mean that person becomes more confused and drowsy.
Challenges toself esteem and dignity- Need to accept personal cares may lead to loss of dignity and loss of independence, loss of privacy may lead to embarrassment sometimes person with dementia may feel useless and as unable to so such activity may feel burden to family.
Loss of independence- person may becaome frustrated for not being able to complete the task.(e.g dressing up and feeding herself). Aggression may occur due to frustration with own inability to carry out previous task.
Strategies for Dementia Care
Behavioral strategies (diversion)- it can be a very effective way to challenging behavior it means distracting from present situation. Take them for a walk smell flowers, look at the garden, use of CD, playing music of their music song, encourage to do household task with a client who is capable of folding clothes. Etc.
Individualised service plan- Services should be safe, and services providers shall ensure that a patient receives best possible care available and that patient is safe from harm for both themselves and others.
Safe social and physical environment- when a person starts to wander and become dangerous to themselves it may be necessary to assessed as required stage 3 residential care. this is where all external gates to the facility are blocked and residents are unable to leave their own desire. As dementia progress person with dementia is vulnerable safety issue and requirements and protection is important not only from physical injury but also from exploitation and abuse.
Individualised activity plan- Activities should be safe voluntary, familiar and provide chance of satisfaction and success. Each client have and requires activity plan.
Avoidance of triggers- It is the key to management and problem solving consultation with family/whanau. Use of behavior charts and good documentation with times, location, dates and the staff involved. Ensuring that the care being delivered is client not task oriented, assist with ensuring values and self esteem.
Timeout- timeout for person with dementia means gently taking their hand and encouraging them to walk away from a situation which causing them distress. Going for a walk, going back to their room or in a quiet area should be assisting in reducing tensions.it should not be necessary toi restrain or shut someone into isolation.
Communication techniques- It is provided and acknowledge required that carers should talk in a respectful and calm way to residents and even to staff’s as a sign of respect.
Staff education and training- It is ongoing training and monitoring of systems and strategies. Manangement often offer trainings to staff to familiarize and know whats to do when the situation arises example falls, what to do etc.
Debriefing- Support workers having regular meeting and discussion to relieve the stress and discuss concerns or just have a meeting and talk to relieve the stress. Having trained support workers such as team leaders to open discussion and assistance to other support worker.
Stress management- Stress management is a spectrum of techniques and psychotherapies aimed at controlling a person’s level of stress especially chronic stress. One way to solve and lessen the stress was to d solving the problem which causing to stress thinking intervention how to deal with it remove yourself from the stimuli, listening to music watching movies and talking to friends to lessen and cope with the stress.
Care Worker Strategies
Personal restraint- it means that the service provider uses their own body to intentionally limit the movement of client upper body and arm that can be held to allow for a bloodtest, and a body and legs might be restrained for insertion of a catheter.
Physical restrain- which limit a person normal freedom of movement mostly applied directly to a person’s body. Strap and lapbelt are used in a bed chair. Vest restrain-vest crosses body at the front and strap to secure at a chair or bed to decreased forward or sideway movement. Mitten restrain- restrain person hand to restrict the ability to use finger thumb. Wrist ankle-limit movement of legs/arm . Elbow restrain- preventing elbow from bending.
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Environment restrain- Reduction of social contact or intentionally removing environment stimulation, it is a change to a person surrounding that restricts or control movement example bed rails can be raised on side of the bed some are padded which make them suffer. Locked doors- locking doors to a room and certain area. It can stop people who are wandering to go into a place they are not supposed to.
Seclusion- can be reduced if they are at risk of injury for themselves or other. It means locking a person in a particular room, it should be used in mental health and intellectual disability to prevent violent behavior compromising safety. Fences it can be used as a restrict on outdoors area, Indoors can be used in a corridor or at a top of staircase. Furniture portable tables or reclining chairs can be used as form of environment restrain.
Important Factors for Dementia Care
2.2 Dignity- Restrain reduces dignity when our choices are diminished and we rely on others to meet our needs such as fluids,toileting bathing, etc. Person or support worker should make sure that they are continually aware of dignity am person.
Privacy- Person al information should be stored securely and should not be visible to people who are not authorized to see it.
Support- positive communication is essential to reduce agitation and anxiety. Should be within the person’s understanding and it may be repeated. Touch are useful ways to communicate with the person. Be sure touch is culturally acceptable for demented client.
Communication- use simple short clear sentences as the person my be having difficulty understanding because of dementia, speak politely this will decreased client stress.
Safety- document the use of restrain example progress notes, Make sure that it is culturally accepted, during restrain monitoring forms and if a new restrain it can be check every 15 mins, then it can become less if a person get used with the restrain.
Process of Dementia Care
Approval process- This is the first step before it needs to approved, before restrain full restrain can be used, any risk desired ourtcome, person age, gender, current treatment, recovery plan, possible alternative, hoe the person will be affected, and the possible effect of this like confusion response on future treatment.
Documentation- document sufficient detail and the intervention and outcome that is being done. Documentation is a legal proof of what is being done. It consist if details of advocacy, intervention and observation, and monitoring, type of restrain being used the time, the risk and the cultural considerations. Document it on restrain form which can be checked and fillup every 2 hours for the notes.
Assessment is needed before the treatment is being started, it includes here the clients health gender, culture, if experience trauma, being abuse in the past , how long should be in place and what factor should be considered and what is the expected outcome on this.
Informed consent- Informed consent is a process of involving indivisual and or their representative if the individual does not have the capacity to consent all involves needs to be appropriately involved and are willing to agree on what is being suggested.consent must be obtained before doing retrain. The ffg should be explained like what is the restrain being used, the risk and benefits, alternatives on the use of restain and the outcome of its use.
Planning- The decision to approve for restrain on a client should be made only as a last resort, to maintain safety for the clients workers and others. It is also based on the information that is being gathered during the assessment process and the organisation policies and procedure.
Care and Monitoring- The need for continuous use of restraint is continually monitores and regulatly reviewed to ensure it is applied for the minimum amount of time necessary. To minimize the risk of harm to the patient during anby period of the restrain the patient safety, comfort, provision of all are support and treatment must met at all times. Must check the color- the skin may also feel cool if blood flow is restricted the circulation restricted blood floew affects circulation which they may feel tingling sensation especially in fingers, hands and feet and toes. Sakin breakdown may occur especially in the area where the restrain is it can become red and will develop sores. Breathinh- The person should breath normally when the restrain is in the place if the person having difficulty of breathing the restrain may be too tight.Posture- if the person is uncomfortable the restrain may be too tight or incorrectly placed. Degree of restriction- there should be enough two finger space between restrain and person body. Comfort- make it comfortable to keepthe injury on its minimum.Personal needs- Ensuring that needs are met and opportunities to eat and drink go to toilet is being prioritized and being given to decrease the impact of restrain.
Reporting and recording- A restrain is being registered or equivalent process is established to record sufficient information to provide audible record of restrain use. Organisation policies will describe what observation monitoring and unexpected changes you need to record and how often this needs to be done.
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