'Managing Behaviours Which Challenge Services

1. 'Managing Behaviours Which Challenge Services Andy Shewan NHS Tayside

2. Behaviours That Challenge • Delusions • Hallucinations • Anxiety • Depression • Apathy • Agitation • Aggression • Wandering • Disinhibition

3. Background to Behaviours • Pre-morbid personality • Lifestyle • Perceived on-going responsibilities • Anxiety over needs

4. Triggers and Causes of distressed Behaviour • Biological • Having physical illness • Experiencing pain • Being dehydrated • Being constipated • Psychological • Disinhibition • Loneliness • Low mood • Social and Environmental • Too hot or too cold • Too much stimuli – light, noise etc • Misidentifying people as partners • Uncomfortable clothing, seating etc

5. Medications • Only have modest efficacy • Have significant side effects • Potential detrimental impact on quality of life • 180,000 being treated with anti-psychotics – only 20% will benefit (Banerjee 2009)

6. Non-Pharmacological Interventions • Functional Analysis – sometimes referred to as behavioural modification, behavioural management or behavioural intervention. • Interventions which derive an understanding of the purpose or meaning of an individuals behaviour. • Also known as ‘ABC’ approach

7. Functional Analysis • Requires clear cataloguing or the problem behaviour (B) • (B) is understood in terms of the observed influence of events preceding it (antecedents ‘A’) • And the consequent events upon it (C). • Traditional ‘ABC’ behavioural interventions imply that behaviour is always observable and linear in nature

8. This is not always true for the development and maintenance of challenging behaviour in dementia. • Staff anxiety may be a consequence (‘C’) of a challenging behaviour (‘B’) but staff behaviour (including anxiety) can simultaneously act as an antecedent (‘A’)

9. Example 1 • A man’s unobservable (superstitious) belief (‘A’), precipitated aggression (‘B’), which led to use of an anti-psychotic (‘C’), which in turn reduced his mobility (‘A’), requiring increased staff supervision (‘A’) which further exacerbated his aggression (‘B’).

10. Example 2 • A student approached a lady with dementia and offered her a tea cup with orange juice in it. The lady took one sip from the tea cup and promptly threw the tea over the student. The student then reacted by shouting at the lady asking the lady why she threw the tea. A staff nurse intervened and settled the situation by getting the lady a hot cup of tea. The student required to change, the bed required changing, the floor required cleaning.

11. Core Values • Dignity • Compassion • Respect

12. Resources • Promoting psychological wellbeing for people with dementia and their carers: An enhanced practice resource • Promoting Excellence – A framework for all health and social services staff working with people with Dementia, their family and carers

13. Other Options • Cognitive Stimulation Therapy (CST) • Acceptance & Commitment Therapy (ACT) • Interpersonal Therapy (IPT)

14. Stress & Distress Andy Shewan NHS Tayside