Understanding The GPEP Model

1. Understanding The GPEP Model Geropsychiatric Education Program (GPEP) Vancouver Coastal Health

3. Learning Objectives • Identify four types of influences on behaviours: • Psychiatric • Physiological • Psychosocial • Environmental: social, physical environment • Discuss the GPEP Model as a tool for understanding behaviour and planning individualized care

4. Psychiatric Influences on Behaviour

6. Psychiatric Influences • Dementia • Depression • Delirium • Other: • Schizophrenia • Bipolar Disorder • Personality disorder • Obsessive Compulsive Disorder

7. Physical Influences on Behaviour

9. Affects everyone Occurs in every system of our body Individual – no fixed pattern 1. Aging: A Universal Process

11. 2. Physical Illnesses and Behaviour • Arthritis • Diabetes • Parkinson’s Disease • Chronic Obstructive Pulmonary Disease • Emphysema • High Blood Pressure • Visual disturbance….

12. Normal Cataracts

13. Normal Diabetic Retinopathy

14. Normal Glaucoma

15. Normal Macular Degeneration

16. 3. Medications and Side Effects • All medications have possible side-effects • Your role: • to notice if there is a sudden change in behaviour • REMEMBER: role of medications in delirium

18. 4. Pain • What percentage of elders in the community have significant pain? a. 10 – 25 % b. 45 – 60 % c. 70 – 85%

19. Why Elders May Not Report Pain • Fear of being called a complainer • Think no one would listen • Think pain is a normal part of aging • Cannot tell you because of dementia • Fear of consequences • May express pain differently

20. Psycho-Social Influences on Behaviour Who is this Person?

23. Psychosocial Influences • Personal routines • Early life events • Life roles/work history • Important relationships • Coping strategies • Culture • Spiritual values/beliefs • Personality style…

25. The Physical Environment’s Influence on Behaviour

28. How does the Physical Environment affect behaviour? • Level of stimulation • Private space • Lighting / Glare • Room temperature • Signs & labels • Poor colour contrast • Safety concerns

29. The Social Environment’s Influence on BehaviourHow OUR communication and approach affects the client/resident

31. Parts of OUR Communication • Only 7-10% of our message is found in our WORDS • Verbal communication – the actual words we say…

33. Parts of OUR Communication • But…90% of our message is found in our NON-VERBALS • Non-verbal communication – how we say what we say: • Tone • Volume • Body language…

35. Do WE have Good Listening Skills: • Not interrupting • Being non-judgmental • Validating • Allowing for silence • Using supportive body language • Are we paying attention…

37. Understanding Responsive Behaviours

39. What is a Behaviour? • Something someone is doing that you can see or hear • Descriptive • Specific • Non-judgmental / not labeling

40. Understanding Behaviours • Refusal, agitation, and aggression always has a cause/trigger: • Protecting oneself • Unmet needs • Broken brain • When cognition and communication are impaired it is the way in which people with dementia tell us that something is wrong • Very often starts with anxiety • Has a pattern

41. Tools to Describe Behaviours: Identify the behaviour: Identification of Behaviours and Guidelines for Intervention* Document the Behaviour: Behaviour Pattern Record* Care Planning: Behaviour Assessment Tool (BAT) * Cohen-Mansfield, 2004

42. Tool to help with describing behaviour and classify types of behaviour IDENTIFICATION OF BEHAVIOURS & GUIDELINES FOR INTERVENTIONS Cohen-Mansfield

43. Behaviour Pattern Record

44. Care Strategies

46. The resident will: feel safe feel physically comfortable experience a sense of control experience optimal stress experience meaning and pleasure Goals of Care Strategies