Building on the concept of a basic understanding of challenging behaviour, Figure 2 presents a schematic outlining the steps to follow when dealing with an individual with dementia who is resisting care. Of primary importance, the first step is to stop and ask why the individual is resisting. This very important first step is often overlooked as caregivers insist on completing the task or arguing with the individual, frequently making matters worse. The next step is a three-pronged approach:
First, following arm "A" in Figure 2, caregivers must try to look at the behaviour objectively, possibly recording observed behaviour. This may take the form of a behaviour log used by long-term care homes, or it may be something simple such as a journal kept by a caregiver in the person's own home. Such behaviour tracking may reveal patterns to the behaviour or identify triggers. This information can be crucial in planning next steps.
Another step in this process, as shown in arm "B" of Figure 2, supports caregivers taking the time to reflect on their own feelings. Too often, caregivers are frustrated and emotionally exhausted, they blame the individual for acting out, and they blame themselves for the way they feel. They need reassurance and support regarding these feelings.
As arm "C" of Figure 2 indicates, a thorough examination of the multiple physical as well as environmental issues that can contribute to the distress of an individual with dementia is necessary. Such an examination leads to a range of possible interventions, each tailored to a specific possible cause.
Managing resistance to care does not stop with an intervention. Rather, following arm "D" in Figure 2, interventions must be monitored for effectiveness. This step is reluctantly taken by some caregivers, as admitting failure is not easy. However, to increase the chances of long-term success, interventions must be constantly monitored and communication is imperative. If an intervention is successful, the approach must be shared with everyone involved, as consistency is a key to success when working with individuals who have dementia. Equally important is recognition of techniques that are not successful. However, rather than calling this a failure, caregivers should be encouraged to reconsider the approach, gather more information, and use this information in planning a new or different strategy.
Geriatrics and Aging. 2007;10(3):182-191. © 2007 1453987 Ontario, Ltd.
Cite this: Dementia: A Systematic Approach to Understanding Behaviour - Medscape - Feb 01, 2007.