Speech and Language Disorders

• Responsive behaviors are actions, words, and gestures expressing something important about a person's personal, social, or physical environment

• Responsive behaviors are often intentional, yet cannot be controlled

• Responsive behaviors occur with clients with dementia

• Responsive behaviors can be disruptive to other clients or residents

• Responsive behaviors are often challenging for caregivers

• All responsive behaviors have meaning

• Clients living with dementia may be unable to understand what they want or what is happening due to brain dysfunction

• Brain dysfunction can cause the inability to sort out messages, send correct messages, or understand the meaning of actions

• Neurological changes may result in acting out such as resisting staff, becoming very vocal, or physically combative

• Aggression toward other clients or caregivers may involve spitting, biting, or punching

• Responsive behaviors can be applied to clients with mental health disorders, substance abuse disorders, and other neurological disorders

• "Responsive behavior" is preferred over "challenging client" or "challenging behavior"

• Changes in the brain can cause responsive behaviors such in the areas of memory, judegment, orientation, mood, and behavior

• Understanding Responsive Behaviors enables PSWs to provide safe, ethical care, best practice, a systematic approach to care and enhanced communication skills, all while respecting the client

• All personal expressions have meaning and communicate needs and concerns

Assessing Responsive Behavior (RB)

• Physical assessments for RB must include evaluation of basic needs, discomfort, pain, and physical condition changes

• Intellectual assessments for RB must include evaluation of recent memory changes, impulsive behavior, and difficulty with speech or sequenced tasks

• Emotional assessments for RB must include evaluation of increased tearfulness or anxiety, loneliness, and new unusual behavior

• Assessment of capabilities for RB must evaluate what a client can do more than realizes, and whether client/patient/family understand what help they need

• Environmental assessments should adress too much noise, poor lighting or insufficient stimulation for the client

• Social assessments should adress childhood, early adulthood or employment experiances and the patient's religion and culture

• Other assesments should assess the actions of others and what may contribute to the client's behaviour

• Grabbing onto people and general restlessness and agitation are common responsive behaviours for clients in LTC

• Screaming and constant unwarranted requests for help are common responsive behaviours for clients in LTC

• Cursing or verbal aggression, along with pacing behaviours, are common responsive behaviours for clients in LTC

• Making strange noises and repetitive sentences or questioning are common responsive behaviours for clients in LTC

• Trying to get to a different place and aimless wandering are common responsive behaviours for clients in LTC

• Complaining or whining are common responsive behaviours for clients in LTC

Personal Support Worker (PSW) Role in Responsive Behaviour (RB)

• PSWs cannot expect the client to change; instead, PSWs are responsible for changing their approach

• PSWs must understand the disease, be patient, and accept the person in the moment

• PSWs must prioritize safety, avoid positions they cannot leave, and seek help immediately after leaving a client

• PSWs should consult a supervisor if the client's behavior affects the quality of life of family or co-residents

Types of Responsive Behaviors

• Agitation
• Wandering
• Inappropriate sexual behavior
• Sundowning
• Repetition
• Aggression
• Hallucinations and paranoia
• "I want to go home"

Responding to Agitation (RB)

• Environmental factors, fear, dehydration, fatigue, or feeling overwhelmed/confused can all cause agitation

• To appropriately respond, redirect attention, remain calm and positive, use visual and verbal cues, simplify tasks and routines, and provide options

Responding to Wandering (RB)

• Wandering can be active (including pacing searching or keeping busy) or passive (aimless and easily distracted), and may include stress, anxiety, the inability to recognize people/places, a desire to fulfill former obligations, boredom, a search for something familiar, or needing to find the bathroom

• Encourage movement/exercise, maintain routines, remove visual reminders, involve patients in productive activities, connect them with familiar items/photos, reassure them, and accommodate wandering

Responding to Inappropriate Sexual Behavior (RB)

• Interest in sex does not decrease with age, and a client's actions may be an attempt to communicate

• When behavior expresses a sexual desire, give them privacy

• They have the right to be left alone provided that the behavior is contained and between consenting adults

• In dementia patients consider whether sexual behavior is consensual, and utilize other strategies if it's determined not to be

• Distract patients to disengage behaviour

• Less control over urges, medication side effects, tight clothing, overheated rooms, needing the washroom, or disorientation can all cause inappropriate sexual behavior

• Potential strategies include identifying triggers, providing privacy, staying calm, offering comfort with activities or items, changing wardrobes, and distracting them

• Consider a pillow in the lap for inappropriate touching and remember contact your supervisor immediately if your physical well-being is in danger

Responding to Sundowning (RB)

• Sundowning involves agitation that occurs specifically in the late afternoon and evening where an individual may become suspicious, upset, disoriented, or believes unreal things

• Causes of sundowning include end-of-day exhaustion, boredom, wanting to go home, disorientation, and reduced lighting

• Strategies for managing sundowning include discouraging napping, scheduling calming activities, careful diet and caffeine intake, adequate lighting, comfort items, and reassurance

Responding to Repetition (RB)

• "Perseverating" is the verbal repeating of questions

• Repetitive movements of a physical nature

• Feelings of insecurity or loss, loneliness, separation from a loved one, under or over stimulation and the inability to express a need can all cause repetition

• Strategies may include distraction, responding to the underlying emotion, providing an object to occupy hands, household chores, and calm, repeated answers

Responding to Aggression (RB)

• Anger may reflect many feelings and occur for reasons that are not always clear; it is important to figure out why and respond accordingly

• Potential causes include fatigue, grief, pain/discomfort, sensory overload, feeling lost/insecure, fear, and lessened control due to dementia

• Watch physical ques like sudden increase in movement to indicate anxiety

• Respond with support, in a gentle voice, and reduce noise

• Maintain routines, speak slowly, use repetition, break activities into steps, distract the, approach slowly from the front at the same eye level

• Do not agrue, instead leave the room for a time out! Always leave the room or get help to ensure that you and other patients are safe.

Responding to Hallucinations and Paranoia (RB)

• When someone hallucinates, they see or hear things no one else does

• If a hallucination is not upsetting, there is no need to intervene

• Delusions refer to beliefs contrary to fact that remain persistent even when evidence contradicts them

• Causes include sensory changes, medications, an unrecognized environment, inadequate lighting, disruption of routines, and removal of items like money/jewelry

• Review medications, schedule hearing/vision testing, seek medical evaluations (UTIs), and investigate suspicions that might be true

• Provide physical touch as reassurance, increase lighting, and, generally, do not disagree with a false idea

Responding to "I Want to Go Home" Behavior (RB)

• The desire to "go home" reflects wanting a sense of relief, contentment, and safety, to be surrounded by people and things that provide comfort

• Fatigue, over-stimulation, an unfamiliar task, or moving to a new room or unit are all causes of "I want to go home."

• Use a clam voice and tone, be aware of your nonverbal actions

• Ask simple questions to start a conversation about where 'home' is

Responding to Catastrophic Reactions (RB)

• Catastrophic reactions are extreme responses to what the client perceives as extreme danger, disaster, or tragedy, often caused by overstimulation

• Actions involve screaming, crying, or becoming agitated/combative, and can be caused by a noisy dining room, high volume on the TV, or too many questions

• Key strategies for all reactive behaviors include revising goals, considering client abilities/feelings, not taking behavior personally, avoiding confrontation, and providing structure/routine while being flexible

• Persons with dementia respond to what is going on within and around them