Behavioural issues also known as responsive behaviours are generally characterized by challenging outbursts of aggression, agitation, repetitive or bizarre actions, shouting and/or disinhibited behaviours. They are generally associated with cognitive impairments due to complex mental health conditions and addictions (substance abuse), dementia or neurological conditions. Symptoms generally include observable behaviours that are inappropriate or excessive within the situation and disturbing, disruptive or potentially harmful to the resident or others.(4)
Why is it Important?
Older adults with responsive behaviours require specialized services to meet their complex needs.(3)
One in four seniors lives with a mental health problem (e.g., depression, anxiety or dementia) or illness.
5-10% have severe psychiatric impairment that may require specialized services.(3)
79% with serious behaviours live at home: 18% live alone and 58.8% live with their primary caregiver.(3)
Challenging behaviours of individuals are a major source of distress to the person experiencing them and to their caregiver(s).(5)
30% of home care clients with dementia exhibited some behavioural symptoms.(3)
64.5% of caregivers expressed distress/inability to continue caring for individuals with serious behaviours.(3)
34% of nurses have experienced physical assault from a patient and 47% reported emotional.(5)
May be precipitated by variety of triggers (follow P.I.E.C.E.S.TM acronym): Physical: pain, constipation, polypharmacy, infections; especially UTI and pneumonia Intellectual: Review Brain and Behaviour Emotional:depression, anxiety Capacity: miss match between functional ability and expectations Environmental: changes in living environment, relocation, admission to hospital Social: change or stress/illness of caregiver
Assess medical, neurological, functional and psychiatric status using evidence based assessment and screening tools.
Ongoing evaluation and modifications based upon client, and family/ caregiver needs. Commonly “under recognized” especially with patients living in their own homes. Often presents as a crisis and with atypical presentation.
Clients should receive individualized, self-directed person centered care. Responsive behaviours respond to appropriate and timely interventions.
The goal of care is to support the person and family to remain in their home.(4)
Look for signs of caregiver stress.(3)
Determine concerns (e.g. fears) and expectations (hopes) of the person and family using the 3 question framework:
What are the main concerns and what has changed?
What are the RISKS and possible causes (Think P.I.E.C.E.S.TM)?
What is the action?
Minimization of pharmacological interventions and use of the Beers criteria for potentially inappropriate medication use in older adults. Identify conditions that only respond to environmental or caregiving approaches.
Continuity of health care providers helps both the patient and the family.
1. Abbott-McNeil, D., Barber, D., Murphy. & Puxty, J. (2009). Behavioral & Psychological Symptoms of Dementia (BPSD) in Long Term Care. Bridges to Care Guide, The Centre for Studies in Aging and Health. www.sagelink.ca/bpsd_toolkit_full_pdf
2. Conn, D., Gibson, M., Hirst, S., Leung, S., MacCourt, P., McGilton, K., Mihic, L., Cory, K., Le Clair, K., McLeary, L., Powell, S.,& Roberts, E. (2006). National guidelines for senior’s mental health. The assessment and treatment of mental health issues in long term care home. Retrieved Feb. 2014 from: http://www.ccsmh.ca/en/natlGuidelines/ltc.cfm
3. Dudgeon, S. & Reed, P. (2010). Older Adults Behaviour Support System. Retrieved Feb 19, 2014