Archbold Memorial Hospital held a lecture entitled “Behind the Behavior: Understanding Aggression in the Older Adult” on Wednesday. The lecture was led by Barbara Ann Lang, RN, BC.
The main focus of Lang’s lecture was to instill in the audience that all behavior has meaning.
She said, “It is our job to try to understand where it’s coming from. It’s very hard to do when the patient can’t effectively communicate with you.”
Lang is the senior vice president at Clinical Practice Horizon Health in Lewisville, Texas. She is a graduate of Brockville Psychiatric Hospital School of Nursing with post graduate certificate in Hospital Administration in Ontario, Canada. Lang is also a ANCC Board certified psychiatric mental health nurse.
For 45 years, she has studied behavioral health and been a psychiatric nurse, and most recently focused on the implementation and development of Recovery Model/Trauma Sensitive pilot projects for inpatient programs. She is responsible for client support and regulatory oversight in approximately 100 hospitals in over 30 states while working for Horizon Health.
Recently, Alzheimer’s Disease has been classified as a neurocognitive disorder. It is believed the new classification will help with the stigma of the disease. A neurocognitive disorder is in ordinance with DSM-5 disorders rather than DSM-IV TR Dementia. In short, the DSM is the diagnostic and statistical manual for mental disorders for psychiatrists references.
She used strategies in considering different approaches to patients who are suffering from some type of dementia. It is suggested to that when a person becomes confused not to try to bring them to reality by telling them what they are seeing is not there. Validation therapy is suggested. This is when the nurse or overseer of the confused person asks about the hallucinations. With handling the situation in this manner, the patient is less likely to become violent and even more confused.
The environment plays a role in affecting behavior. It is important to consider what may be happening outside. If there is roadwork or other loud noises, this could cause the patient to become aggressive and confused. Routine can be a good thing, but never make it rigid. If the patient is required to do something and does not want to do it when asked, try again later.
There are simple things that can always be done to help improve the patient’s behavior. When words do not work with the patient, sometimes signs or motions help. Frustrations from the caregiver to the patient can always be picked up on from the patient. People realize when they are cared about. An important rule of thumb is to sincerely care.
“Everyone is an individual. This is another important thing to remember,” said Lang.
The person’s history needs to be considered carefully when dealing with behavioral issues. Caregivers need to know things such as, how were they brought up? Aggressive behavioral can be traced back in the patients history, usually. Statistics show that 70-80 percent of aggressive patients are a victim of trauma or abuse.
Caregivers need to know how to approach these things. It could be a build up of something, but not necessarily anything that has happened recently.
The attitude of the caregiver plays a key role in the outcome of aggressive situations. It is important for them to use their personality. If they are humorous, it is best for them to use their humor to comfort the aggressive patient. One needs to identify their strengths and limitations.
Lang suggested, “If you can’t handle it, take a break. Plan for it and do it differently.”
Since a patient rarely has any control over their surroundings, this could be a source of agitation and aggression. When they are allowed some control, it helps with their behavior.
“Ask them what they want. If they are getting dressed, ask them if they want to wear the blue sweater or the pink sweater. Don’t just pick for them. This may take some time, but it will be worth it,” Lang said.
It is difficult to be consistent with actions. There are several recommended approaches for dealing with people who have dementia. Some of these include, knocking before entering their room, smiling, greeting, approaching from the front, moving slowly, standing to the side, shaking hands and delivering a simple, short message to them. Even though people may not consider these things a big deal, they help with dealing with the patient.
“We don’t need to get focused on what we need to get done. These are all simple things we don’t do often enough. Follow these recommended approaches and give them time to respond to you. They may not be able to say even if they want to,” said Lang.
Lang asked the audience to think about how it must feel to be the patient. From their viewpoint, consider the environment, what they may be used to and if there may be something else medically wrong.
“It is all about problem solving. Every circumstance is different,” Lang said.
For more information on behavioral and psychiatric care, visit www.archbold.org/northside.
Reporter Susanne Reynolds can be reached at (229) 226-2400, ext. 1826.