A hospital stay can be stressful for anyone, but take a person with dementia out of their routine and into the unfamiliar setting of a hospital, and the stress can be overwhelming. According to the Nurses Improving Care of Healthsystem Elders (NICHE) Program, 25 percent of older patients have dementia, a condition of progressive loss of memory and of at least one other cognitive area. Dementia is also associated with gradual functional decline and mood/behavior changes. Common behavior and psychological symptoms of dementia include anxiety, irritability, anger outbursts, verbal and physical aggression, and/or resistance to care.
“When caring for patients with dementia, we have to remember that all behavior has meaning and communicates unmet needs or unmanageable stress,” said Ellen Munsterman, M.S.N., APRN, AGCNS-BC, Gerontology Program coordinator at Texas Health Fort Worth. “Our goal needs to be to meet their needs and reduce their stress before the behavior occurs.”
While some behaviors may indicate discomfort or general anxiety, aggressive behaviors, such as hitting, kicking, pinching, biting or verbal threats, likely indicate fear.
“If we aren’t able to prevent challenging behaviors, the best response when it occurs is to stop what you are doing, take a step back, take a deep breath, and calmly reassure the patient that they are safe,” said Ellen. “However, our priority should be to recognize escalating stress and intervene before patients exhibit difficult behaviors. “
Ellen offers the following strategies for preventing difficult behavior in patients with dementia.
General triggers:
- Ask family members about any common triggers of difficult behavior and effective prevention strategies
- Approach patients with positivity and kindness. Avoid appearing frustrated, angry or rushed, which can trigger aggressive behaviors in a patient with dementia.
Environment:
- Help maintain the patient’s circadian rhythm (blinds open during the day, lights off and minimal interruptions at night)
- Reduce stimuli (such as noise from the TV and alarming equipment)
Physical approach:
The way you approach a patient with dementia can help reduce anxiety and prevent aggressive behavior.
- Approach the patient from the front so they can see you coming
- Move slowly
- Position yourself next to the patient at their same level
- Offer your hand palm facing up, which is a non-threatening motion
Communication:
- Eliminate potential distractions when speaking with a person with dementia (TV, music, etc.)
- Provide orienting information at the beginning of a conversation
- Ask simple yes/no or either/or type questions
- Allow sufficient time for the person to respond
- When discussing tasks, break the task up into smaller, easier steps
- Demonstrate visually (using non-verbal communication) what you are trying to say
- Match the patient’s level of energy and concern to demonstrate empathy
- Don’t argue with the person
- Offer choices – “do you want apple or orange juice?” – and make statements instead of asking questions – “Let’s get up and go to the restroom.”
- Use distraction through reminiscence, singing or changing the conversation
“These strategies don’t require special skills or extra time, but they can make a significant difference in keeping ourselves and patients safe,” said Ellen.
Helpful resources:
- Information on caring for older adults – www.nicheprogram.org
- Resources including provider practice tools, video tutorials and dementia education – www.actonalz.org (select “provider resources”)
- Information on Alzheimer’s disease – www.alz.org
