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Angela D. Broadus, PhD

University of Nevada School of Medicine

Nevada Geriatric Education Center

Spring 2013

Program sponsored by the Nevada Aging and Disability Services Division

Explain the progression of Alzheimer’s Disease

Describe physical and emotional symptoms of Alzheimer’s

List the ABC’s of behavior managementDiscuss methods of dealing with problem

behaviors Identify similarities and differences between

Alzheimer’s and mental health disorders such as depression, psychosis, and substance abuse/dependence

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Alzheimer’s Disease is a form of dementia, a progressive disorder resulting in impaired memory, behavior, and the ability to perform everyday tasks….

http://mamontoff.org/growth%20and%20life%20cycles.htm

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Normal Aging Bad decisions

occasionally

Misses an occasional bill or payment

Sometimes forgets the day, but remembers it later

Alzheimer’s Disease Pattern of poor or

illogical decisions

Change in bill paying pattern

Forgets the day and doesn’t remember it later

Normal Aging Forgets a word

occasionally

Loses or misplaces things occasionally

Missing a monthly payment

Alzheimer’s Disease Loses words, mixes up

words

Losing or misplacing things all of the time

Checkbook problems, inability to manage budget

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Memory loss that disrupts daily life

Challenges in planning or solving problems

Difficulty completing familiar tasks at home, at work, or at leisure

Confusion with time or place

Trouble understanding visual images or spatial relationships

New problems with words: speaking or writing

Misplacing things and losing ability to retrace steps

Decreased or poor judgment

Withdrawal from work or social activities

Changes in mood or personality

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Early (2-6 years)Middle (2-10 years) Late (1 or more years)

RESEARCH SUGGESTS THAT ALZHEIMER’S COULD BEGIN AS LONG AS 15 YEARS BEFORE SYMPTOMS BECOME

OBVIOUS!

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Normal function and medical exam may not detect issues

Recognizes they are having memory lapses

Forgets familiar words or the location of everyday objects

Trouble remembering names when introduced to new people

Normal function and medical exam may not detect issues

May be confused in familiar places

Trouble with planning: handling money, paying bills

Mild mood and personality changes

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Symptoms become more challenging and assistance may be required

Difficulty recognizing family and friends

Continuously repeating stories, favorite words or motions

Difficulty with multi-step tasks

Symptoms become more challenging and assistance may be required

Difficulty with mental arithmetic (Counting backward by 7’s)

Forgetting personal history

Lowered concern for hygiene or appearance

Moody or withdrawn in social situations

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Full-time care is needed, including hospice

Lose ability to recognize self in mirror

Lose ability to remember own address, phone number, etc.

Lose ability to recognize family

Major changes in sleep patterns, switching night and day

Lose ability to communicate

Loss of bladder or bowel control

Increasing suspiciousness, paranoia, or delusions

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What are some examples of behavior issues?Where do these occur most frequently?What is the impact on you, your family, your

staff?How do you currently respond? Is it working?

De-escalate the difficult behavior while still addressing the need

Encourage the desired behavior while maintaining Dignity and Autonomy Sense of Control and Freedom of Choice Feelings of safety

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Define the problem: Analyze the ABC’s

Plan intervention

Implement

Evaluate and modify

A - Triggering event (Antecedent- what happens before the behavior)

B - The Behavior itself

C - The Consequence of the behavior: Caregiver response

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Change antecedent

Change consequence

Change both

One task at a time

Simple communication (yes, no)

Set routines and create a daily plan

Prepare ahead of time

Create a calm environment

Create a stable environment

Realistic expectations

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Strengthen appropriate behaviors

Accept rather than contradict

Validate feelings

Distraction and humor to diffuse

Let’s walk through two examples and see if we can find the ABC’s.

Mr. P, a 99 year old male, has walked into the day room without his glasses or hearing aids. He seems delirious and confused, shouting at staff attempting to help him. When asked if he ate breakfast, he states that he does not wish to go to bed. Other residents are becoming agitated from his shouting, so staff make him return to his room.

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Mr. J. did not sleep well last night. This morning, he put his clothes on inside out over his PJ’s before breakfast. His caregiver argued with him and tried to persuade him to remove his PJ’s and put his clothes on correctly. Mr. J became agitated, yelled and attempted to hit the caregiver.

Wandering

Restlessness or Anxiety

Mealtimes

Communication

Hygiene

Using the toilet

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http://matthieulerouxel.com/Hallucinations

Mental IllnessDepression

Psychosis: Hallucinations

False sensory perception

Psychosis: Delusions

False belief

Alzheimer’s DiseaseDepression

Psychosis: Hallucinations are more common in LewyBody dementia

Psychosis: Delusions and the later stages

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Coping Strategies: Distraction

Reassurance

Honesty

Assess & Modify

Other causes of strange behavior Substance Dependence

Medication Interactions

Vitamin Deficiency

Urinary Tract Infection

Thyroid problems

???

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Angela Broadus: broadusad@gmail.comDeanna Hearn: deannahearn@sbcglobal.net

http://www.medicine.nevada.edu/ngec/