dealing with dementia behaviors charles crecelius md phd facp cmd
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Dealing with Dementia Behaviors
Charles Crecelius MD PhD FACP CMD
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Selected Behavioral Symptoms in Dementia
• Apathy (50%–70%)• Agitation (40%–60%)• Mood lability (40%)• Blunted affect (40%)• Disinhibition (30%–40%)• Withdrawal (30%–40%)• Delusions (20%–40%)
• Anxiety (30%–50%)• Suspiciousness (30%)• Dysphoria (20%–40%)• Hostility (30%)• Aggression (10%–20%)• Hallucinations (5%–15%)
Sultzer DL. Sultzer DL. Postgraduate medicine: A special reportPostgraduate medicine: A special report. 1999:19-. 1999:19-26.
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Etiology of Dementia BehaviorsIntrinsic Factors
• Brain damage
• Co-morbid diseases
• Medications
• Pain
• Physical needs
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Etiology of Dementia BehaviorsExtrinsic Factors
• Environment
• Social
• Staff
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Behaviors Warranting Urgent & Probable Medication Interventions• Violent behaviors (not redirectable)
• Distressing hallucination, delusions or paranoia
• Abrupt worsening (pending evaluation)
• Depression with rapid change / functional impairment
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Nonpharmacologic Approach to Behaviors
• Define the behavior
• Determine the nature and extent as a problem
• Determine why the behavior occurs
• Design interventions
• Evaluate and redesign as needed
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Basic Principles of ProblemBehavior Solving Strategies
• Early intervention
• Confrontation aviodance
• Control excess stimulation
• Distract and redirect
• Maintain dignity
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Behavior Interventions
• Therapeutic– Music
– Sensory
– Reminescent
– Social
• Control Mechanisms– Contextual
– Consequential
– Stimulus
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End of Life ChangesAffecting Behavior
• Worsening “4 A’s”
• Concomitant diseases
• Difficulty defining behaviors
• Care plan goal changes
• Shifts in behavior types
• Intervention limitations