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Understanding The GPEP Model Geropsychiatric Education Program (GPEP) Vancouver Coastal Health Slide 2 Slide 3 Learning Objectives Identify four types of influences on behaviours: Identify four types of influences on behaviours: Psychiatric Psychiatric Physiological Physiological Psychosocial Psychosocial Environmental: social, physical environment Environmental: social, physical environment Discuss the GPEP Model as a tool for understanding behaviour and planning individualized care Discuss the GPEP Model as a tool for understanding behaviour and planning individualized care Slide 4 Psychiatric Influences on Behaviour Slide 5 Slide 6 Psychiatric Influences Dementia Dementia Depression Depression Delirium Delirium Other: Other: Schizophrenia Schizophrenia Bipolar Disorder Bipolar Disorder Personality disorder Personality disorder Obsessive Compulsive Disorder Obsessive Compulsive Disorder Slide 7 Physical Influences on Behaviour Slide 8 Slide 9 1. Aging: A Universal Process Affects everyone Affects everyone Occurs in every Occurs in every system of our body Individual no fixed Individual no fixed pattern pattern Slide 10 Slide 11 2. Physical Illnesses and Behaviour Arthritis Diabetes Parkinsons Disease Chronic Obstructive Pulmonary Disease Emphysema High Blood Pressure Visual disturbance. Slide 12 Normal Cataracts Slide 13 Normal Diabetic Retinopathy Slide 14 Normal Glaucoma Slide 15 Normal Macular Degeneration Slide 16 3. Medications and Side Effects All medications have All medications have possible side-effects possible side-effects Your role: Your role: to notice if there is a sudden change in behaviour to notice if there is a sudden change in behaviour REMEMBER: role of medications in delirium REMEMBER: role of medications in delirium Slide 17 Slide 18 4. Pain What percentage of elders in the community have significant pain? What percentage of elders in the community have significant pain? a. 10 25 % b. 45 60 % c. 70 85% Slide 19 Why Elders May Not Report Pain Fear of being called a complainer Think no one would listen Think pain is a normal part of aging Cannot tell you because of dementia Fear of consequences May express pain differently Slide 20 Psycho-Social Influences on Behaviour Who is this Person? Slide 21 Slide 22 Slide 23 Psychosocial Influences Personal routines Personal routines Early life events Early life events Life roles/work history Life roles/work history Important relationships Important relationships Coping strategies Coping strategies Culture Culture Spiritual values/beliefs Spiritual values/beliefs Personality style Personality style Slide 24 Slide 25 The Physical Environments Influence on Behaviour Slide 26 Slide 27 Slide 28 How does the Physical Environment affect behaviour? Level of stimulation Private space Lighting / Glare Room temperature Signs & labels Poor colour contrast Safety concerns Slide 29 The Social Environments Influence on Behaviour How OUR communication and approach affects the client/resident Slide 30 Slide 31 Parts of OUR Communication Only 7-10% of our message is found in our WORDS Only 7-10% of our message is found in our WORDS Verbal communication the actual words we say Verbal communication the actual words we say Slide 32 Slide 33 Parts of OUR Communication But90% of our message is found in our NON-VERBALS But90% of our message is found in our NON-VERBALS Non-verbal communication how we say what we say: Non-verbal communication how we say what we say: Tone Tone Volume Volume Body language Body language Slide 34 Slide 35 Do WE have Good Listening Skills: Not interrupting Not interrupting Being non-judgmental Being non-judgmental Validating Validating Allowing for silence Allowing for silence Using supportive body language Using supportive body language Are we paying attention Are we paying attention Slide 36 Slide 37 Understanding Responsive Behaviours Slide 38 Slide 39 What is a Behaviour? Something someone is doing that you can see or hear Something someone is doing that you can see or hear Descriptive Descriptive Specific Specific Non-judgmental / not labeling Non-judgmental / not labeling Slide 40 Understanding Behaviours Refusal, agitation, and aggression always has a cause/trigger: Refusal, agitation, and aggression always has a cause/trigger: Protecting oneself Protecting oneself Unmet needs Unmet needs Broken brain Broken brain When cognition and communication are impaired it is the way in which people with dementia tell us that something is wrong When cognition and communication are impaired it is the way in which people with dementia tell us that something is wrong Very often starts with anxiety Very often starts with anxiety Has a pattern Has a pattern Slide 41 Tools to Describe Behaviours: 1. Identify the behaviour: Identification of Behaviours and Guidelines for Intervention* Identification of Behaviours and Guidelines for Intervention* 2. Document the Behaviour: Behaviour Pattern Record* Behaviour Pattern Record* 3. Care Planning: Behaviour Assessment Tool (BAT) Behaviour Assessment Tool (BAT) * Cohen-Mansfield, 2004 Slide 42 Tool to help with describing behaviour and classify types of behaviour IDENTIFICATION OF BEHAVIOURS & GUIDELINES FOR INTERVENTIONS Cohen-Mansfield Slide 43 Behaviour Pattern Record Slide 44 Care Strategies Slide 45 Slide 46 Goals of Care Strategies The resident will: feel safe feel physically comfortable experience a sense of control experience optimal stress experience meaning and pleasure