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Support Residents With Challenging Behaviors

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

  • Build a POSITIVE, TRUSTUNG RELATIONSHIP. You are familiar and you are SAFE 

  • Use effective verbal and nonverbal communication techniques. 

  • Encourage independence in the person. Try to help the resident build a sense of control and 
competence over his/her life. 

  • Avoid “why” questions. 

  • Avoid arguing, yes/no battles, rational or logical explanations, and debates. 

  • Re-direct questions to save the resident grief and reduce problem behaviors (i.e., validation 
therapy). 

  • Redirect or divert the resident’s attention to a positive topic, activity, or object. 

  • When a behavior requires intervention, act quickly with positive techniques and activities. 


Dementia related behaviors: Non-pharmacologic responses and interventions.

❖ Wandering/Pacing 


  • Movement with or without a purpose or goal 
  • Interventions: 
  • Distraction/diversion 

  • Use signs for cueing 

  • Maintain a safe area to pace 

  • Monitor fatigue 

  • Create purposeful activity such as rummage or sensory stimulation kits. 

  • Create interesting places to move toward. 

  • Consider a change in body temperature. Go outside in a safe internal 
space. Walk/Wheel with resident. Drink something cold or hot. Wash hands in cold 
water etc. 


❖ Rummaging/Pillaging 


  • Searching, looking at 
  • Interventions: 
  • Provide safe objects to touch, hold, manipulate. The more familiar the objects, the better.
  • Invite residents to take objects from one place to another. 

  • Is the environment or something in it new? 

  • Ensure personal items have resident names in place. 

  • Support a resident’s interest in organizing and repositioning items.  


❖ Anxiety/Agitation 


  • AEB: inappropriate verbal, vocal or physical activity
  • Interventions: 
  • Avoid frequent changes 

  • Decrease crowds or loud noises 

  • Recognize what can create overwhelming feelings for a resident. 

  • Watch for signs in advance of mood changes and distract or remove person from the 
stressful situation to a calmer space. 

  • Recognize anniversary events or response to family leaving. 

❖ Catastrophic Reaction

  • Exaggerated or over-reaction to an incident demonstrated by sudden mood change, 
uncontrolled crying, agitation, and restlessness, anger - with or without violence.
  • Interventions: 
  • Anticipate stressors 

  • Use positive statements 

  • Distraction/diversion 

  • Failure-free activities 

  • Respond to the emotion 

  • Use exercise through meaningful, movement based activities to reduce stress 


❖ Combativeness/Aggression
 

  • Physical striking out (hitting) due to a fear, anger, misinterpretation, or challenges 
  • Interventions: 
  • Check residents sleep and fatigue level. Has resident slept well in the past 48 hours? 
  • Ensure resident is physically comfortable.
  • Respond, distract to avoid further aggression
  • Move and speak slowly, remind resident who you are; do not threaten 

❖ Sun downing

  • Increased behaviors (pacing, confusion, yelling, restlessness, etc.) that occur mid to late afternoon and evening, possibly due to circadian rhythm, physical, emotional exhaustion or dehydration
  • Interventions: 
  • Simplify approaches and environment 

  • Rule out PAIN or lack of sleep 

  • Take the resident outdoors – exposure to sunlight 

  • Encourage fluids 

  • Rest periods after lunch 

  • Involve in a quiet activity 

❖ Screaming, yelling, calling

  • Expressions of fear, or losing control 

  • Interventions: 
  • Check hearing and vision?  
  • Evaluate for pain? 

  • Distract, divert (use music, folding towels, etc.) 

  • Use touch, if appropriate 

  • Try turning on a light 

❖ Repeated movement 


  • Using hands or fingers to take apart or pull at things or hitting or wiping surfaces, or chewing, clapping etc.
  • Interventions: 
  • Side effects or medication?
  • Give resident something to hold 
  • Provide resident with music of choice and personal earphones.  Perhaps the behavior is self-stimulating.

❖ Layering or stripping off clothes

  • Dressing/undressing of clothes in inappropriate places or times.
  • Interventions: 
  • Gently assist the resident to put on a robe or clothes

  • Keep clothes accessible for resident to change between. 
  • Assess whether resident is hot, cold or simply uncomfortable in the garment.
  • Evaluate for soiled undergarments.

❖ Socially Inappropriate Sexual Behavior

  • Sexual activity involving socially inappropriate language, public exposure, offensive and/or misunderstood gestures.
  • Interventions: 
  • Remain cam; don’t overreact, argue, scold or laugh 

  • Ignore language and behavior, distract or divert 

  • Assist resident to private space 

  • Evaluate whether behavior is a side effect of medication.

 ❖ Demanding or accusing


  • Wants everything done immediately or cannot remember where possessions are located 
  • Interventions: 
  • Use caring calm voice 

  • Assist to find missing items 

  • Use food or tasks to distract 


❖ Hallucinations and Delusions 


  • Hallucinations: sensory experiences (hearing, seeing, tasting, smelling, feeling) not experienced by anyone else

  • Delusions: persistent incorrect beliefs (“you’re not my daughter”) 
  • Interventions: 
  • Check hearing, vision, hearing aids, glasses 

  • Modify environment to eliminate causes 

  • If harmless, let go and distract with tasks 

  • Remember that it is real to the resident 

  • Don’t take it personally 


❖ Withdrawal and Apathy 

  • Sadness or depression - surroundings and people
  • Blank look of sadness

  • Absence of expression
  • Retreating to room 

  • Interventions: 

  • Anticipate and avoid problem situations 

  • Encourage positive situations 

  • Reassure resident that he/she will be cared for as long as necessary 

  • Do not force participation 

  • Help resident to feel safe and secure. 
Support Residents With Challenging Behaviors

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

  • Build a POSITIVE, TRUSTUNG RELATIONSHIP. You are familiar and you are SAFE 

  • Use effective verbal and nonverbal communication techniques. 

  • Encourage independence in the person. Try to help the resident build a sense of control and 
competence over his/her life. 

  • Avoid “why” questions. 

  • Avoid arguing, yes/no battles, rational or logical explanations, and debates. 

  • Re-direct questions to save the resident grief and reduce problem behaviors (i.e., validation 
therapy). 

  • Redirect or divert the resident’s attention to a positive topic, activity, or object. 

  • When a behavior requires intervention, act quickly with positive techniques and activities. 


Dementia related behaviors: Non-pharmacologic responses and interventions.

❖ Wandering/Pacing 


  • Movement with or without a purpose or goal 
  • Interventions: 
  • Distraction/diversion 

  • Use signs for cueing 

  • Maintain a safe area to pace 

  • Monitor fatigue 

  • Create purposeful activity such as rummage or sensory stimulation kits. 

  • Create interesting places to move toward. 

  • Consider a change in body temperature. Go outside in a safe internal 
space. Walk/Wheel with resident. Drink something cold or hot. Wash hands in cold 
water etc. 


❖ Rummaging/Pillaging 


  • Searching, looking at 
  • Interventions: 
  • Provide safe objects to touch, hold, manipulate. The more familiar the objects, the better.
  • Invite residents to take objects from one place to another. 

  • Is the environment or something in it new? 

  • Ensure personal items have resident names in place. 

  • Support a resident’s interest in organizing and repositioning items.  


❖ Anxiety/Agitation 


  • AEB: inappropriate verbal, vocal or physical activity
  • Interventions: 
  • Avoid frequent changes 

  • Decrease crowds or loud noises 

  • Recognize what can create overwhelming feelings for a resident. 

  • Watch for signs in advance of mood changes and distract or remove person from the 
stressful situation to a calmer space. 

  • Recognize anniversary events or response to family leaving. 

❖ Catastrophic Reaction

  • Exaggerated or over-reaction to an incident demonstrated by sudden mood change, 
uncontrolled crying, agitation, and restlessness, anger - with or without violence.
  • Interventions: 
  • Anticipate stressors 

  • Use positive statements 

  • Distraction/diversion 

  • Failure-free activities 

  • Respond to the emotion 

  • Use exercise through meaningful, movement based activities to reduce stress 


❖ Combativeness/Aggression
 

  • Physical striking out (hitting) due to a fear, anger, misinterpretation, or challenges 
  • Interventions: 
  • Check residents sleep and fatigue level. Has resident slept well in the past 48 hours? 
  • Ensure resident is physically comfortable.
  • Respond, distract to avoid further aggression
  • Move and speak slowly, remind resident who you are; do not threaten 

❖ Sun downing

  • Increased behaviors (pacing, confusion, yelling, restlessness, etc.) that occur mid to late afternoon and evening, possibly due to circadian rhythm, physical, emotional exhaustion or dehydration
  • Interventions: 
  • Simplify approaches and environment 

  • Rule out PAIN or lack of sleep 

  • Take the resident outdoors – exposure to sunlight 

  • Encourage fluids 

  • Rest periods after lunch 

  • Involve in a quiet activity 

❖ Screaming, yelling, calling

  • Expressions of fear, or losing control 

  • Interventions: 
  • Check hearing and vision?  
  • Evaluate for pain? 

  • Distract, divert (use music, folding towels, etc.) 

  • Use touch, if appropriate 

  • Try turning on a light 

❖ Repeated movement 


  • Using hands or fingers to take apart or pull at things or hitting or wiping surfaces, or chewing, clapping etc.
  • Interventions: 
  • Side effects or medication?
  • Give resident something to hold 
  • Provide resident with music of choice and personal earphones.  Perhaps the behavior is self-stimulating.

❖ Layering or stripping off clothes

  • Dressing/undressing of clothes in inappropriate places or times.
  • Interventions: 
  • Gently assist the resident to put on a robe or clothes

  • Keep clothes accessible for resident to change between. 
  • Assess whether resident is hot, cold or simply uncomfortable in the garment.
  • Evaluate for soiled undergarments.

❖ Socially Inappropriate Sexual Behavior

  • Sexual activity involving socially inappropriate language, public exposure, offensive and/or misunderstood gestures.
  • Interventions: 
  • Remain cam; don’t overreact, argue, scold or laugh 

  • Ignore language and behavior, distract or divert 

  • Assist resident to private space 

  • Evaluate whether behavior is a side effect of medication.

 ❖ Demanding or accusing


  • Wants everything done immediately or cannot remember where possessions are located 
  • Interventions: 
  • Use caring calm voice 

  • Assist to find missing items 

  • Use food or tasks to distract 


❖ Hallucinations and Delusions 


  • Hallucinations: sensory experiences (hearing, seeing, tasting, smelling, feeling) not experienced by anyone else

  • Delusions: persistent incorrect beliefs (“you’re not my daughter”) 
  • Interventions: 
  • Check hearing, vision, hearing aids, glasses 

  • Modify environment to eliminate causes 

  • If harmless, let go and distract with tasks 

  • Remember that it is real to the resident 

  • Don’t take it personally 


❖ Withdrawal and Apathy 

  • Sadness or depression - surroundings and people
  • Blank look of sadness

  • Absence of expression
  • Retreating to room 

  • Interventions: 

  • Anticipate and avoid problem situations 

  • Encourage positive situations 

  • Reassure resident that he/she will be cared for as long as necessary 

  • Do not force participation 

  • Help resident to feel safe and secure. 
Support Residents With Challenging Behaviors

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

TOP TEN TIPS TO PREVENT FALLS AND FALL RELATED INJURIES

GENERAL GUIDELINES FOR COPING WITH CHALLENGING BEHAVIORS 

  • Build a POSITIVE, TRUSTUNG RELATIONSHIP. You are familiar and you are SAFE 

  • Use effective verbal and nonverbal communication techniques. 

  • Encourage independence in the person. Try to help the resident build a sense of control and 
competence over his/her life. 

  • Avoid “why” questions. 

  • Avoid arguing, yes/no battles, rational or logical explanations, and debates. 

  • Re-direct questions to save the resident grief and reduce problem behaviors (i.e., validation 
therapy). 

  • Redirect or divert the resident’s attention to a positive topic, activity, or object. 

  • When a behavior requires intervention, act quickly with positive techniques and activities. 


Dementia related behaviors: Non-pharmacologic responses and interventions.

❖ Wandering/Pacing 


  • Movement with or without a purpose or goal 
  • Interventions: 
  • Distraction/diversion 

  • Use signs for cueing 

  • Maintain a safe area to pace 

  • Monitor fatigue 

  • Create purposeful activity such as rummage or sensory stimulation kits. 

  • Create interesting places to move toward. 

  • Consider a change in body temperature. Go outside in a safe internal 
space. Walk/Wheel with resident. Drink something cold or hot. Wash hands in cold 
water etc. 


❖ Rummaging/Pillaging 


  • Searching, looking at 
  • Interventions: 
  • Provide safe objects to touch, hold, manipulate. The more familiar the objects, the better.
  • Invite residents to take objects from one place to another. 

  • Is the environment or something in it new? 

  • Ensure personal items have resident names in place. 

  • Support a resident’s interest in organizing and repositioning items.  


❖ Anxiety/Agitation 


  • AEB: inappropriate verbal, vocal or physical activity
  • Interventions: 
  • Avoid frequent changes 

  • Decrease crowds or loud noises 

  • Recognize what can create overwhelming feelings for a resident. 

  • Watch for signs in advance of mood changes and distract or remove person from the 
stressful situation to a calmer space. 

  • Recognize anniversary events or response to family leaving. 

❖ Catastrophic Reaction

  • Exaggerated or over-reaction to an incident demonstrated by sudden mood change, 
uncontrolled crying, agitation, and restlessness, anger - with or without violence.
  • Interventions: 
  • Anticipate stressors 

  • Use positive statements 

  • Distraction/diversion 

  • Failure-free activities 

  • Respond to the emotion 

  • Use exercise through meaningful, movement based activities to reduce stress 


❖ Combativeness/Aggression
 

  • Physical striking out (hitting) due to a fear, anger, misinterpretation, or challenges 
  • Interventions: 
  • Check residents sleep and fatigue level. Has resident slept well in the past 48 hours? 
  • Ensure resident is physically comfortable.
  • Respond, distract to avoid further aggression
  • Move and speak slowly, remind resident who you are; do not threaten 

❖ Sun downing

  • Increased behaviors (pacing, confusion, yelling, restlessness, etc.) that occur mid to late afternoon and evening, possibly due to circadian rhythm, physical, emotional exhaustion or dehydration
  • Interventions: 
  • Simplify approaches and environment 

  • Rule out PAIN or lack of sleep 

  • Take the resident outdoors – exposure to sunlight 

  • Encourage fluids 

  • Rest periods after lunch 

  • Involve in a quiet activity 

❖ Screaming, yelling, calling

  • Expressions of fear, or losing control 

  • Interventions: 
  • Check hearing and vision?  
  • Evaluate for pain? 

  • Distract, divert (use music, folding towels, etc.) 

  • Use touch, if appropriate 

  • Try turning on a light 

❖ Repeated movement 


  • Using hands or fingers to take apart or pull at things or hitting or wiping surfaces, or chewing, clapping etc.
  • Interventions: 
  • Side effects or medication?
  • Give resident something to hold 
  • Provide resident with music of choice and personal earphones.  Perhaps the behavior is self-stimulating.

❖ Layering or stripping off clothes

  • Dressing/undressing of clothes in inappropriate places or times.
  • Interventions: 
  • Gently assist the resident to put on a robe or clothes

  • Keep clothes accessible for resident to change between. 
  • Assess whether resident is hot, cold or simply uncomfortable in the garment.
  • Evaluate for soiled undergarments.

❖ Socially Inappropriate Sexual Behavior

  • Sexual activity involving socially inappropriate language, public exposure, offensive and/or misunderstood gestures.
  • Interventions: 
  • Remain cam; don’t overreact, argue, scold or laugh 

  • Ignore language and behavior, distract or divert 

  • Assist resident to private space 

  • Evaluate whether behavior is a side effect of medication.

 ❖ Demanding or accusing


  • Wants everything done immediately or cannot remember where possessions are located 
  • Interventions: 
  • Use caring calm voice 

  • Assist to find missing items 

  • Use food or tasks to distract 


❖ Hallucinations and Delusions 


  • Hallucinations: sensory experiences (hearing, seeing, tasting, smelling, feeling) not experienced by anyone else

  • Delusions: persistent incorrect beliefs (“you’re not my daughter”) 
  • Interventions: 
  • Check hearing, vision, hearing aids, glasses 

  • Modify environment to eliminate causes 

  • If harmless, let go and distract with tasks 

  • Remember that it is real to the resident 

  • Don’t take it personally 


❖ Withdrawal and Apathy 

  • Sadness or depression - surroundings and people
  • Blank look of sadness

  • Absence of expression
  • Retreating to room 

  • Interventions: 

  • Anticipate and avoid problem situations 

  • Encourage positive situations 

  • Reassure resident that he/she will be cared for as long as necessary 

  • Do not force participation 

  • Help resident to feel safe and secure. 

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