Transcript Powys - Non Pharmacological Approaches

Managing Challenging Behaviour
Non-pharmacological
Approaches
1000Lives plus
National Learning event
May1st 2012
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BPSD
Defined as symptoms of disturbed
perception, thought content, mood or
behaviour that frequently occurs with
dementia:
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Disinhibited behaviour
Delusions and hallucinations
Verbal and physical aggression
Agitation
Anxiety
Depression/Apathy
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Key messages
Non-pharmacological options are
recommended (NICE, 2006) as the firstline approach
Unless a person is at risk to
themselves or others
If the approaches do not help the
person and their symptoms are severe
or distressing, medication may be
necessary
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Key messages
Offer an early assessment to identify factors
that might influence behaviour. Include:
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The person’s physical health
Possible undetected pain or discomfort
Side effects of medication
Individual biography
Psychosocial factors
Physical environmental factors
Behavioural and functional analysis, conducted by
professionals with specific skills, in conjunction with
carers and careworkers
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Key messages
Develop an individually tailored care
plan to help carers and staff address
the behaviour that challenges
Recorded in the patients notes
Regularly reviewed
The importance of working with care
home staff to change
entrenched/inappropria attitudes and
behaviours through training
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Key messages
For co-morbid agitation, consider
interventions tailored to the person’s
preferences, skills and abilities
 Monitor response and adapt the care plan as
needed
 Consider options including; aromatherapy,
multisensory stimulation, therapeutic use of
music and dancing, exercise, animal assisted
therapy, massage
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Key messages
For co-morbid emotional disorders –
depression and /or anxiety:
 Consider cognitive-behavioural therapy
(possibly involving carers)
 A range of tailored interventions, such as
reminiscence therapy, multi-sensory
stimulation, animal assisted therapy and
exercise should be available.
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Key messages
Health and social care staff should be trained
to anticipate behaviour that challenges and
how to manage violence, aggression and
extreme agitation, including de-escalation
techniques
 Offer people with dementia and their carers
the opportunity to discuss their experiences
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Managing risk
Address environmental, and psychosocial
factors that may increase the likelihood of
behaviour that challenges:
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Prevention Guidance:
Recognition of triggers and early signs
Pain, dehydration, constipation,
malnourishment, physical illness such as
infection
Stress, irritability, mood disturbance and
suspiciousness
Increased levels of distress
Early signs may be noticed at certain times
of the day, particularly during personal care
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Prevention Guidance:
Person-centred care
 Is the person being treated with dignity and respect?
 Is there good communication between the person
and staff? And is there consistency of approach?
 Do you know about their history, lifestyle, culture
and preferences?
 Does the person have an opportunity for relationship
with others?
 Does the person have the opportunity for stimulation
and enjoyment?
 Has the person’s family or carer been consulted?
 Does the person’s care plan reflect their
communication needs and abilities?
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Prevention Guidance:
Physical environment
If in a bed or a chair, is the person
comfortable and free of pressure sores?
Is the TV playing something they can relate
to and enjoy?
If the person is mobile, can they move
around freely and have access to an outside
space?
Does the person have enough privacy?
Is the layout and signposting friendly?
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Watchful waiting
A pro-active process over 4 weeks involving
on-going assessment of contributing factors
and simple non-drug treatments.
It does not mean doing nothing!
Watchful waiting is the safest and most
effective therapeutic approach unless there
is severe risk or extreme distress
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Watchful waiting Guidance
Person-centred care
Have the carers considered the person’s
relationship with others? How are these
supported?
Do the carers help the person to feel socially
confident and not alone?
Are the person’s fears recognised and
addressed?
How is the person included in conversations
and care? How are they shown respect,
warmth and acceptance?
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Watchful waiting Guidance:
Consult with the family
It is essential to discuss the person’s
symptoms and possible treatments
with their family or carer
They may be able to shed light on the
reasons for their symptoms and ways
to engage them in activities
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Watchful waiting Guidance:
Soothing and creative therapies
Evidence is poor and sample sizes small:
 Aromatherapy and hand massage
 Hairbrushing and manicures
 Music, singing and movement; structured
social interactions and meaningful activities
 Art therapy
 Animal assisted therapy
 Multi-sensory stimulation
 Reminiscence/Life-story
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Specific interventions: Guidance
There is good evidence for the value of
specific psycho-social interventions
delivered by a clinical psychologist or
equivalent health professional. Appropriate
approaches include the Antecedent
Behaviour Consequence (ABC) approach to
develop individualised intervention plans.
These approaches are effective, but require
specialist referral
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Dem3/ Meds Mgt
collaborative
Non-pharmacological options are
recommended (NICE, 2006) as the first-line
approach*
Evidence for non-pharmacological options is
poor, but known anecdotally to be effective.
Learning from the experiences of others is
therefore a vital tool in disseminating good
practice – already good examples in action
Saves time, energy, good will and costs
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Suggested key areas for
sharing
1. Environmental improvements
2. Alternative therapies (NICE 2006) –
‘Aromatherapy, multisensory stimulation,
therapeutic use of music and/or dancing,
animal assisted therapy, massage’
3. Reminiscence/Life story
4. Staff training courses
5. Activities (e.g. exercise gardening,
cooking)/Refocusing roles
6. Behavioural analysis
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