Transcript Aging Well
Coping with Challenging Behaviors Presented by Kathleen Borland, M.Ed., LADC This program is presented based on information largely obtained from Tips and Techniques for Supporting Residents with Mental Illness: A Guide for Staff in Housing with Older Adults. Written by: Marsha Frankle, MSW, LICSW Gaye Freed, MSW, LICSW Laura Isenburg, MSW, LICSW Kathy Burnes, MED ©2012 JCHE and JF &CS Information obtained for other sources is sited according. Anxiety Depression Confusion Hoarding Behavioral disturbances Memory/cognitive problems Delusions, hallucinations, and substance abuse Those diagnosed with a mental illness sometime in their life Those that develop a mental illness later in life-frequently physiological, such as hypertension, diabetes, stroke. Appearance: dressed appropriately, layered clothing, dirty Speech: loud, fast, logical, difficulty answering questions, inappropriate language Physical: pacing, fidgety, lack of facial expression Eye Contact: avoid, staring Mood: sad, depressed, anxious Cognition: Oriented X 4, short term memory, long term memory, judgment, paranoia Ways to de-escalate Use the “I” or “we” message to convey respectful listening, Watch your body language, watch where you are standing, keep arms at sides, maintain eye contact If their voice is raised, lower yours Set limits Validate feelings: “I am hearing that you are frustrated with…” Redirect/reframe: “Any thoughts on how this can be resolved?” Speak respectfully and refer to resident’s possessions using his/her language Don’t make negative remarks about his/her things. Be clear about lease violations Have one person in “enforcement” role, i.e., agency and another person in supportive role. Involve the resident in reducing clutter Not a normal part of aging Only 1:6 are treated Suicide rate for Caucasian males over age of 85 is 2.5 times the rate of all ages 75 to 80% respond to medications and talk therapy Depressed mood most of day Loss of interest Sleep disturbance Fatigue Feeling of worthlessness Excessive guilt Difficulty concentrating Recurrent thoughts of death Express concern and give specific examples No one should suffer needlessly, give referrals Offer support Occurs frequently with high intensity Interferes with older adults ability to function and manage every day activities Occurs when no real threat/danger Often express anxiety in terms of physical symptoms, chest pain, difficulty breathing Generalized anxiety disorder Panic disorder Obsessive compulsive disorder Post traumatic stress disorder Social anxiety disorder/social phobia Specific phobias Establish if they are avoiding activities/tasks they once were doing Establish if they are excessively worrying, anything has changed If they have had a recent stressor, check in Encourage treatment, see the doctor Long standing and maladaptive patterns of perceiving and responding to other people and stressful circumstances Significant trauma in early life Difficulty to form and maintain interpersonal and therapeutic relationships Antisocial Borderline Histrionic Narcissistic Dependent personality disorder Set limits Recognize stress can increase problematic behaviors Minimize the effects of splitting, triangulating, communicate with staff Marked changes: extreme highs and lows Extreme high: euphoric mood Racing thoughts, difficulty with concentration Poor judgment Provocative, intrusive, aggressive behavior Encourage the resident to continue with treatment /medications Be aware of early signs of mania/depression Encourage regular routine exercise and socialization Loss of contact with reality usually including false beliefs about what is taking place or who one is (delusions) Seeing, hearing, feeling, tasting or smelling things that are not there (hallucinations) Also part of a number of psychiatric disorders, bipolar, delusional, depression, schizophrenia Delirium: 3rd most common cause of psychosis in seniors receiving outpatient services Alcohol/substance abuse/use Brain tumors Mild cognitive impairment: dementia, Alzheimer’s disease Degenerative brain diseases: Parkinson’s HIV and other infections that affect the brain Prescription drugs: epilepsy, stroke An acute or sudden state of confusion, with rapid changes in brain function. Medical crisis and needs prompt medical attention Causes: alcohol/sedative drug withdrawal, drug abuse, electrolyte/chemical disturbances, infections: UTI, pneumonia, poisons Mental function changes over day Personality changes: anger, agitation, anxiety Remain calm, need a quiet environment, minimize the number of people Speak slowly, identify self by name Repeat questions Educate family/resident Call 911 Falls under psychosis Characterized by organized delusions of persecution. Quite common and represent change in way resident is behaving Speak clearly Ask resident to repeat what you have said, clarify Be accepting but firm. Remember what triggers: stress/change, increase symptoms Acknowledge strengths and weaknesses Defined as: fixed, false ideas/beliefs that are not consistent with the person’s educational, cultural, or social background but are held to strongly despite evidence that does not support the belief. No matter was proof is offered, the resident insists on the delusion Involve the senses: hearing, seeing, smelling, tasting something that is not real. Can involve touch or olfactory Develop a relationship based on empathy and trust Promote effective coping skills for stress and anxiety Encourage treatment: medication/counseling Collaborate with others Defined: psychotic disorder that impairs a person’s ability to link thought, emotion, and behavior. Usually occurs in young adulthood (18-24) Can occur later in life, usually women where paranoia is prominent Delusions, hallucinations, “word salad” speech, behaviors common, sitting for hours (catatonic). Dementia: caused by destruction of brain cells from either Alzheimer’s or Parkinson’s, head injury, stroke or brain tumor Two types of dementia: Dementia with depression: 40% of people with dementia exhibit depression Dementia with psychosis: occurs in 25% of people with advanced dementia. More than 50% of Alzheimer’s patients have behavioral disturbances Do not argue Avoid reasoning, try to divert Do not shame, try to distract Reminisce Repeat Memory: Depression: impaired concentration Dementia: Can’t remember Memory and Mood: Depression: related if memory is impaired Dementia: not related Orientation: Depression: Oriented Dementia: not, confused Language: Depression: speaks, writes, uses language appropriately Dementia: Difficulty in naming objects, not able to use correctly Mini Mental Status: Depression: Feels memory is worse Dementia: Tries to hide/compensate We can not change the person. If we try, it is unsuccessful and leads to resistance Remember we can change our behavior or physical environment Have patience and realistic expectations Set boundaries Practice mindfulness, be aware of your surroundings. Mental health first aid classes: Leslie Broadhead: Midwest City private practice Dane Libart: ODMHSAS Tres Savage: Variety Care [email protected] QPR/SBIRT training Karen Orsi, Northcare ODMHSAS HOPE, CSI Areawide Aging Agency Community Mental Health Centers: HOPE, Community Services, Inc. NorthCare Red Rock Behavioral Health Services Adult Mental Health Hospitals: St. Anthony’s South Campus Midwest City Regional Hospital Autumn Life/Edmond Regional Medical Center Cedar Ridge/Bethany Hospital based outpatient treatment Stages: St. Anthony South St. Anthony’s Outpatient Behavioral Health: Edmond Inspirations: Norman Regional Integris Decisions Day Treatment Kathleen Borland Email: [email protected] Phone: 405-510-3724 HOPE Community Services, Inc