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Management of Challenging Behavior in Elderly People

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Management of Challenging Behavior in Elderly People
The aim of this assignment is to explore challenging behaviour in the person with dementia. As it is outside the scope of this assignment to explore all the potential reasons for challenging behaviour, the focus of this assignment will be on challenging behaviour in the context of the communication of pain, using a case study to illustrate this. This assignment will describe challenging behaviours, the behaviours associated with pain, and the management strategies employed by nursing staff, using a person-centred approach to care. Finally, ways of improving the care provided will be explored and recommendations made.

The rationale for choosing to discuss this issue is that I currently work as a staff nurse on an organic assessment ward, and am frequently involved in caring for people with dementia who present with challenging behaviours that are difficult to manage in the community setting.

There are currently 750,000 people with dementia in the UK. As the UK’s population grows, there will be substantial increases, and it is estimated that there will be 940,000 people with dementia by 2021, rising to over 1.7 million by 2051. Alzheimer’s disease is the most common form of dementia (Alzheimer’s Society, 2010). Gogia and Rastogi (2009) describe Alzheimer’s disease as a progressive illness, where there is a decline in almost all functions, including memory, movement, language and communication skills, behaviour, judgement and abstract reasoning, and the ability to carry out activities of daily living, although the manifestation of these symptoms varies from person to person. As Pelletier and Landreville (2007) highlight, the majority of people with dementia exhibit behavioural and psychological symptoms, including increased agitation and aggression, which can be distressing for the individual, be difficult for caregivers to manage, and lead to institutionalisation.

The case study I have chosen to use for this assignment relates to Ruth (name changed for



References: Alzheimer’s Society (2010) Demography Position Statement. Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200167&documentID=412 (Accessed: 15 April 2010). Andrews, G. (2006) Managing challenging behaviour in dementia. British Medical Journal, 332, p. 741. Benedetti, F., Arduino, C., Vighetti, S., Asteggiano, G., Tarenzi, L. and Rainero, I. (2004) Pain reactivity in Alzheimer’s patients with different degrees of cognitive impairment and brain electrical activity deterioration. Pain, 111 (1-2), p. 22-29. Blake, S., Ruel, B., Seamark, C. and Seamark, D. (2007) Experiences of patients requiring strong opioid drugs for chronic non-cancer pain: a patient-initiated study. British Journal of General Practice, 57, p. 101-109. Bourgeois, M.S. and Hickey, E.M. (2009) Dementia. From Diagnosis to Management – A Functional Approach. New York: Psychology Press. Brooker, D. (2007) Person-Centred Dementia Care. Making Services Better. London: Jessica Kingsley Publishers. Cohen-Mansfield, J. (2000) Theoretical Frameworks for Behavioural Problems in Dementia. Alzheimer’s Care Quarterly, 1 (4), p. 8-21. Cohen-Mansfield, J. (2005) Nursing Staff Members’ Assessment of Pain in Cognitively Impaired Nursing Home Residents. Pain Management Nursing, 6 (2), p. 68-75. Cohen-Mansfield, J. and Creedon, M. (2002) Nursing Staff Members’ Perceptions of Pain Indicators in Persons With Severe Dementia. The Clinical Journal of Pain, 18 (1), p Cunningham, C. (2006) Understanding challenging behaviour in patients with dementia. Nursing Standard, 20 (47), p. 42-45. Department for Constitutional Affairs (2005) The Mental Capacity Act 2005. Available at: http://www.opsi.gov.uk.acts/acts2005/ukpga_20050009_en.pdf (Accessed: 04 May 2010). Department of Health (2001) National Service Framework for Older People. London:DH. Gogia, P. P. and Rastogi, N. (2009) Clinical Alzheimer Rehabilitation. New York: Springer Publishing Company. Gudgeon, E., Shirley, L. and James, I.A. (2007) Challenging Behaviour. PSIGE Special Interest: Challenging Behaviour Page. Available at: http://www.psige.org/special_interest_challenging_behaviour.php (Accessed: 16 March 2010). Horgas, A.L. and Dunn, K. (2001) Pain in Nursing Home Residents: Comparison of Residents’ Self-Report and Nursing Assistant Perceptions. Journal of Gerontological Nursing, 27 (3), p. 44-53. Jacobsen, P.B. (2009) Clinical Practice Guidelines for the Psychosocial Care of Cancer Survivors. Cancer, 115 (18, supplement), p. 4419-4429. James, I. and Stephenson, M. (2007) Behaviour that challenges us: the Newcastle support model. Journal of Dementia Care, 15 (5), p. 19-22. Kaasalainen, S. (2007) Pain Assessment in Older Adults with Dementia. Journal of Gerontological Nursing, 33 (6), p. 6-10. Kerr, D. and Cunningham, C. (2004) Finding the right response to people with dementia. Nursing and Residential Care, 6 (11), p. 539-542. Killick, J. and Allan, K. (2001) Communication and the care of people with dementia. Buckingham: Open University Press. King, S.A. (2009) The Challenge of Geriatric Pain. Psychiatric Times, 26 (7), p. 13. Kitwood, T. (1997) Dementia Reconsidered. The person comes first. Buckingham: Open University Press. Kovach, C.R., Weissman, D.E., Griffie, J., Matson, S. and Muchka, S. (1999) Assessment and Treatment of Discomfort for People with Late-Stage Dementia. Journal of Pain and Symptom Management, 18 (6), p. 412-419. Kovach, C.R., Griffie, J., Muchka, S., Noonan, P.E. and Weissman, D.E. (2000) Nurses’ Perceptions of Pain Assessment and Treatment in the Cognitively Impaired Elderly: It’s Not a Guessing Game. Clinical Nurse Specialist, 14 (5), p. 215-220. McAuliffe, L., Nay, R., O’Donnell, M. and Fetherstonhaugh, D. (2008) Pain assessment in older people with dementia: literature review. Journal of Advanced Nursing, 65 (1), p. 2-10. National Institute for Health and Clinical Excellence (2006) Dementia. Supporting people with dementia and their carers in health and social care. London: NICE. Pelletier, I.S. and Landreville, P. (2007) Discomfort and agitation in older adults with dementia. BMC Geriatrics, 7 (27). Available at: http://www.biomedcentral.com/1471-2318/7/27 (Accessed: 22 March 2010). Pool, J. (2008) The Pool Activity Level (PAL) Instrument for Occupational Profiling. A Practical Resource for Carers of People with Cognitive Impairment, 3rd edn. London: Jessica Kingsley Publishers. Reynolds, K.S., Hanson, L.G., DeVellis, R.F., Henderson, M. and Steinhauser, K.E. (2008) Disparities in Pain Management Between Cognitively Intact and Cognitively Impaired Nursing Home Residents. Journal of Pain and Symptom Management, 35 (4), p. 388-396. Royal College of Psychiatrists (2007) Challenging behaviour: a unified approach. London: Royal College of Psychiatrists. Available at: http://www.rcpsych.ac.uk/files/pdfversion/cr144.pdf (Accessed: 14 April 2010). Shega, J., Emanuel, L., Vargish, L., Levine, S.K., Bursch, H., Herr, K., Karp, J.F. and Weiner, D.K. (2007) Pain in Persons With Dementia: Complex, Common, and Challenging. The Journal of Pain, 8 (5), p. 373-378. Smith, D.M. (2007) Assessing Pain in People with Dementia 1: The Challenges. Nursing Times, 103 (29), p. 28-29. Available at: http://www.nursingtimes.net (Accessed: 10 March 2010). Stokes, G. (2000) Challenging Behaviour in Dementia. A Person-Centred Approach. Bicester: Speechmark Publishing Ltd. Thompsell, A. and Jesson, B. (2008) Medicines and people with dementia: 2. Managing pain in people with dementia. Journal of Dementia Care, 16 (6), p. 18-20. Tsai, P.F. and Chang, J.Y. (2004) Assessment of Pain in Elders With Dementia. Medsurg Nursing, 13 (6), p. 364-390. Turner, S. (2005) Behavioural symptoms of dementia in residential settings: A selective review of non-pharmacological interventions. Aging and Mental Health, 9 (2), p. 93-104. Zwakhalen, S.M.G., Hamers, J.P.H. and Berger, M.P.F. (2007) Improving the clinical usefulness of a behavioural pain scale for older people with dementia. Journal of Advanced Nursing, 58 (5), p. 493-502.

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