Challenging Behaviour Patterns - Essay Example

Challenging Behaviour Patterns An extended argument of on the area of Challenging Behaviour Patterns. Managing individual behaviour and caring forthe patient. (Write your name here) (Write the name of your college/school) if not the name of your city/state or city/country. ABSTRACT This paper deals with Challenging behaviour patterns focusing mainly on that of dementia. It begins by looking first at the attitudes and conflicts that every one of us experience as individuals living in this world and how we need to adjust with each other in order to survive. We then step into the world of patients suffering from illnesses that alter their behaviour patterns and rob from exercising full control of their mental abilities. Charlie a patient who suffers from dementia is used as an example within this paper and his behavioural changes are expounded. We also take a look at the results of dementia and list ways and means of dealing with dementia and providing special care to these individuals. We close by mentioning some of the most important symptoms of dementia and ways, which one can use to adjust to these symptoms. This paper is interesting and also challenging, simple but yet detailed, exposes the helplessness of the patient, the hardship on the people who care for them and the challenges involved in coping. Challenging Behaviour Patterns Introduction: Irrespective of your personality, your profession or your age one time or the other we have all felt that we needed space, for people invariably tend to step on our toes giving voice to that common adage "Your getting on my nerves" syndrome. Fortunately or unfortunately the world that we live in is filled with people and no matter where, what or when you will always be confronted with people. But what has all this to do with challenging behaviour patterns Where does giving special attention to people who suffer from dementia, dyslexia and other Behaviour-altering ailments come into picture What are the best procedures and attitudes that need to be followed in order to see that people suffering from challenging behaviour patterns receive the best possible care Dementia: What is dementia Corey-Bloom, J., et al.,(1995), says The term "dementia" is used by the medical community to describe patients with impaired intellectual capacity. Dementia patients may also be labelled as having "presenile" or "senile" dementia, "chronic" or "organic brain syndrome," "arterio-sclerosis," or "cerebral atrophy." It is important to point out that dementia is not a normal part of the aging process. Dementing conditions are caused by abnormal disease processes, and can affect younger as well as older persons. The U.S. Congress Office of Technology Assessment (1990) estimates that 1.8 million Americans have severe dementia and another 1 to 5 million Americans have mild to moderate dementia. According to the Alzheimer's Association, approximately 4 million of these people are afflicted with Alzheimer's disease. By the year 2040, the number of persons with Alzheimer's disease may exceed 6 million. The prevalence of Alzheimer's disease doubles every five years after age 65, and nearly half of all people age 85 and older are thought to have some form of dementia. The prevalence of dementia is expected to increase dramatically in future years as life expectancy continues to increase and the baby-boomer population ages. The cumulative incidence of Alzheimer's disease has been estimated to be as high as 4.7 percent by age 70, 18.2 percent by age 80 and 49.6 percent by age 90.(Hebert LE, Scherr PA, Beckett LA, Albert MS, Pilgrim DM, Chown MJ1995), Proposed risk factors for dementia include a family history of dementia, previous head injury, lower educational level and female sex. (Larson EB, Kukull WA, Katzman RL, 1992) Alzheimer's disease is the most common cause of dementia; many of the remaining cases of dementia are caused by vascular disease and Lewy body disease. Vascular disease and Lewy body disease often occur in combination with Alzheimer's disease. (Bachman DL, Wolf PA, Linn R, Knoefel JE, Cobb J, Belanger A, 1992) (Collerton D, Davies C, Thompson P, 1996) Clinical Presentation: (Rabins PV, Lyketsos CG, Steele CD, 1999) While the clinical presentation of dementia may vary, depending on the etiology, the diagnostic features are constant. They are well described in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). (APA, 1994) Cognitive changes: New forgetfulness, more trouble understanding spoken and written communication, difficulty finding words, not knowing common facts such as the name of the current U.S. president, disorientation. Psychiatric symptoms: Withdrawal or apathy, depression, suspiciousness, anxiety, insomnia, fearfulness, paranoia, abnormal beliefs, hallucinations Personality changes: Inappropriate friendliness, blunting and disinterest, social withdrawal, excessive flirtatiousness, easy frustration, explosive spells Problem behaviors: Wandering, agitation, noisiness, restlessness, being out of bed at night. Changes in day-to-day functioning: Difficulty driving, getting lost, forgetting recipes when cooking, neglecting self-care, neglecting household chores, difficulty handling money, making mistakes at work, trouble with shopping. Charlie: (Interview: With staff that worked with Charlie, names left out upon request.) I will step into the world of Charlie who is suffering from dementia for the past 6 years; he is 54 years old and at first glance would pass of as an extinguished old gentleman, greying at the temples having an air of aristocracy about him. When Charlie first started to exhibit symptoms of dementia, his family put it down to mood swings and thought he was going through a period of depression and tried to help him. At first there were upset over his forgetfulness but soon realised that something was happening to Charlie which he had no ability to control and soon they found out that he was suffering from dementia. There are different forms of dementia but two of the most common ones are called Alzheimer's disease and multi-infarct dementia. Alzheimer's was the disease Charlie was suffering from; it causes the brain to lose its ability and makes it stop its cease from functioning normally and causes the person to be helpless and robs him or her of their independence. Multi-infarct dementia on the other hand is a disease where it causes damages to different parts of the brain resulting in minor strokes. This is brought on because there is a blockage in the blood vessels, and exposes the individual to the possibility of suffering from minor strokes, which can get worse with time. Charlie suffered bouts of depression where he would have days of complete silence refusing to talk to anybody, sometimes even refusing food. When physically touched or requested to have his meals, the reaction would be violent and sometimes self- inflicting. Dealing with Charlie became harder with time, as he wanted to be alone, would sleep on his bed nearly all day and mumble incoherent sentences. Charlie talked constantly in his sleep and on occasions even started to sleep walk. The people who attended to him had a constant challenge on their hands which was brought on mostly by the violent behaviour and the resentment he showed towards those who had to care for him. Working with people who have sudden mood swings and violent behaviour patterns require foremost love and understanding on the part of the carer and then comes in the medical understanding of the disease and what it does to a person and how one should adapt and react to the patient as time goes on. Vascular dementia is also a common cause of dementia, CVD is associated with a higher risk of dementia, and vascular factors are related to other causes of dementia. (Erkinjuntti T, Hachinski VC, 1990), (Tatemichi, TK, 1990), (Kokmen E, Whisnat JP, O'Fallon WM, Chu C-P, Beard CM, 1960-1984 & 1996), (Skoog I, Nilsson L, Palmertz B, Andreasson L-A, Svanborg A, 1993) Consequently, it has been suggested that stroke is related to dementia more frequently than previously assumed. (Hachinski, VC, 1992) Since vascular causes can be prevented and treated, the identification of stroke-related cognitive impairment is a challenge. The frequency of dementia associated with ischemic stroke is still incompletely known. In an exploratory effort, Tatemichi et al (Tatemichi TK, Foulkes MA, Mohr JP, Hewitt JR, Hier DB, Price TR, Wolf PA 1990) found that dementia was present in 16% (116/726) of patients in a stroke cohort aged 60 years. In a subsequent hospitalized stroke cohort studied 3 months after stroke, dementia was found in 26% (66/251), and stroke increased the risk of dementia by a factor of 9. (Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, Remien RH, Williams JBW, Mohr JP, Hauser WA, Figueroa M, 1992) The Work Environment: When patients such as Charlie begin to throw tantrums, exhibit violent behaviour such as throwing objects, spitting and throwing his food around, together with verbal abuse and attempts to physically hurt you, the human tendency is two reach in either of these two ways. One can become physically intimidated and let the fear of caring for such patients sink into you. This causes you to dread looking after your patient and not only affects your attitude as it is mixed with fear but also prevents you from giving your patient the much needed special care and attention. The other response is to get angry at the person's behaviour and forget the fact that you are dealing with someone suffering from a behaviour altering disease and react in a manner where you try to intimidate him or her and become physically aggressive with the patient in order to get them to behave themselves and stay quiet. Management and Treatment: Early diagnosis and intervention allow the patient to compensate for the disability, minimize disease-related and education complications, improve quality of life and optimize the use of resources. While new experimental cholinergic drugs for the treatment of Alzheimer's disease are introduced periodically, tacrine (Cognex) and donepezil (Aricept) are the only cholinesterase inhibitors currently labeled for the symptomatic treatment of Alzheimer's disease. Acetylcholinesterase inhibitors act by delaying neurotransmitter degradation, thereby enhancing cortical cholinergic activity. Clinical trials in patients with mild to moderate dementia suggest that symptomatic improvement is possible. (Rogers SL, Farlow MR, Doody RS,Mohs R, Friedhoff LT, 1998) (Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, 1997) Cholinergic side effects, such as nausea, vomiting and diarrhea, are usually transient but may be intolerable to some patients. The treatment of dementia with Lewy bodies has not been well studied. However, it is important to note that parkinsonian features in these patients rarely respond to dopaminergic drugs, and that adverse responses to neuroleptic agents may occur.(McKeith I, Fairbairn A, Perry R, Thompson P, Perry E, 1992) Dealing with Inappropriate Behaviour: (A.Robinson, B. Spencer, and L.White, 2001) We cannot change the person. The person you are caring for has a brain disorder that shapes who he has become. When you try to control or change his behavior, you'll most likely be unsuccessful or be met with resistance. It's important to: a) Try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable. b) Remember that we can change our behavior or the physical environment. Changing our own behavior will often result in a change in our loved one's behaviour. Check with the doctor first. Behavioral problems may have an underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem. Behaviour has a purpose. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behaviour and, when possible, try to accommodate them. Behaviour is triggered. It is important to understand that all behavior is triggered, it doesn't occur out of the blue. It might be something a person did or said that triggered a behaviour or it could be a change in the physical environment. The root to changing behaviour is disrupting the patterns that we create. Try a different approach, or try a different consequence. What works today, may not tomorrow. The multiple factors that influence troubling behaviours and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow-or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue. Get support from others. Expect that, like the loved one you are caring for, you will have good days and bad days. You are not alone; there are many others caring for someone with dementia. Call your local Area Agency on Aging, the local chapter of the Alzheimer's Association, a Caregiver Resource Center or if you know someone who has already joined a group for behaviour altering pattern's, ask for their help and join. Conclusion: Although screening all elderly patients for dementia is not warranted, (U.S. Preventive Services Task Force, 1996) being alert for cognitive and functional decline is a prudent way of recognizing dementia in its early stage. In concluding we see that providing the necessary care and attention for patients suffering from dementia has a price tag both emotionally and financially if the patient is to be looked after by qualified individuals who understand the symptoms and results of dementia. Charlie the patient mentioned in this paper suffered a heart attack and died in his sleep one night, leaving this world in a quiet and peaceful manner. Patients suffering from dementia become in many ways like children losing control over their mind and become strongly dependant on others to function normally. Hence the people who care for these patients must do so with love, understanding and patience for dealing with dementia will often cost you tears that you are unwilling to pay! References: A.Robinson, B. Spencer, and L.White, (2001), Understanding Difficult Behaviors: Some Practical Suggestions for Coping with Alzheimer's Disease and Related Illnesses, Eastern Michigan University, Ypsilanti, MI, (734) 487-2335. American Psychiatric Association, Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:123-63,684. Bachman DL, Wolf PA, Linn R, Knoefel JE, Cobb J, Belanger A, et al. Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham Study. Neurology 1992;42:115-9. Collerton D, Davies C, Thompson P. Lewy body dementia in clinical practice. In: Perry RH, McKeith IG, Perry EK, eds. Dementia with Lewy bodies: clinical, pathological, and treatment issues. New York: Cambridge University Press, 1996:171-86. Corey-Bloom, J., et al., 1995, Diagnosis and Evaluation of Dementia, Neurology, 45:211- 218. Erkinjuntti T, Hachinski VC. Rethinking vascular dementia. Cerebrovasc Dis. 1993;3:3- 23. Hachinski VC. Preventable senility: a call for action against the vascular dementias. Lancet. 1992;340:645-648. Hebert LE, Scherr PA, Beckett LA, Albert MS, Pilgrim DM, Chown MJ, et al. Age- specific incidence of Alzheimer's disease in a community population. JAMA 1995;273:1354-9. Kokmen E, Whisnat JP, O'Fallon WM, Chu C-P, Beard CM. Dementia after ischemic stroke: a population-based study in Rochester, Minnesota (1960-1984). Neurology. 1996;46:154-159. Larson EB, Kukull WA, Katzman RL. Cognitive impairment: dementia and Alzheimer's disease. Annu Rev Public Health 1992;13:431-49. McKeith I, Fairbairn A, Perry R, Thompson P, Perry E. Neuroleptic sensitivity in patients with senile dementia of Lewy body type. BMJ 1992;305:673-8. Rabins PV, Lyketsos CG, Steele CD. Practical dementia care. New York: Oxford University Press, 1999. Rogers SL, Farlow MR, Doody RS,Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology 1998;50:136-45. Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med 1997;336:1216-22. Skoog I, Nilsson L, Palmertz B, Andreasson L-A, Svanborg A. A population-based study on dementia in 85-year-olds. N Engl J Med. 1993;328:153-158. Tatemichi TK. How acute brain failure becomes chronic: a view of the mechanisms and syndromes of dementia related to stroke. Neurology. 1990;40:1652-1659. Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, Remien RH, Williams JBW, Mohr JP, Hauser WA, Figueroa M. Dementia after stroke: baseline frequency, risks, and clinical features in a hospitalised cohort. Neurology. 1992;42:1185- 1193. Tatemichi TK, Foulkes MA, Mohr JP, Hewitt JR, Hier DB, Price TR, Wolf PA. Dementia in stroke survivors in the Stroke Data Bank cohort: prevalence, incidence, risk factors, and computed tomographic findings. Stroke. 1990;21:858-866. U.S. Congress, Office of Technology Assessment, July, 1990, Confused Minds, Burdened Families, Washington, D.C. U.S. Preventive Services Task Force. Guide to clinical preventive services. 2d ed. Baltimore: Williams & Wilkins, 1996. Read More