Person-Centred Dementia Care in the Prevention of Aggressive Behaviours - Literature review Example

Person-Centred Dementia Care in the Prevention of Behaviours and Aggression Introduction Dementia is a syndrome consisting of several symptoms such as decreased ability to carry out familiar activities, memory impairment, judgment/reasoning impairment as well as changes in mood and behavior (Martin et al, 2009). In dementia, the pathological changes in the brain lead to gradual decline in the brain and this affects an individual’s memory, behaviours, personality as well as functional ability. Changes in the behaviour of individuals with dementia are common are caused by the inability of the brain to control impulsive actions. Behaviours of concern associated with dementia include aggression, wandering, shadowing, hoarding, calling out, agitation, in addition to insomnia (Sampson et al, 2009). Aggressive behaviours include verbal abuse and threats, hitting out, destroying properties and being physically violent towards other people. Person-centered care in dementia focuses on: the whole individual and not on the diseased brain; remaining abilities, emotions, and cognitive abilities and not on the lost ones; and on the individual in the context of society and its values, family, gender, ethnicity, culture, marriage as well as gender (Sampson et al, 2009). Therefore, each individual is handled uniquely because the personal journey of dementia progression varies from one individual to another. The focus of this essay is on dementia and the application of person-centered care in the prevention and management of behaviours and aggression. Dementia Kunik et al (2010) explain that dementia is a broad term that consists of a group of illnesses and define dementia as a the progressive decline of cognitive functionalities encompassing; loss of memory and intellect, loss of rationality, loss of language skills and social skills, loss of perception as well as loss of physical function (Kunik et al, 2010).this is in line with Martin et al (2009) who defines dementia as a syndrome used to explaining the steady decrease in functionalities such as thinking, perception, communication, languages, reasoning, memory and ability to function. Dementia occurs in several types which include Alzheimer's disease, Vascular Dementia, Dementia with Lewy Bodies and Fronto-temporal Dementia (Martin et al, 2009). Since dementia is a severe and permanent decline of mental functions, the disease interferes with the normal social functioning as well as occupational functioning. During the initial stages of dementia, a person may lose memory and have problems in thinking clearly. Afterwards, disruptive behaviours such as aggression and other problems set in. Dementia affects all individuals regardless of their cultural and educational backgrounds. Dementia can change an individual’s personality and moods as well. Damage of brain cells is what causes dementia and aspects such as head injury, Alzheimer’s disease, Lewy Bodies, brain tumor and other causes can destroy brain cells (Kunik et al, 2010). There are various comorbid medical conditions that are common in individuals with dementia. Physical comorbidities allied to dementia consist of falls, epilepsy, delirium, hallucinations, sleep problems and visual impairment (Martin et al, 2009). Mental and neurological conditions are also common in people with dementia and as Alzheimer's Society London (2009) demonstrates, a third of individuals with dementia experience moderate to several mental health problems. The common mental health problems in people with dementia encompass; anxiety, psychosis, depression, aggression as well as Post-Traumatic Stress Disorder (PTSD). The common neurological problems in dementia include Parkinson’s disease and Pick’s disease (Kunik et al, 2010). Behaviours and Aggression in Dementia Dementia presents several behavioral problems to people with dementia and their care providers as well. There are various causes of behaviour change in people with dementia and each individual reacts differently to situations in their own way (NSW Government, 2014). At times the behaviour change may result from changes occurring within the brain and also the behaviour change can occur due to events or environmental factors that trigger the behaviour. As Work-Safe BC (2010) puts it, changes in behaviour in individuals with dementia occurs and this can encompass aggressive behaviors like verbal abuse and threats, property destruction as well as physical violence towards other individuals. Other behaviors that people with dementia experience include agitation, restiveness, walking about as well as being sexually inappropriate (NSW Government, 2014). The intricacy of dementia presents various behavioral challenges to the individuals as well as their care providers. Work-Safe BC (2010) emphasizes that aggressive behaviour is the most common challenging behaviour within various stages of dementia. Kunik et al (2010) supports this argument and explains that aggressive behaviour in people with dementia is an ongoing and critical matter for care providers who handle the individuals. Studies show that the risk of care providers experiencing aggression from patients with dementia is high with incidence rate of 60-80% (Alzheimer Society of Canada, 2011). At times the aggressive behaviour leads to physical injuries. Reasons for aggression in people with dementia are multifaceted and are allied to various factors including; resident factors, competencies and characteristics of the care providers as well as environmental factors. Numerous studies indicate that the cognitive impairment of people with dementia is related to the aggressive behaviour. As the dementia advances, individuals typically become unconscious of time and place and have difficulties in recognizing family members and friends, require assisted self care, and have behavioral changes that may escalate and consist of aggression (Kunik, 2010). Person-centred Dementia Care Person-centered care is care that acknowledges that people have distinctive values, individual history and personality and that every individual has equal right to dignity, respect and to take part fully within their environment (Kunik et al, 2010). Person-centered dementia care takes into account the assumptions made regarding individuals with dementia, attitudes of caregivers, care models as well as implemented practices, organization and cultural aspects and also structural factors like lighting and flooring (Work-Safe BC, 2010). As NSW Government (2014) suggests, Person-centered dementia care is a holistic approach across the continuum of services which considers the specific needs of every individual with dementia. The basis of the approach is the mutual beneficial partnerships that are established between individuals with dementia and their care providers. Kunik et al (2010) further explains that the foundation of person-centered dementia care is the interactive process where individuals with dementia actively participate in their won care throughout various phases of dementia and also family members play an important role in supporting the wellbeing and health of their family member with dementia (Anderson & Krishnamoorthy, 2011). The objective of person-centered dementia care is to establish partnerships among care providers, individuals with dementia as well as their families to ensure that the best outcomes are achieved and there is improvement in regard to the quality of life and quality of care of individuals with dementia. As mentioned earlier, person-centered care centers on the person and the individual’s strengths and abilities instead of focusing on the condition and losses. Alzheimer’s Australia (2007) further adds that person-centered dementia care values all human care irrespective of age or cognitive ability, uses personalized approach that recognizes uniqueness of each person with dementia and understands the world from the perception of the individual with dementia. Additionally, person-centered dementia care provides a social environment that supports psychological and emotional needs and takes into account the needs of everybody involved (Alzheimer’s Australia, 2007). Person-centred Dementia Care to Prevent Behaviours and Aggression Person-centred dementia care utilizes knowledge on the characteristics and experiences of the person with dementia to plan care that improves quality of life and reduces responsive behaviours (Christofoletti, et al., 2008). To prevent behaviours and aggression, person-centred care seeks to understand the individual with dementia in his/her context and this facilitates understanding of the behaviours/aggression and their causes and hence assists in identifying strategies of preventing and managing the behaviours and aggression. Since the approach views the individual with dementia as a whole, the physical, mental as well as psychological needs of the person (Alzheimer Society of Canada, 2011). For instance, when an individual with dementia starts being aggressive or agitated; the goal is to find out if there are any triggers of the behaviour change. Basically, everybody involved in the care is supposed to have a clear picture of the traits, life history, interests along with the skills of the individual there are caring for. When a person-centered dementia care approach is utilized, it becomes easy to establish and identify factors that trigger behavioural symptoms such as aggression (Fossey, 2014). For instance, if an individual with dementia has always taken pride in his/her appearance might react negatively if a caregiver chooses clothes for him/her. A study carried out by Fossey (2014) found out that when care providers use various ways to find out what the individual’s feelings are, the care provision improves and the person with dementia is understood better and this in turn prevents behaviours and aggression (Fossey, 2014). According to Alzheimer Society of Canada (2011) it is important to have consistent care providers when caring for people with dementia because this builds trust and a sense of safety. At times, people with dementia become anxious and restless which can result to aggressiveness and thus it is important to have consistent care providers to prevent triggering anxiety and restlessness (Anderson & Krishnamoorthy, 2011). A person-centered environment is typified by emotional connectedness and emotional security, respect, optimization of the individual’s sense of worth and strengths and supports an individual’s dignity, autonomy and respect. This ensures that an individual is emotionally and psychologically stable and hence prevents behaviours that may be triggered due to psychological and emotional factors (Anderson & Krishnamoorthy, 2011). In person-centered care, care providers collaborate with people and family members who have known the individual with dementia throughout his/her in order to identify the possible triggers of negative behaviours and also to identify ways of establishing an enjoyable now. Identifying the triggers is important since it helps care givers and families avoid situations that are likely to trigger behaviours and thereby facilitates in preventing negative behaviours (Christofoletti, et al., 2008). Anderson & Krishnamoorthy (2011) further explains that a person-centered dementia care necessitates a personalized evaluation and is enhanced by using life information when interacting with the individual with dementia. If possible, care givers should consult the individual regarding their needs in a manner that respects their cognitive ability (Work-Safe BC, 2010). Use of person-centred language also plays a role in preventing behaviours and aggression. A person-centred language describes the behaviour instead of labeling behaviours (Alzheimer Society of Canada, 2011). For example, care providers should say “the person pushes away drugs” instead of labeling the person as non-compliant to medication or should say “the person strikes out after undressing” rather than labeling the person as resistant to care. Such distinctions enable care providers to understand the cause of the behaviour instead of using medications to ‘manage’ the behaviour change which maybe a way of the individual to communicate his/her needs (Anderson & Krishnamoorthy, 2011). Tackling the underlying need, dissatisfaction, fear or frustration can calm and compose the individual and prevent the behaviours from aggravating. Additionally it is important for care providers to communicate efficiently and meaningfully with the individual with dementia and avoid using; baby or elder talk or taking a lower cognitive level. This is because studies show that using infantilizing communication can lead to resistant to care (Alzheimer Society of Canada, 2011). Studies show that person-centered dementia care is effective in preventing behaviours and aggression. An RCT of person-centred dementia care for bathing individuals with dementia found out that; behaviours such as discomfort, agitation and aggression in people with dementia decreased considerably in the group that received person-centered care in comparison to the control group (Christofoletti, et al., 2008). Conclusion Person-centered dementia care focuses on people with dementia having meaningful relationships in addition to social contact and having schedules in accordance with the individual’s personal preferences and care that will meet the unique needs of every individual in care. Person-centered care approach ensures that the changing needs of every person are met and his/her preferences on care are respected. The approach includes everybody including the care providers, person with dementia and their families and this helps in identifying triggers of negative behaviours and therefore makes it possible to avoid triggers and thereby prevents negative behaviours. In a nut shell, the person-centred care approach assists care providers in exploring and understanding the causes and reasons of challenging behaviour and aggression in individuals with dementia. Care providers then utilize this information to develop or modify care plans to lower the risk of aggressive response behaviours. Even though studies and evidence advocate person-centered care in people with dementia, there is need for further research to find out the type and at which stage of dementia is the approach most effective and the type of care providers who should be caring for the people with dementia. References Anderson D & Krishnamoorthy A, 2011, Managing challenging behaviour in older adults with dementia, Progress in Neurology and Psychiatry, 15(3). Alzheimer Society of Canada, 2011, Guidelines for Care: Person-centred care of people with dementia living in care homes, Canada: Alzheimer Society of Canada. Alzheimer’s Australia, 2007, Quality Dementia Care: Practice in Residential Aged Care Facilities for all Staff, Sydney: Alzheimer’s Australia. Alzheimer's Society London, 2009, Dementia. http://alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200167&documentID=402 Christofoletti G., Oliani M.M., Gobbi S & Stella F, 2008, Effects of motor intervention in elderly persons with dementia: an analysis of randomized controlled trials, Topics in Geriatric Rehabilitation, 23(2):149-55. Fossey J, 2014,Training for staff can reduce use of sedatives in care homes, The Journal of Quality Research in Dementia, 4 (1). Kunik M, Snow A, Davila J, Steele A, Doody R & Morgan R, 2010, Causes of aggressive behavior in patients with dementia, J Clin Psychiatry, 71(9):1145-52. doi: 10.4088/JCP.08m04703oli. Martin AJ, Marottoli R & O'Neill D, 2009, Driving assessment for maintaining mobility and safety in drivers with dementia, Cochrane Database of Systematic Reviews, 1(6222). NSW Government, 2014, Aged Care - Working with People with Challenging Behaviours in Residential Aged Care Facilities, Sydney: Mental Health and Drug and Alcohol Office. Sampson EL, Blanchard MR, Jones L, et al, 2009, Dementia in the acute hospital: prospective cohort study of prevalence and mortality, Br J Psychiatry, 195:61-6. Work-Safe BC, 2010, Dementia: Understanding Risks and Preventing Violence, Columbia: Workers’ Compensation Board of British Columbia. Read More