“The majority of care staff were generally unaware of best practice guidance and some felt their knowledge was insufficient or they didn’t have enough time to be able to give the care they wanted to.” Care Commission and Mental Welfare Commission joint report on the quality of care for people with dementia living in care homes in Scotland (2009)
Challenging behaviour is a catch-all term that, in the context of caring for older people, is used to include one or combinations of shouting, wandering, biting, throwing objects, repetitive talking, destroying personal possessions and other objects, agitation and general anger, physical attacks on others, and waking others at night. In short, this term is used to describe any behaviour by patients that is deemed to be dangerous to themselves, their fellow patients, and staff, or is considered antisocial within environments where those patients have to coexist with others on a long term basis.
We prefer to call these “Stress-Related Behaviours for People Living in Care Environments” as a more helpful way to describe the situation, knowing that using this term places more of an emphasis on the causes of the behaviour, rather than the disposition of the person themselves.
The best approaches emphasise Person-centred approaches and the recognition of a person’s core needs, which when they are not met, may be causing them to be frustrated or aggressive. Carers who skillfully identify and recognise these unmet needs often devise and employ creative strategies to resolve situations which could otherwise become dangerous.
We have examples of wonderfully creative activity and occupational approaches, life-history resources, music therapy and others which, when the culture of a facility allows staff the freedom to do so, can become very effective interventions which increase the level of care and comfort of the resident.
The practice of observation and of developing awareness of stress triggers can be important ways of ensuring staff and resident safety. Passing on information about changes in behaviour can be critical also, to ensure other staff don’t unwittingly stumble across previously-identified triggers. This practice is underpinned by risk assessment principles, where constant identification of possible hazards is one of the key tenets of the risk control process.
What can be done to reduce stress-related behaviours in people with dementia?
• Get to know the person – not just the illness
• Screen for and treat underlying physical illnesses and symptoms
• Increase training and skills in person centred approaches
• Reduce the impact of the environment
• Provide clear and consistent guidance (local protocols, care plans etc)
• Adopt and develop organisational models of support for staff and carers
All of our programmes for the Care of Older People encourage staff to move towards person-centred and person-directed care models as the best way to ensure that they treat people with dignity and show people respect, reducing the risk of aggression and violence in their services.
Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant. He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict. www.dynamis.training