Managing Difficult Behavior

Agitation
Potential causes or antecedents	Management strategies
Discomfort, pain	Determine source of pain and provide appropriate remedy; check clothing for comfort
Physical illness	Obtain medical examination and treatment of illness
Medication/Substance effects	Assess and monitor medication, eliminate caffeine, alcohol and other stimulants
Fatigue	Schedule adequate rest, monitor activity level and adjust as necessary
Overstimulation - excessive noise, people, radio, television	Remove patient from situation, provide quiet and safe setting; play soothing music
Caregiver becomes upset/angry	Remain calm in interactions, use low tone and slow rate of speech, control emotions
Overextending capabilities (resulting in failure)	Do not put patient in failure-oriented situations, maintain appropriate expectations

Sleep Disturbance
Potential causes or antecedents	Management strategies
Illness, pain, medication	Medical evaluation, change or eliminate medications as appropriate
Depression	Have patient evaluated for use of antidepressant medication or bedtime sedative
Less need for sleep	Increase daytime activity, schedule later bedtime, provide safe evening activities
Uncomfortable	Adjust temperature, lighting, determine if patient is hungry or needs to use bathroom
Excessive daytime sleepiness	Limit or eliminate naps, provide activity during the day, increase exposure to light

Difficulty with Personal Care Tasks
Potential causes or antecedents	Management strategies
Task too difficult or overwhelming	Divide task into small successive steps, provide assistance as needed
Caregiver impatience, rushing	Be patient, allow ample time, try again at a later time, obtain caregiving assistance from others
Cannot remember task	Demonstrate action or task, allow patient to perform parts of task that can still be completed
Cannot understand or follow caregiver instructions	Re-state instructions more simply, break down task, provide step-by-step instructions
Fear of task--cannot understand need for task or instructions	Reassure, comfort, distract with music or conversation, have patient help perform task
Inertia, lack of motivation; difficulty initiating tasks	Set up task sequence by arranging material (i.e., clothing) in order to be used, help initiate task
Pain involved with movement	Have physician evaluate; consider medication that will not further affect mental functions

Incontinence
Potential causes or antecedents	Management strategies
Infection, chronic illness, medication side effect, stress	Evaluate and treat medically
Difficulty finding bathroom	Place signs, picture on door, ensure adequate lighting
Difficulty seeing toilet	Use contrasting colors on toilet and floor
Difficulty undressing or impaired mobility	Simplify clothing, use elastic waistband, provide a commode, treat associated pain
Dependence created by socialized reinforcement	Allow independence when possible, even if inconvenient
Cannot express need	Schedule toileting, reduce bedtime liquids when possible
Task overwhelming	Simplify; establish step-by-step routine

Suspiciousness or Paranoia
Potential causes or antecedents	Management strategies
Forgot where objects were placed	Offer to help find, have more than one of same object, learn favorite hiding places
Misinterpreting actions or words	DO NOT argue or try to reason with patient, distract, do not take personally
Misinterpreting who people are, suspicious of their actions	Introduce self and role routinely, draw on old memory, connections; do not argue or quiz
Change in environment or routine	Reassure, provide familiar objects, maintain stable and consistent routine
Misinterpreting environment	Assess vision, hearing; modify environment, provide simple explanation, distract
Social isolation	Encourage and provide familiar social opportunities
Physical illness	Medical evaluation and treatment
Actual theft	Verify the situation, intercede when appropriate

Inappropriate or Impulsive Sexual Behavior
Potential causes or antecedents	Management strategies
Decreased judgment and social awareness	Do not overreact or confront; respond calmly and firmly; distract and redirect
Misinterpreting caregiver's interaction	Do not give mixed sexual messages-even in jest, distract while performing personal care
Uncomfortable-too warm, tight clothing, genital irritation	Check room temperature, ensure elimination needs are met, examine for medical problems
Need for attention, affection, intimacy	Meet basic need for touch and warmth, offer soothing objects, hand or back massage
Self-stimulating, reacting to what feels good	Offer privacy, remove from inappropriate places