Nonpharmacological Management of Behavioral Problems in Persons with Dementia: The TREA Model
ABSTRACT : Several subtypes of problem behaviors are related differentially to personal and environmental characteristics. These subtypes are useful in guiding the formulation of an individualized treatment plan. This article presents the TREA-Treatment Routes for Exploring Agitation-approach for individualizing treatment plans for behavioral problems. Such a plan involves several stages: (a) hypothesize which need underlies the agitated behaviors; (b) characterize the way in which the behavior results from the need (eg, Does the behavioral attempt to accommodate the need? Does it express discomfort? Does it attempt to communicate the need?); and (c) provide an intervention that either provides for the unmet need, or, alternatively, when the behavior itself is alleviating the need, provide a method in which the behavior can be accommodated, When an intervention to provide for the unmet need is required, it needs to be matched to the person's sensory, mental, and physical abilities, as well as to the person's habits and preferences. The goal of the plan is to improve the quality of life for the patient, and to reduce the burden on caregivers. Case examples illustrate this approach.
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- "Caring for people who demonstrate behavioural disturbance, such as Behavioural and Psychological Symptoms of Dementia (BPSD) has been characterised as a pendulum between a loss of power and capability, as well as rejection and acceptance (Graneheim et al., 2005): experiences which are painful both for the person with dementia and staff (Rodney, 2000; De Deyn et al., 2005; Verkaik et al., 2005). Healthcare providers are at times surrounded by chaos and situations that usually lead to restrictions for the person receiving care, including the loss of personal space, which could trigger aggressive behaviour (Cohen-Mansfield, 2000; Graneheim et al., 2001). Traditionally, threatening actions directed towards healthcare providers are described as 'aggressive' or 'problematic' and not as 'violent', even if research has shown that a majority of providers actually experience acts of violence (Gates et al., 1999, 2003). "
ABSTRACT: Studies indicate that physical and pharmacological restraints are still often in the frontline of aggression management in a large number of nursing homes. In the present literature review the aim was to describe, from a nursing perspective, aggressive and violent behaviour in people with dementia living in nursing home units and to find alternative approaches to the management of dementia related aggression as a substitute to physical and chemical restraints. A systematic literature review in three phases, including a content analysis of 21 articles published between 1999 and August 2009 has been conducted. The results could be summarised in two themes: 'origins that may trigger violence' and 'activities that decrease the amount of violent behaviour'. Together, the themes showed that violence was a phenomenon that could be described as being connected to a premorbid personality and often related to the residents' personal care. It was found that if the origin of violent actions was the residents' pain, it was possible to minimise it through nursing activities. This review also indicated that an organisation in special care units for residents who exhibit aggressive and violent behaviour led to the lesser use of mechanical restraints, but also an increased use of non-mechanical techniques. The optimal management of aggressive and violent actions from residents with dementia living in nursing homes was a person-centred approach to the resident. Qualitative studies focusing on violence were sparsely found, and this underlines the importance of further research in this area to elucidate how violence and aggressiveness is experienced and understood by both staff and patients. To communicate with people with dementia provides a challenge for nurses and other health caregivers. To satisfy the needs of good nursing care, an important aspect is therefore to get knowledge and understanding about aggressive and violent behaviour and its management.International Journal of Older People Nursing 06/2011; 6(2):153-62. DOI:10.1111/j.1748-3743.2010.00235.x
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ABSTRACT: Assessment of behavior problems in elderly persons with dementia is important for understanding and managing those behaviors. The most common method for assessing agitation is the use of informant ratings; however, these ratings may be affected by staff bias, inaccurate or insufficient memory, or stress. An alternative method is direct observation, which is more objective, but very costly and necessitates time sampling, thereby limiting the period covered by the assessment. To date, little research attention has been given to the degree to which these two methods converge. In the present study, 175 elderly persons with dementia who manifested problem behaviors were recruited from 11 nursing home facilities in Maryland. The average age for the participants was 87 years; 78% were female. Two methods were employed for assessing agitation: the Agitated Behaviors Mapping Instrument (ABMI), which is based upon direct observations, and the Cohen-Mansfield Agitation Inventory (CMAI), which is a frequency rating scale completed by a formal caregiver. The ABMI and CMAI contain some identical items for tapping behavior problems. Data analysis revealed significant Pearson correlations between identical items on the two assessment instruments, as well as significant correlations of summary measures based on these different instruments, demonstrating a strong convergence between informant ratings and direct observations. Informant ratings can achieve moderate agreement with direct observation when valid instruments and informants are used.International Journal of Geriatric Psychiatry 09/2004; 19(9):881-91. DOI:10.1002/gps.1171 · 2.87 Impact Factor