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.
(C)2000Aspen Publishers, Inc.
- SourceAvailable from: Ingela Enmarker[Show abstract] [Hide abstract]
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.
- [Show abstract] [Hide abstract]
ABSTRACT: Behavioral symptoms are common in persons with dementia, and nonpharmacological interventions are recommended as the first line of therapy. We describe barriers to conducting nonpharmacological interventions for behavioral symptoms. A descriptive study of barriers to intervention delivery in a controlled trial. The study was conducted in six nursing homes in Maryland. Participants were 89 agitated nursing home residents with dementia. Personalized interventions were developed using the Treatment Routes for Exploring Agitation decision tree protocol. Trained research assistants prepared and delivered the interventions. Feasibility of the interventions was determined. Barriers to Intervention Delivery Assessment, activities of daily living, cognitive functioning, depressed affect, pain, observed agitation, and observed affect. Barriers were observed for the categories of resident barriers (specifically, unwillingness to participate; resident attributes, such as unresponsive), barriers related to resident unavailability (resident asleep or eating), and external barriers (staff-related barriers, family-related barriers, environmental barriers, and system process variables). Interventions pertaining to food/drink and to 1-on-1 socializing were found to have the fewest barriers, whereas higher numbers of barriers occurred with puzzles/board games and arts and crafts activities. Moreover, when successful interventions were presented to participants after the feasibility period, we noted fewer barriers, presumably because barrier identification had been used to better tailor interventions to each participant and to the environment. Knowledge of barriers provides a tool by which to tailor interventions so as to anticipate or circumvent barriers, thereby maximizing intervention delivery.Journal of the American Medical Directors Association 08/2011; 13(4):400-5. · 5.30 Impact Factor