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October 24, 2018

Behaviour Analysis for Dementia

Reuel S. Amdur

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On October 18, the Royal Ottawa Hospital hosted a presentation by two staff from the Champlain Local Health Integration Network (LHIN) who spoke about behaviour analysis with dementia patients. Their presentation began with a film of a mute man suddenly activated when earphones were installed, playing music he liked. He started talking animatedly about the music and then began to sing. Mary Lesiuk, a registered nurse and the manager of geriatric outreach for the LHIN, said that to be effective the music should be to the person's taste. Lesiuk was accompanied by behaviour analyst Nick Feltz.

Utilization of behavioural therapy with dementia patients begins, Lesiuk explained, by understanding the nature of the condition.  Dementia is characterized by memory loss and change of mood or behaviour and by difficulty thinking and solving problems.  The purpose of LHIN intervention is to keep the patient in his long-term care facility with minimum drug interventions.

According to Feltz, behaviour analysis attempts to pinpoint the patent’s unwanted conduct, such as violence or wandering.  Generally speaking, the therapy takes time, explained Feltz.  In order to know when and how to intervene, detailed observation is needed.  Take violence as an example.  The therapist will attempt to discover the triggers for the outbursts. He will then try to extinguish that behaviour by, so far as possible, intervening minimally and by rewarding / re-enforcing positive behaviour. 

In looking for triggers, the behaviour analyst considers a variety of factors: changes in routines of daily life, illness, ongoing sources of stress, sleep patterns, dietary issues, medicines, and staffing matters.  Triggers may also include interaction with other residents. Then it is necessary to look for patterns.  How often does the undesirable behaviour occur?  What day of the week, what time, and where?  On the basis of the analysis, a care plan is developed, with an eye to prevention, including modification of the environment and identification of cues that the undesired conduct is to occur.  The need is to personalize the care plan, taking into account the patient’s values, culture, and preferences. 

Behaviour analysis is a useful approach but it is not always effective in allowing a patient to remain in the long-term facility.  Sometimes there is a need for him to be removed to a facility that is specialized in dealing with the problem, with the possibility of returning him to his long-term facility once the problem behaviour is resolved. 

While behaviour analysis provides a useful approach, quick fixes are not to be expected, though music seems to get immediate reaction in many cases.  I was told that in one residence in Quebec, on an all-too-quiet dementia unit where a staff member brought in a radio playing music, the residents erupted in skipping around.

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