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Dementia Management: Evidence-Based Interventions to Reduce Unwanted Behaviors

Dementia Management: Evidence-Based Interventions to Reduce Unwanted Behaviors
Kathleen Weissberg, OTD, OTR/L
December 27, 2016
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Kathleen Weissberg: Thank you to everyone for coming. This is my niche area, and one that I am very passionate about. 

Background (AHRQ, 2014)

An estimated five million Americans right now suffer from dementia, and about 14% of those age 70 or older actually have dementia. We have more than 15 million people providing caregiving to the individuals who have dementia. When you look at the cost of that caregiving, we are looking at both formal care that we provide perhaps in a facility or informal care that we are providing at home. Statistics, from 2010, show that we are spending $215 billion in caregiving alone, and it is the most costly thing in dementia care. The reality is that the cost goes up 30% more when an individual has behaviors.

Behavioral and Psychological Symptoms of Dementia (BPSD)

We are now going to talk about the behavioral and psychological symptoms of dementia. BPSD is an umbrella term to talk about the symptoms of disturbed perception, thought content, mood, or behavior that frequently occur in patients with dementia. This is the actual definition from the International Psychogeriatric Association. When you look at folks in long-term care, specifically with dementia, we see that we have upwards of 78% with dementia. Of those with dementia, 76% of them have behavioral and psychological symptoms of dementia. Symptoms include: wandering, pacing, disrobing, overdressing, and all those different types of things. Unfortunately, we end up labeling them as agitated, aggressive, or disruptive, none of which are attractive labels for these individuals (AHRQ, 2014).

Distress to Caregivers

Obviously these behaviors cause a great amount of distress to caregivers, both informal and formal. It is a large part of why individuals are brought to long-term care or to institutions. Even in our facilities, we see that caregivers are inclined to either abuse the client or turn to antipsychotic medications to deal with those behaviors. I have seen scenarios where individuals are left to sit in their urine because they are asking repeatedly to go to the bathroom or something like that. That is a form of abuse, and we do still unfortunately see those things happening.

Theoretical Frameworks

There are four theoretical frameworks that we can look at that help to explain the etiology of behavioral disorders. The first is the biologic/genetic. This says that dementia causes changes in the brain, that in turn result in these problematic behaviors. We also see a behavioral framework which indicates that there is a relationship, if you will, between the client and his or her environment. Something in the environment causes this person to have these behaviors or to act out the way that they are. We will also talk about reduced stress threshold frameworks. These say the person is unable to reduce their stress that they have because of environmental stimuli, maybe sounds or light in the environment, or something else that is happening. They cannot manage their stress, and we see behaviors. Finally, there are the unmet needs (Cohen-Mansfield, 2013). This is where we will start.


kathleen weissberg

Kathleen Weissberg, OTD, OTR/L

Dr. Kathleen Weissberg, (MS in OT, 1993; Doctoral 2014) in her 25+ years of practice, has worked in rehabilitation and long-term care as an executive, researcher and educator.  She has established numerous programs in nursing facilities; authored peer-reviewed publications on topics such as low vision, dementia quality care, and wellness; has spoken at numerous conferences both nationally and internationally, for 20+ State Health Care Associations, and for 25+ state LeadingAge affiliates.  She provides continuing education support to over 17,000 therapists, nurses, and administrators nationwide as National Director of Education for Select Rehabilitation. She is a Certified Dementia Care Practitioner and a Certified Montessori Dementia Care Practitioner.  She serves as the Region 1 Director for the American Occupational Therapy Association Political Affairs Affiliates and is an adjunct professor at both Chatham University in Pittsburgh, PA and Gannon University in Erie, PA. 



Related Courses

Dementia Management: Techniques for Staging and Intervention
Presented by Kathleen Weissberg, OTD, OTR/L
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Course: #9410Level: Intermediate2 Hours
This seminar provides an overview of types of dementia including characteristics at each stage, protocols for staging clients with dementia and related treatment strategies. Documentation and treatment planning based on dementia staging results is reviewed. Behavior management and communication strategies for this population are discussed as well as techniques for nursing to follow.

Fall Management: Evidence-Based Interventions for Screening and Intervention
Presented by Kathleen Weissberg, OTD, OTR/L
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Course: #9453Level: Intermediate2 Hours
This session will review evidence-based screening and intervention strategies applicable to a balance and falls management program including research-based exercise programs, environmental modification, patient and caregiver education and balance retraining activities. Falls management program rationale and implementation is also discussed as well as interdisciplinary techniques and strategies to reduce fall risk in the elderly.

Elder Abuse and Child Abuse: Know the Signs and Your Role
Presented by Kathleen Weissberg, OTD, OTR/L
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Course: #4370Level: Intermediate1 Hour
Elder abuse and neglect and child abuse and neglect are harsh realities. This course will identify the physical, clinical, and behavioral indicators of physical, emotional, and sexual abuse needed to identify and report to appropriate agencies. Participants will gain an improved awareness of warning signs of abuse, the clinician's role in reporting abuse, and the steps for reporting abuse and getting proper assistance.

Bullying Among Older Adults: Not Just A Playground Problem
Presented by Kathleen Weissberg, OTD, OTR/L, CMDCP, CDP
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Course: #5660Level: Introductory1 Hour
The definition and incidence of bullying in adult living communities and day centers including what older adult bullying looks like in this population are reviewed in this session. Characteristics of older adult bullies as well their targets and gender differences will be explored. The reasons why bullying occurs as well as the five different types of bullies are defined. Interventions for the organization, the bully, and the target will be reviewed to help communities minimize (and prevent where possible) bullying and mitigate the effects on the target. Addressing bullying behavior among older adults is critically important for enhancing quality of life and promoting emotional well-being; strategies to create caring and empathic communities for all residents and staff members are also reviewed.

Fostering Meaning And Purpose For Individuals In Senior Living
Presented by Kathleen Weissberg, MS, OTD, OTR/L, CMDCP, CDP, CFPS
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Despite such positive outcomes of meaningful engagement, recent studies have suggested that elderly residents are inactive most of their time, are engaged in passive activities, and do not experience significant verbal interaction with their caregivers. This session explores meaningful activities by focusing on the intersection of the individual, his/her occupations, and the environment. Participants are offered techniques for soliciting individual preferences, interests, roles, and hobbies and using these to encourage client choice and control over activities and occupations of interest.

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