This is the 18th installment in the Critical Dementia Skills (CDS) series. For more information on the series, start HERE. You can also click on the CDS tags in the blog for more.
Sometimes in the course of dementia, your loved one may exhibit “behavioral expressions.”
These used to be called “problem behaviors” and they were named, I suspect, not because it offended anyone (although it could), but because “expression” is a more accurate way of looking at our loved one. Some examples of behavior expressions include shouting, slapping, repeating comments or questions, pacing, refusal to take medications, or resisting a bath.
Most of the time, when the person living with dementia’s behavior that is not pleasing to others is their way of expressing what they can no longer communicate. They could be trying to say that they are bored, too warm or too cold, hungry or thirsty, in pain, confused and scared of their confusing environment, or annoyed with a person or what they are trying to do. As you know, many lose the ability to communicate.
I’ve spoken before on the Dementia Rosary Daily about becoming a detective to find the underlying reasons for behavioral expressions. In this CDS, I’ll give you a formula to try. This method can also be used in assisted living facilities, group homes, nursing homes, and other settings.
This particular formula was created and studied by Linda Teri, PhD, and her colleagues at the University of Washington and was funded with a “pioneer grant” by the Alzheimer Association.
The formula is ABC: Activators, Behaviors, and Consequences. NOTE: While this is a non-drug strategy and is not considered a medical intervention, this is not a substitute for seeing and working with a physician. There could be underlying medical reasons for agitation, fatigue, and anxiety.
Activators (A) are things that happen just before the person’s behavior expression.
Behavior (B) is an “observable act” that describes exactly what the person did in the behavior expression and also includes who was present when it happened, where it happened.
Consequences (C) are what follow immediately after the behavior expression.
**When using the formula, start with the observable behavior:
Behavior (B): Mr. Smith is an 81-year-old man with dementia who lives at home with his wife. An aide was just hired because Mrs. Smith can no longer help him bathe. On Tuesday morning, he refused to take a bath with the assistance of the aide, who is female. Mrs. Smith is also present right outside the bathroom.
Activator: (A) The aide, without getting to know Mr. Smith, tells him that he must take a bath and that they are not leaving the bathroom until it is complete
Consequences: (C) Mr. Smith yells at his wife and the aide. This makes 7 days without a bath. Mrs. Smith cries in frustration and the aide leaves the home calling her manager about the situation.
Now that we have the ABCs know (as best that we can from not being there), I am curious about what you are thinking about the example scenario. Please see the questions below and comment to a friend and/leave comments in the blog. I’ll comment in the near future.
Questions for you to think, write down, and share in the comments section (any or all):
- What recently changed in the Smith household?
- What are some reasons why Mr. Smith may have refused to take a bath?
- Do you have a scenario to share?
Thank you for reading this far and for commenting. Let’s tell hundreds more care partners about this concept by sharing the article. God bless you.
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