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Care Models Addressing Behaviors in Persons With Dementia

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

February 28, 2020

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Question

Can you explain the two care models that address behaviors in persons with dementia?  

Answer

The first is the Progressively Lowered Stress Threshold Model.  According to this model, adults are less able to manage stress as the disease progresses.  Their threshold for stress is lower thus resulting in anxiety and dysfunctional behaviors.  Stressors include fatigue; changes in routine, caregiver or environment; demands that exceed their ability; multiple and competing stimuli; perception of loss; physiologic factors such as pain, illness, discomfort or medication side effects. 

It is based on six principles of care: Modify the environment to ensure safety, provide unconditional positive regard, use anxiety as a gauge of activity and stimulation levels, teach the caregiver(s) to listen for behaviors, modify the environment to support losses and enhance safety, and provide education and support to the caregiver(s).

The second model is called the Need-Driven Dementia-Compromised Behavior Model.  Developed in 1993, this model changes the view that behaviors are disruptive and instead are needs that, if responded to correctly, can enhance the quality of life.  Behaviors are a result of “background” factors and “proximal” factors.  Background factors, which are stable individual and disease-related characteristics include: dementia compromised functioning (language issues, memory, etc),  poor overall health status, demographic variables (e.g., marital status), psychosocial variables (e.g., personality traits)

Proximal factors, meaning those inducing a need state include unmet physiologic needs, unmet psychological needs (e.g., contact with family), disturbing environmental factors (e.g., cold room), and uncomfortable social surroundings (e.g., too many people in the room).

It is the proximal factors that we can control and those that will guide our interventions.

 


kathleen d weissberg

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP

Kathleen Weissberg, OTD, OTR/L, in her 25 years of practice, has worked in adult rehabilitation, primarily in long-term care as a clinician, manager, researcher, and most recently as Education Director with Select Rehabilitation where she oversees continued competency and education for close to 12,000 therapists. In her role, she conducts audits and provides denials management and quality improvement planning training for more than 700 LTC sites nationwide. She also conducts compliance, ethics, and jurisprudence training to therapists.  Kathleen has authored several publications that focus on patient wellness, fall prevention, dementia management, therapy documentation, and coding/billing compliance.  

 


Related Courses

Put Down the Drugs: Evidence-Based Interventions to Reduce Unwanted Behaviors with Dementia
Presented by Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Recorded Webinar

Presenter

Kathleen D. Weissberg, OTD, OTR/L, CMDCP, CDP
Course: #3072Level: Intermediate1 Hour
  'The expertise, content volume, and pacing of presentation were excellent'   Read Reviews
PTs can apply evidence-based interventions to improve dementia care. This session reviews the etiology of common behaviors. Cognitive-emotion, multi-sensory, animal-assisted, and exercise interventions to reduce agitation are discussed as well as specific strategies for improving task-related engagement. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Dementia Management: Techniques for Staging and Intervention
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Course: #3649Level: Intermediate2 Hours
  'It was very easy to read and follow, but still informative with good techniques'   Read Reviews
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. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Georgia Ethics and Jurisprudence
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Course: #3918Level: Intermediate4 Hours
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PTs and PTAs in the state of GA are required to complete a 4 hour course on jurisprudence and ethics for license renewal. This course reviews the jurisprudence and ethics components as outlined by the Georgia Board of Physical Therapy and is applicable for PTs and PTAs licensed in the state of Georgia.

Health Literacy: Effective Client Communication and Education
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Harassment, and more specifically, sexual harassment, is illegal. This course reviews the definition of sexual harassment, ways to prevent harassment, and what to do should harassment occur in the workplace. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.