Management of Challenging Behavior in Elderly People

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The aim of this assignment is to explore challenging behaviour in the person with dementia. As it is outside the scope of this assignment to explore all the potential reasons for challenging behaviour, the focus of this assignment will be on challenging behaviour in the context of the communication of pain, using a case study to illustrate this. This assignment will describe challenging behaviours, the behaviours associated with pain, and the management strategies employed by nursing staff, using a person-centred approach to care. Finally, ways of improving the care provided will be explored and recommendations made.

The rationale for choosing to discuss this issue is that I currently work as a staff nurse on an organic assessment ward, and am frequently involved in caring for people with dementia who present with challenging behaviours that are difficult to manage in the community setting.

There are currently 750,000 people with dementia in the UK. As the UK’s population grows, there will be substantial increases, and it is estimated that there will be 940,000 people with dementia by 2021, rising to over 1.7 million by 2051. Alzheimer’s disease is the most common form of dementia (Alzheimer’s Society, 2010). Gogia and Rastogi (2009) describe Alzheimer’s disease as a progressive illness, where there is a decline in almost all functions, including memory, movement, language and communication skills, behaviour, judgement and abstract reasoning, and the ability to carry out activities of daily living, although the manifestation of these symptoms varies from person to person. As Pelletier and Landreville (2007) highlight, the majority of people with dementia exhibit behavioural and psychological symptoms, including increased agitation and aggression, which can be distressing for the individual, be difficult for caregivers to manage, and lead to institutionalisation.

The case study I have chosen to use for this assignment relates to Ruth (name changed for reasons of confidentiality), a 79 year old lady with a diagnosis of Alzheimer’s disease of 6 years duration. Ruth was born locally and lived locally throughout her adult life. She worked for many years in a responsible job in the shipyard offices. Ruth was married and has two daughters. Her husband of 45 years died 10 years ago. Ruth was diagnosed with breast cancer 8 years ago, and underwent surgery for a mastectomy, followed by radiotherapy treatment. Ruth was admitted to the organic assessment ward from a care home following a period of disruptive and aggressive behaviour, which proved difficult to manage in the community setting.

The Royal College of Psychiatrists (2007, p. 14) define challenging behaviour as “behaviour that is of such an intensity, frequency or duration as to threaten the quality of life and / or the physical safety of the individual or others and is likely to lead to responses that are restrictive, aversive or result in exclusion.”

Killick and Allan (2001, p. 59) suggest that challenging behaviour refers to “the sorts of things people do which others find unwelcome or even offensive.”

Challenging behaviour includes shouting, screaming, repetitive speech, restlessness, pacing, wandering, agitation, aggression, and behaviours inappropriate to social norms (Andrews, 2006; Cohen-Mansfield, 2000), and Brooker (2007) includes heightened distress, anxiety, inappropriate sexual behaviour, low mood, and withdrawal. Killick and Allan (2001) identify that the term challenging behaviour has replaced more negative terms such as problem behaviour or disruptive behaviour, however it continues to have a negative bias. Cohen-Mansfield (2000) points out that problem behaviours are defined as such by those who perceive them to be inappropriate, and Cunningham (2006) suggests that patients with dementia whose behaviour interferes with ward routines can be regarded as disruptive, aggressive or difficult, which may undermine attempts to...
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