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Management of Challenging Behavior in Elderly People

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Management of Challenging Behavior in Elderly People
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



References: Alzheimer’s Society (2010) Demography Position Statement. Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?categoryID=200167&documentID=412 (Accessed: 15 April 2010). Andrews, G. (2006) Managing challenging behaviour in dementia. British Medical Journal, 332, p. 741. Benedetti, F., Arduino, C., Vighetti, S., Asteggiano, G., Tarenzi, L. and Rainero, I. (2004) Pain reactivity in Alzheimer’s patients with different degrees of cognitive impairment and brain electrical activity deterioration. Pain, 111 (1-2), p. 22-29. Blake, S., Ruel, B., Seamark, C. and Seamark, D. (2007) Experiences of patients requiring strong opioid drugs for chronic non-cancer pain: a patient-initiated study. British Journal of General Practice, 57, p. 101-109. Bourgeois, M.S. and Hickey, E.M. (2009) Dementia. From Diagnosis to Management – A Functional Approach. New York: Psychology Press. Brooker, D. (2007) Person-Centred Dementia Care. Making Services Better. 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