1. ALL ABOUT BEHAVIORS 1

2. The New York Times April 11, 2005

3. The New York Times October 12, 2006

4. Objectives: Part One (III) Describe principles of communication Discuss behavior as communication Identify factors  behavioral communication Mass Senior Care Foundation Antipsychotic Initiative 2011-12 4

5. Objectives: Part Two (IV) Recognize non-verbal communication of unmet need Describe common challenging behaviors Describe strategies to address Mass Senior Care Foundation Antipsychotic Initiative 2011-12 5

6. About communication 10% is through words or speech 40% is through the tone of voice 50% is through body language Mass Senior Care Foundation Antipsychotic Initiative 2011-12 6

7. About communication Try to understand Be open-minded Stand in the other’s shoes Mass Senior Care Foundation Antipsychotic Initiative 2011-12 7

8. Communication obstacles Personal problems Emotional state Anger Anxiety Depression Paranoia Sensory deficits Cognitive deficits Hallucinations Thought disorder Mass Senior Care Foundation Antipsychotic Initiative 2011-12 8

9. Communication obstacles Interferences Environmental noise Lack of privacy Lack of perceived power Mass Senior Care Foundation Antipsychotic Initiative 2011-12 9

10. About Behavior All behavior has meaning Attempt to communicate Need or feeling Effect a change Start or stop Mass Senior Care Foundation Antipsychotic Initiative 2011-12 10

11. Practices Staff Resident Family/Larg er community 11 Mass Senior Care Foundation Antipsychotic Initiative 2011-12

12. About Behavior "What needs to change?" Environment My behavior or attitude The resident's I-care plan Mass Senior Care Foundation Antipsychotic Initiative 2011-12 12

13. Understanding Behavior What is the communication? What needs to change? Is it a problem? Whose problem is it? Mine Resident’s Administrator Family Regulatory agency Mass Senior Care Foundation Antipsychotic Initiative 2011-12 13

14. Institution-Behavior Relationships Clocks Assignments Restraints Management Mass Senior Care Foundation Antipsychotic Initiative 2011-12 14

15. Your turn Mass Senior Care Foundation Antipsychotic Initiative 2011-12 15

16. Common Behaviors Rummaging, Pillaging, Hoarding Wandering Irritability Delusions Hallucinations Agitation Lack of cooperation Paranoia Socially unaware behavior Aggression Sexual activity Accusatory behavior Anxiety Mass Senior Care Foundation Antipsychotic Initiative 2011-12 16

17. Slides 18-25 Mass Senior Care Foundation Antipsychotic Initiative 2011-12 17

18. Brain-behavior relationships Right The big picture Visuospatial relationships Self-awareness Creativity Visual memory Mass Senior Care Foundation Antipsychotic Initiative 2011-12 18

19. Brain-Behavior Relationships Left Language Emotional regulation Verbal memory Logic Sequencing Mass Senior Care Foundation Antipsychotic Initiative 2011-12 19

20. Brain-Behavior Relationships Frontal Parietal Occipital Temporal Brain stem Hippocampus Amygdala Mass Senior Care Foundation Antipsychotic Initiative 2011-12 20

21. *Frontal lobe = Chief Executive Initiation Self-monitoring Inhibition Judgment Mass Senior Care Foundation Antipsychotic Initiative 2011-12 21

22. Temporal Lobe Memory Understanding language Organizing and sequencing Hearing Mass Senior Care Foundation Antipsychotic Initiative 2011-12 22

23. Parietal Lobe Orientation Getting lost Apraxia Mass Senior Care Foundation Antipsychotic Initiative 2011-12 23

24. Hippocampus Memory Amnesia Mass Senior Care Foundation Antipsychotic Initiative 2011-12 24

25. *Amygdala Regulates emotions Fear Anger Apathy Paranoia Outbursts Mass Senior Care Foundation Antipsychotic Initiative 2011-12 25

26. MODULE III Unmet Needs Building Observation Skills 26

27. Importance of language Mass Senior Care Foundation Antipsychotic Initiative 2011-12 27

28. Agitation Slapping thighs Clapping Yelling Screaming Self-referred Something is wrong with me Do something! Mass Senior Care Foundation Antipsychotic Initiative 2011-12 28

29. Aggression Hitting out Kicking Pinching Biting Threatening Swearing Other referred Something is wrong with you STOP! Leave me alone Mass Senior Care Foundation Antipsychotic Initiative 2011-12 29

30. Agitation Aggression Dementia Delirium Stroke Developmental disability Brain injury Agitated depression Dementia Delirium Stroke Paranoia Developmental disability Brain injury Intoxication Delusions of persecution Mass Senior Care Foundation Antipsychotic Initiative 2011-12 30

31. Agitation and Aggression Common causes Noisy environment Pain Constipation Discomfort Infection Drugs Hearing loss Boredom (agitation) Loneliness (agitation) Abrupt, tense or impatient staff (aggression) Frustration(aggression) Mass Senior Care Foundation Antipsychotic Initiative 2011-12 31

32. Aggression FEAR Mass Senior Care Foundation Antipsychotic Initiative 2011-12 32

33. Summary Behavior is communication Understanding guides intervention Goal is prevention Easier to change ourselves than others Mass Senior Care Foundation Antipsychotic Initiative 2011-12 33

34. What do you see? Mass Senior Care Foundation Antipsychotic Initiative 2011-12 34

35. What happened Scenario One Scenario Two Disinterest No eye contact Busy Frustration (  Anxiety) Threat Touch Respect Eye contact Full attention Comfort Accompanies Help to look Introduces pleasant event

36. Repetitive Questions What happens?