Calming Aggressive Physical Behavior
Mrs. Smith*, a resident in a Pennsylvania nursing home, frequently yells and demands to be taken home. When she does this she, like many nursing home residents who suffer from dementia, is exhibiting Aggressive Physical Behavior (APB). These behaviors are disruptive and potentially harmful to care workers, family members, and other residents. Luckily, researchers at Penn State are working with innovative techniques to intervene and prevent such outbursts.
Ann Kolanowski
"These behaviors are the demented person's way of telling us they need something," explains Dr. Ann Kolanowski, Associate Professor of Nursing, who is leading several studies in Pennsylvania nursing homes. "A person with dementia can't tell us that they're in pain. Often, they're in the nursing home because they're functionally impaired, not because they suffer from a specific health problem."
APB occurs in 30-50% of persons with dementia, and can include biting, grabbing, kicking, punching, pushing, spitting or throwing objects. The most common ways of intervening are physical and chemical restraints, which generally result in undesirable outcomes and often increase outbursts.
Kolanowski has been taking a different approach. Tailoring special activities based on personality profiles of nursing home residents, she has found success in reducing aggressive behavior among nursing home residents.
"We are working with the Need Driven Dementia Compromise Behavior Model," explains Kolanowski. "This involves finding what activities engage people with dementia and using the engagement to reduce aggressive behaviors. We have had good responses to these activities and our nursing home residents are in better moods."
Mrs. Smith's extroverted, open, and creative personality lent itself well to an activity called the feeling cube, a large dice with an emotion on each side that residents roll and then talk about whatever feeling comes up.
"They talk about the things that make them feel a certain way," Kolanowski says. "For example when it comes up 'happy', Mrs. Smith will talk about the sun being out or looking forward to having lunch."
Remembering and reminiscing also played a part in engaging Mrs. Smith, Kolanowski says. "She just loves going through old books and pictures and talking about them and the things she remembers. That was very successful."
"It is very important for them to have something to do," Kolanowski explains. "People in nursing homes spend 85% of their time sitting and doing nothing, and this can lead to aggressive behavior. It is very important for them to have recreational therapy as part of their care plan."
Kolanowski is also working to incorporate a physical component into engaging activities. She employs stretching and other low-level activity to try to improve physical functioning in patients.
"One item we have is called the 'look-inside purse,'" she explains. "It is filled with trinkets and tends to engage very curious patients. One of the objects in the purse is a squeeze ball, like a stress reliever ball, that we encourage them to squeeze. This helps them build a little bit of strength."
Future research will focus on using more subjects to gain a better assessment of personalities and developing new activities that combine physical components with mental stimulation.
*Note: Name has been changed to preserve resident's anonymity.