Agitated - Older Nursing Home Patients - YouTube.mov

Summary

This script explores the challenges of managing agitation in elderly nursing home residents with dementia. It emphasizes three key principles: anticipate behaviors, tolerate abnormal actions, and avoid further agitation. Through various vignettes, it demonstrates how professionals can creatively and patiently address these situations, often requiring trial and error to find effective solutions that promote calm and understanding for both residents and caregivers.

Takeaways

• 😖 Agitation in elderly individuals, especially those with dementia, can be challenging and potentially dangerous for both the person and caregivers.
• 🔮 The three guiding principles for managing agitation are: anticipate, tolerate, and don't agitate.
• 👵 Anticipation involves recognizing common behaviors among dementia patients and preparing for them to prevent agitation.
• 🤔 Tolerance requires accepting behaviors that are not normal but are common in dementia patients, which can help maintain calm for both the caregiver and the patient.
• 🧐 Understanding the patient's perception as their reality is crucial, as reorientation may not always be helpful and could exacerbate agitation.
• 👨‍⚕️ Caregivers should approach situations with creativity, trial and error, and patience when finding solutions to agitation.
• 🍽️ Routine is important for residents, and disruptions can cause agitation; recognizing and respecting this can help avoid conflicts.
• 🌿 Visual spatial defects in dementia patients can lead to misunderstandings, such as mistaking a planter for a toilet, which caregivers should be aware of.
• 🏠 When residents express a desire to go home, it's important to understand their perception and reality, and to approach the situation with empathy and creativity.
• 📞 Communication techniques, such as asking for a resident's name or involving family members, can help diffuse agitation and provide comfort.
• 👂 Listening and responding to a resident's concerns with patience and understanding can lead to more effective solutions for agitation.
• 👨‍🦳 Fluctuating moods in elderly residents can be managed with a calm and positive approach, even when the resident is already agitated.

Q & A

What are the three guiding principles for managing agitation in elderly care settings as mentioned in the script?

The three guiding principles are anticipate, tolerate, and don't agitate. Anticipate certain behaviors common among residents with dementia, tolerate behaviors that are not normal to remain calm, and avoid actions that may further agitate the elderly person.

Why is it important to anticipate behaviors in elderly care?

Anticipating behaviors can help caregivers avoid episodes of agitation by understanding and preparing for common actions and reactions among residents with dementia.

What does the script suggest about tolerating behaviors that are not normal?

Tolerating abnormal behaviors can allow caregivers to remain calm and assist the resident in staying calm as well, and it may provide clues to the underlying causes of agitation.

How does the script illustrate the principle of not agitating further?

The script shows that understanding the resident's perception as their reality, such as not forcing reorientation on a confused person, can help in reducing agitation.

What is the situation with Mrs. Williams at lunchtime in the nursing home?

Mrs. Williams is agitated because she believes her lunch has been taken away. The nurse resolves the situation by recognizing Mrs. Williams' routine and seating preferences and addressing them accordingly.

What is the issue with Mr. Jackson's behavior in the script?

Mr. Jackson, who has early onset Alzheimer's, is agitated and acting inappropriately, likely because he cannot find the bathroom and is unable to communicate his needs.

How does the nurse handle Mr. Jackson's agitation in the second vignette?

The nurse in the second vignette calmly tolerates Mr. Jackson's behavior, avoids getting angry, and asks for assistance to take him back to his room, demonstrating patience and understanding.

What is the main challenge for Mrs. Owens in the script?

Mrs. Owens, who has Alzheimer's dementia, is agitated because she wants to go home and believes she is in a hospital. She is also struggling with the recent move to the nursing home.

How does the doctor and nurse approach Mrs. Owens' agitation in the last vignette?

The doctor and nurse approach Mrs. Owens' agitation by acknowledging her feelings, using calming techniques like the stethoscope, and redirecting her focus to something positive, like a photo album of her family.

What is the issue with Mrs. Mahoney's interaction with the nurse in the script?

Mrs. Mahoney, who has had a stroke affecting her visual fields, is startled because the nurse approached her from her blind side, causing her agitation.

How does the nurse in the script handle Mr. Sherman's agitation about calling his daughter?

The nurse initially tries to calm Mr. Sherman by offering a snack and changing the subject. When that doesn't work, she allows him to use the phone to call his daughter, demonstrating flexibility and understanding of his needs.

Outlines

00:00

😖 Managing Agitation in Elderly Care

The video script addresses the challenge of agitation among elderly patients, particularly those with dementia, in nursing homes. It introduces three key principles for managing such situations: anticipate, tolerate, and don't agitate. The script uses a scenario with Mrs. Williams to illustrate these principles, emphasizing the importance of understanding and respecting the resident's perception of reality. The video also highlights the need for creativity, trial and error, and patience when finding solutions to agitation.

05:03

🤔 Creative Solutions for Agitated Behaviors

This paragraph explores various ways to handle agitated behaviors in elderly patients with dementia, focusing on Mr. Jackson who has early onset Alzheimer's. The script presents different vignettes showing how calm tolerance, anticipation, and understanding the patient's reality can lead to effective solutions. It emphasizes the importance of not forcing reorientation if it's not effective and suggests that getting into the patient's world can help in managing their agitation.

10:05

🏥 Dealing with the Desire to Go Home in Dementia Patients

The script presents a scenario involving Mrs. Owens, an 84-year-old Alzheimer's patient who wants to go home. It discusses the agitation that can arise from her perception of being in a hospital and the importance of understanding her reality. The video suggests techniques such as reorienting the conversation, using a calm demeanor, and offering alternatives like a phone call to her daughter to alleviate her distress.

15:08

🤗 Techniques for Calming Agitated Patients

The video script continues with examples of how to approach agitated patients, such as Mrs. Mahoney who has had a stroke affecting her visual fields. It points out the mistake of approaching from her blind side and suggests maintaining calm, using simple language, and offering honest but hopeful responses. The script also includes a scenario with Mr. Sherman, who is fixated on calling his daughter, and how offering alternatives and involving family members can be part of a solution.

20:08

🔄 Adaptability in Elderly Care Solutions

The final paragraph emphasizes the importance of adaptability and creativity in finding solutions for agitated elderly patients. It suggests that what works one day might not work the next and encourages the use of new techniques. The script concludes by reinforcing the need for patience and the willingness to try different approaches to address the unique needs of each patient.

Keywords

💡Agitation

Agitation refers to a state of increased anxiety, irritability, or restlessness, often observed in individuals with dementia or other cognitive impairments. In the video, agitation is a central theme, as it is portrayed as a common and challenging behavior among elderly residents in nursing homes. The script describes how various situations can lead to agitation and emphasizes the importance of managing it carefully to ensure the well-being of both the residents and the caregivers.

💡Dementia

Dementia is a general term for a decline in cognitive ability severe enough to interfere with daily life. It is a key concept in the video, as the residents depicted are living with dementia, which influences their behaviors and reactions. The script uses scenarios involving residents with dementia to illustrate the unique challenges faced in caring for this population and the need for specialized approaches to manage their agitation.

💡Anticipate

To anticipate in the context of the video means to predict or expect certain behaviors or actions, particularly among residents with dementia. The script highlights anticipation as one of the three guiding principles for managing agitation. It is used to illustrate how understanding common behaviors can help caregivers avoid or defuse situations that may lead to agitation.

💡Tolerate

Tolerance, as discussed in the video, involves accepting and remaining calm in the face of behaviors that are not typical or normal, especially those exhibited by individuals with dementia. The script emphasizes the importance of tolerating such behaviors as a means to maintain calmness and observe clues that may indicate the cause of agitation, thus allowing for more effective care strategies.

💡Don't Agitate

The principle of 'don't agitate' suggests avoiding actions or behaviors that could increase the agitation of a resident with dementia. The video script uses this concept to guide caregivers towards understanding the resident's perception of reality and adapting their responses accordingly, rather than imposing standard norms that may not apply to the individual's unique situation.

💡Creativity

Creativity in the video is presented as a crucial element in finding solutions to manage agitation among residents. It is highlighted as a means to devise unique and tailored approaches that can effectively address the individual needs and perceptions of each resident, as seen in the various vignettes where caregivers use creative methods to calm or redirect agitated individuals.

💡Trial and Error

Trial and error is a method of problem-solving in which various solutions are attempted until an effective one is found. The video script mentions this concept as part of the process of finding solutions to agitation, emphasizing that patience and the willingness to experiment with different approaches are necessary for successful care in nursing home settings.

💡Reality Perception

Reality perception, as discussed in the video, refers to how individuals with dementia interpret their surroundings and experiences, which may differ significantly from objective reality. The script uses this concept to illustrate the importance of understanding and respecting the resident's perspective, as it can provide insights into the causes of agitation and guide more effective care strategies.

💡Nursing Home

A nursing home is a residential care facility that provides professional nursing care for elderly individuals who require assistance with daily activities. The video script is set in a nursing home, using it as the backdrop for exploring the challenges of managing agitation among residents and the strategies that caregivers can employ to address these challenges.

💡Reorientation

Reorientation is a common technique used in caregiving to help individuals with cognitive impairments recall or understand their current situation. However, the video script points out that reorientation may not always be effective or appropriate, particularly when dealing with residents with advanced dementia, and suggests that alternative approaches that respect the resident's current perception may be more beneficial.

Highlights

Introduction of professional actors to demonstrate common situations related to agitation in elderly care.

Three guiding principles for managing agitation: anticipate, tolerate, and don't agitate.

Importance of understanding that agitation behaviors in dementia are common, not normal.

The value of anticipating behaviors to avoid agitation episodes in nursing home residents.

Tolerance as a method to remain calm and observe behaviors that may indicate the cause of agitation.

The challenge of not agitating further and understanding the reality of the elderly person's perception.

Practical example of Mrs. Williams' agitation due to routine disruption and its resolution.

The necessity of creativity, trial and error, and patience in finding solutions for agitation.

Different approaches to handling Mr. Jackson's agitation due to early onset Alzheimer's.

The significance of understanding the patient's reality in reducing agitation, as seen with Mr. Jackson.

Scenario of Mrs. Owens wanting to go home and the importance of addressing her agitation with empathy.

The role of reorientation and its limitations when dealing with agitated elderly patients.

The effectiveness of meeting the patient in their world to understand their perception and reduce agitation.

Mrs. Mahoney's case study illustrating the impact of stroke on perception and agitation.

The importance of approaching patients from their aware side to avoid startling them.

Mr. Sherman's fluctuating mood and the challenge of managing his agitation for calling his daughter.

The need for involving family members in managing agitation and the potential of creative solutions.

The reminder that effective techniques may vary and require continuous adaptation for different situations.

Transcripts

welcome the people you see behind me are

professional actors they're about to

doctors and nurses and some of the most

common situations related to the topic

of agitation as many of you know these

situations which older persons are

they're becoming agitated or are already

agitated can be frustrating

time-consuming and even dangerous to

them and those who care for them you are

also about to see possible solutions

there are three guiding principles when

trying to manage these situations

anticipate tolerate and don't agitate

anticipate certain behaviors and actions

are common not normal but common among

nursing home residents with dementia

being able to anticipate these behaviors

and actions may help you avoid an

episode of agitation tolerate this one's

tough but if we can tolerate behaviors

and actions that are not normal this may

allow us to remain calm and help our

resident remain calm when we tolerate

behaviors it also allows us to observe

some of these behaviors that may give us

clues as to what is causing the

agitation don't agitate perhaps the most

difficult of the three principles in

health care we've learned standards and

norms that may not always apply to the

older person with dementia

for example reorientation may not always

help a confused older person it may be

better to try and understand what the

resident is perceiving in their world

for perception is their reality this may

help lessen the agitation finally when

trying to implement any of these three

principles for a given situation

keep in mind finding solutions often

involves creativity trial and error and

a lot of patience

it's lunchtime in the nursing home mrs.

Williams who is in the background pacing

has lived here for over a year

mrs. Johnson who is sitting at this

table has only lived here a week my

lunch no this isn't my lunch no this is

my lunch I want to eat lunch my lawn

don't touch me

go get your own lunch how long you want

mrs. Williams my lunch my lord this is

her lunch help me my lunch help me I'll

get your lunch just wait here don't

touch me I want to eat now

I'll get your lunch what would you like

let's stop and analyze the situation

what's the problem is mrs. Williams

the problem is this one of those

behavioral problems is she anxious is

she depressed does she have a UTI the

answer is probably something quite

different what does she mean when she

says my lunch my lunch my lunch place

remember she's lived here for over a

year

routine is very important to her if the

nurse had remembered this she might have

been able to defuse the situation let's

see if this works

hello mrs. Williams are you ready for

lunch

hungry Mallos can't eat lunch

mrs. Johnson this is mrs. Williams could

I ask you to move over to this chair I'm

sitting here well I know if I could ask

you to move over to this chair I'll be

your chair i sat here first I know that

this chair is mrs. Williams it's very

important to her this chair view will be

yours and mrs. Williams can sit in hers

and we can all have lunch my lunch

I'll get you lunch that was a good

solution and the nurse did a good job of

anticipating a potential problem but not

everybody was happy at the end let's

look at the same vignette with yet one

more possible solution

hello mrs. Williams are you ready for

lunch

hungry time for lunch mrs. Johnson

this is mrs. Williams mrs. Williams has

been with us for over a year you two

aren't to have lunch together today my

lunch

I'll get your lunch the solution in the

last vignette took a proactive nurse she

also used creativity and anticipation

did you notice as she introduced each

resident to each other that she slid the

lunch tray to the other seat there are

many solutions to a situation like this

the key here was creative anticipation

you

the next three vignettes are about mr.

Jackson mr. Jackson is only 72 years old

he has early onset Alzheimer's he has

been in three nursing homes in the past

three months let's see why hello mr.

Jackson you ready for a nice lunch today

look yes Oh mr. Jackson mr. Jackson

what a mess Bob will you help me please

mr. Jackson can you mr. Jackson look you

you can't do this here in public okay we

just can't do it you can't be in a plant

okay please

nope let's go no look yes of course

let's go how can we have handled the

first situation why was mr. Jackson more

agitated

was there a way to tolerate his behavior

let's see hello mr. Jackson ready for a

nice lunch today

lunch is

Oh mr. Jackson think let me help you out

here okay Bob uh can you take mr.

Jackson back to his room please

sure mr. Jackson come with me lunch

we'll be right back we'll be right back

so in the second vignette we saw the

solution was calm

Toleration now let's see the nurse use

anticipation hello mr. Jackson you ready

for a nice lunch today look yes mr.

Jackson are you ready for lunch

Bob mr. Jackson is ready for lunch would

you help him please

absolutely mr. Jackson come with me

nurse Bob reacted in this first vignette

like many of us might he got angry

however in the second and third vignette

he stays calm he also kept his language

calm and simple he did not try to get

mr. Jackson to stop the behavior or

teach him that it was wrong remember mr.

Jackson has dementia at a stage that

probably prevents him from understanding

this lastly it is important to ask the

question why is mr. Jackson doing this

well he probably can't tell us but if we

were to get into his world his reality

we would probably realize that he

couldn't find the bathroom and he

couldn't ask anyone where it was we also

might realize that as we know patients

with dementia have visual spatial

defects he saw the round planter as a

toilet so keep in mind the basic

principles tolerate anticipate and don't

agitate

you

what happens when a resident in a

nursing home wants to go home our main

character in this scenario is mrs. Owens

she's 84 years old and has Alzheimer's

dementia her daughter recently moved her

to this nursing home the setting is this

it's early evening there happens to be a

doctor at the nurse's station but the

doctor is not mrs. Owens is doctor let's

see what happens when miss Owens arrives

at the nurse's station can you help me

what is it I want to go home you want to

go home

yes I don't like this hospital I want to

go home well you can't

and this isn't the hospital oh you don't

fool me

I'm not sick anyway what am I on the

hospital and this is a nursing home no

it's not I want to call my daughter of

course what's her number what her number

ma'am your daughter what's her number

it's sum is it what can I go home tell

you what you give me that number and

I'll I'll call your daughter before we

get to a possible solution for this

situation let's just focus on the

agitation what was agitating mrs. Owens

before you say well it was just the mood

of the doctor and the nurse let's look

at one thing that the doctor did and the

nurse did first the doctor something we

always all of us have learned

reorientation if you reorient someone

and it doesn't work don't keep doing it

the nurse what did he do he asked her a

simple question what's your daughter's

phone number without knowing it he

probably challenged her by asking that

short-term memory question so let's look

at the scenario again where the doctor

and the nurse their mood might not

change but how they approach the

situation they're getting one step

closer to mrs. Owens perception of

what's going on I don't like this

hospital

of course you don't ma'am nobody likes

being in the hospital that's right I

want to call my daughter

okay you can do that my daughter I must

talk to her name is Jane right yes

J that's my daughter okay I'll get her

number for you come on over here we go

hello Jane

yeah this is the nurse that takes care

of your mom as you know she doesn't

really like being in the hospital she

was wondering if she could talk to you

she really wants to come home okay here

she is hi Jane I want to come home I

don't like this hospital oh you can't

come give me why not oh the doctor

thinks I should stay well well I'm not

sick well I guess I am feeling a little

better oh you can you can come get me

tomorrow

okay well I guess I see you tomorrow

although this type of creativity might

seem like your trick in the resident

let's look at it from a different

perspective trying to understand where

your resident is and what their

perception of the situation is may help

you meet that person in their world at

that moment remember mrs. Owens

perception that she's in the hospital is

her reality anything that might refute

that may not only be scary to her but it

could cause agitation on the other hand

trying to get a little bit into her

reality whether it's with words mood or

action could help you find the solution

you need for that certain situation

let's see this time how our doctor and

nurse perform I don't like this hospital

of course you don't dear no one likes to

be in the hospital that's right I want

to go home I'm afraid I don't know you

ma'am I don't like this hospital I want

to go home I understand ma'am what's

your name I'm Barbara Owens so mrs.

Owens I'm dr. Simmons

how have you been feeling okay I guess

how about we just take a look and make

sure everything's okay all right okay

well everything sounds okay okay but I

still want to go home

I understand want to see my

grandchildren I understand tell you what

let me see if I can help you out how

about we get your nurse okay mrs. Owens

I hear you're feeling a lot better you

know I'm very proud of you you know that

your therapy is going really well I have

an idea why don't we go for a walk oh

well I'm gonna do that yeah good deal

you know what we can do we can take a

look at that photo album of yours that

you like so much with all your family in

there and if I'm not mistaken you're a

grandmother aren't you yes my pitch the

doctor a nurse in this last vignette

demonstrates some good techniques that

might be useful in some similar

situations for example the doctor starts

out by asking mrs. Owens water name is

this diffuses the agitation right off

the bat then the doctor came around the

nurse's station to interact with her

face-to-face and she used the doctors

secret weapon for calming patients the

stethoscope while offering to help

notice all this took the doctor less

than a minute the nurse he was calm and

positive but not so positive as to

increase mrs. Owens to stress finally he

changes the subject to take her mind off

the reason for her distress now not

every technique will work in every

situation for example the stethoscope it

can frighten an agitated patient if they

don't understand what it is keep in mind

we are showing you some of these

techniques to help you develop your own

creative techniques so you can help your

patient in these situations

in this situation our resident is mrs.

Mahoney

mrs. Mahoney has lived in the nursing

home for three years ever since her

stroke

it's important to know that mrs.

Mahoney's stroke was in the right side

of her brain which affects the left side

of her body on any given day mrs.

Mahoney likes to go to the nurses desk

after breakfast to talk with the nurses

however today the nurse is quite busy

let's see what happens

hello Gayle hello Gayle have you seen my

daughter

hello mrs. Mahoney um I'm really busy

right now

okay uh my daughter I I don't know where

she is

have you seen her no I don't know where

she's at

I'm sorry a Gail have you seen my

daughter I don't know where she is

hello mrs. Mahoney oh why don't you come

with me we'll go back to your room okay

why I'm just trying to help I'm okay I'm

okay so what went wrong here remember

mrs. Mahoney's had a stroke on the right

side of her brain which not only affects

the left side of her body but affects

her visual fields she has what's called

a left-sided neglect she has a blind

side the nurse approached her from her

blind side no wonder she's startled

let's see how we could have done it

Kayle Kayle do you know where my

daughter is my I've been looking

everywhere

I can't fucq turn I sure don't duck

Alice could you help me over here I can

help you mrs. Mahoney oh that's sweet

dear but do you know where my daughter

is

I I don't but I can sure try to help

pink everywhere for her I can't find

a few final points did you notice how

the nurse the busy nurse maintained her

calm while trying to bring Alice around

to miss Mahoney's right side and Alice

did you notice how few words Alice used

did you notice how Alice approached Miss

Mahoney and had her attention before she

spoke with him and when Miss Mahoney

asks again where's my daughter Alice

gives an honest but hopeful answer I

don't know but I can sure try to help

mr. chairman is 82 years old on any

given day his mood can fluctuate between

happy-go-lucky and angry and demanding

recently he's been fixated on calling

his daughter every day the situation

today though is a little bit more

challenging because when he approaches

the nurse's station

he's already agitated good news mr.

Sherman I want to call my daughter I

don't think there would be such a good

idea I don't think your daughter wants

you to call every day would you talk to

my daughter

I can't let you use this phone give me

the phone I want to talk to my daughter

she needs to hear from me

I'm sorry mr. Sherman I'm really busy

and I'm sure your daughter understands

that you're being well taken care of and

I'm sure she'll call you in a few days

now I want to talk to my daughter

do you blame this nurse for being upset

it would take a very patient nurse to

tolerate this behavior and come up with

the solution to keep mr. Sherman calm

let's see I want to call my daughter

what we call my daughter now okay

here you go mr. Sherman you can use this

phone

do you need some help number but it's I

don't reap me I don't remember

maybe this will help

yes she wants to hear from me assure me

Stan mr. Sherman are you hungry

what do you say we we come back to this

a little later we'll go get you a snack

sir yeah okay okay

although this situation turned out fine

a couple points to remember in a

solution like this sometimes you're

going to have to involve the daughter

the second point to remember is even if

something worked today it may or may not

work tomorrow but don't be afraid to try

new techniques new creative ideas to

find that solution you need

you

you