A Review on Effective Interventions for Managing Behaviours of Dementia Patients Admitted in Acute Care Setting

A Review on Effective Interventions for Managing Behaviours of Dementia Patients
Admitted in Acute Care Setting
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A Review on Effective Interventions for Managing Behaviours of Dementia Patients
Admitted in Acute Care Setting
Abstract
Behavior-related symptoms play a fundamental role in the overall assessment of aggression
and agitation behaviors among dementia patients. Dementia patients often face various
problems which affect their daily living in nursing homes. These behaviors have shown to
have a significant effect on their livelihood thus affecting their quality of life at the nursing
care facility homes. This literature study identified effective interventions aimed at improving
and managing the behavior of dementia patients. Using search strategies in various databases
such as CINhal, EMBASE, BMJ and Pubmed with effective inclusion and exclusion criteria
found out 5 key interventions on managing aggressive and agitation behaviors among the
dementia patients in various nursing care facilities. These activities include activity based,
distraction based interventions, caregiving activities, and nonpharmacological interventions
activities were found to have a significant effect on managing behavioral aspects of
aggression and agitation among dementia patients. These interventions, however, did not
offer a convincing level of evidence, but its implementation and trails have shown a
significant effect in reduced levels of negative behavior among dementia patients in acute
care settings.
Introduction
Behavioral and psychological symptoms associated with dementia have been shown to
increase various symptoms such as agitation, aggression, depression, and apathy. These
factors are common and multifactor often emanating from dementia patients in a care facility
and lead to the complex state of the severity of dementia and environment in which they are
in (Liu, Lewis & Lewis, 2013, pp.156-158).
Dementia patients have been shown to have difficulties in processing and responding to
stimuli thin their environment. These challenges often result in the deterioration of their
effective cognitive behavior and functional ability. Dementia individuals have the ability to
exhibit behavior which can be described at baseline as anxious or dysfunctional behavior, the
behavior often dependents on the perceived environment and the stage in which they live in
(Husebo et al., (2014).

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The baseline behavior often entails a general clam state where the function of the individuals
is able to live within the limits of cognitive management. Anxious behaviour often develop
when the older persons when there is excess stimuli in their environment or an present of
dysfunctional behaviours such as being aggressive or verbal (Wharton & Ford, 2014, p.465).
Chen et al., (2015), among 6 groups of stressors which accelerate the underlying transition
from baseline to an anxious and often dysfunctional state. These stressors have been
investigating and include fatigue, environment changes, anger, medication, changes in daily
routine, perception loss and physical changes such as pain or medication intake. The stressors
make an individual to become anxious and be stressed forcing dysfunctional behavior. With
time the disease progresses and the ability of the individual is compromised on their ability to
cope, thus triggering dysfunctional behavioral patterns. With time as the disease progresses
the ability of an individual tends to cope easily and able to adjust to the stressors available
which may diminish progressively.
The baseline behaviors decrease consequential disruptive behavior being. With time the
disease has shown progression. The decrease in behaviors has shown to have an effect on
adaption and understanding of the stimuli. Often interventions which decrease environmental
stimuli and individual stressors are stress which is reduced and promote appropriate behavior,
(Johansson et al., 2013).
In acute care environments, exposures of the environment which are familiar have a
significant role in behavior patterns. These environments do not offer comfort and calm. The
constants disturbance emanating from equipment being moved, visitors and health care staff
moving around and unfamiliar staff can have significant either positive or negative on
behavior, the patients are often exposed to changes in their daily routine on their social and
periods of activity tend to fluctuate immensely between overstimulation and deprived
sensory. Patients with dementia have been shown to have difficulties in adapting to the
environment and often encounter significant level of stress. The stress can be exhibited on
behavior patterns which are disruptive and challenging in the acute care setting. The health
care nursing and health care officials are often not aware of the excessive stimuli being
received by the patient (Hazelholg et al., 2016, p510).
Critical assessment of the environment in which patients lives have been shown to have a
significant in identify various factors which contribute to stress and need urgent modification
for future care. limited understanding of the behavioral outbursts in the population level has

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been shown to have inappropriate care and frustration for the patient and the health care stuff
in acute settings which contribute to physical restraints an and frustrations (Fauth, Femia &
Zarit, 2016). Most of the time, nurse often receive restrain while enhancing the patients are
kept in a stimulating environment thus increasing the stress level of the patients and thus
being at high risk for injury.
The roles of health care staff have often been put at stake. In many nursing homes and acute
care settings, such as those in the UK, about 5% of the staff located in acute care settings
receive training on dementia care and a third of this had a general feeling that the training
was not at enough at all (Achterberg et al., 2013). Many health care staff lacks the skills to
perform work with confused or unstable patients (Cipriani et al., 2014). In a randomized
controlled trial finding, a specialist for inpatient ward for people with dementia did not
positive any role in helping the patients to cope up with the diseases (Husebo et al., 2014).
Studies have shown that nonpharmacological approaches have been employed managing
interventions and indicate a decrease in behavioral anxious behavior and improve the well
being of the care (Sandvik et al., 2014, pp.1492-1496.). Nonpharmacological intervention has
been used as an alternative in the management of the adverse behavioral observed in the care
homes. The use of antipsychotics as a pharmacological treatment is often employed before
application of nonpharmacological options.
With this overview, acute care settings tend to have an impact on aggressive behaviors
among dementia patients. Various intervention have been employed in managing the stressful
situations, however, none have been established as effective strategic intervention observed
to reduce the aggressive behavior patterns. In a preview of this, this systematic review
endeavors to analyze qualitatively effective interventions which are key in reducing the
aggressive behavior. Thus this stud will come with effective interventions to curb these
behavioral patterns of behavior among the in older persons in acute care settings.
PICO strategy
The research question was framed using PICO strategy. Evidence-based practices use a
process pathway in framing the questions, locating, its assessment and evaluation. This stud
employed the following key terms in framing the question:
Question: What are the effective interventions to manage behaviors of dementia patients