Try: #striking out may be related to extreme pain stress fear or anxiety it may reflect changes to the brain caused by trans-ischemic attacks dementia or other conditions when a cr begins striking out it is important to look for possible medical causes for the behavior particularly if it is unusual or new behavior for the cr #striking out puts the cr and any caregivers at risk once a cr strikes out whether or not a caregiver is hit it is important to pay closer attention to any possible signs of distress leading up to the event such as raised tone or defensive body language #whether evaluating one incident or several it is useful to consider what was happening at the time what was the noise level how calm chaotic cluttered or busy was the environment #slow down and stabilize any care process that causes the cr significant anxiety such as bathing transferring or wound care #at the time an incident of striking out occurs see to the immediate safety of the cr and separate the people involved to make sure that both are safe and receive any needed care or counseling #make a plan to prevent or address future incidents consider who you will call for help or how you will change the care provided to try and avoid future incidents #if necessary discuss with the cr’s doctor whether medication may help treating an underlying physical cause or alleviating intense anxiety with medication may be useful

Materials: Physician visit safety plan

Categories: Behavior Challenging, Emotional Psychological, Mobility, Needs Much Assistance, Independence, Maximum Supervision, Cognitive Awareness, Somewhat Aware, Long-Term Memory, So-So L T Memory, Short-Term Memory, So-So S T Memory

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #rule out any medical conditions that are contributing to the problem #accompany the cr on a short walk outdoors or direct the cr to a private area immediately after meals if the cr is particularly gassy after eating #encourage the cr to say excuse me if gas is passed in public #consider a diet aimed at reducing gas this would mean eliminating broccoli cauliflower and beans replacing dairy products with lactose-free versions and cooking vegetables rather than serving them raw #if the cr is able to exercise design a low-impact exercise routine the cr can do in private that involves stretching and bending over from the waist this may encourage the passing of gas in private so that less is eliminated in public #consider an over-the-counter anti-gas tablet to be taken before meals if the problem persists

Materials: Access to a private area outdoors

Categories: Behavior Challenging, Medical Physical, Personal, Mobility, Needs Some Assistance, Independence, Maximum Supervision, Cognitive Awareness, Somewhat Aware

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #a number of products made to discourage nail biting are sold over-the-counter in drug stores after they are applied they leave a bitter taste in the mouth when the Care recipient (cr) starts to bite a nail #men and women may relax and be less likely to bite nails after a manicure do one at home or go out to a salon or spa for a hand soak wax treatment manicure or buff some people will enjoy nail polish and may take better care of fingernails that are newly polished #open cuts and wounds on the fingertips caused by nail biting may raise the cr’s risk of picking up infections encourage frequent hand washing with mild soap

Materials: Nail biting inhibitors clear fingernail polish

Categories: Behavior Challenging, Emotional Psychological, Medical Physical, Gender, Male, Female, Mobility, Needs Some Assistance, Independence, No Supervision, Taste, Good Taste, Cognitive Awareness, Somewhat Aware

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #select a station on the headset the cr will enjoy remember you don’t have to like the music because you won’t hear it #place the headset on the cr’s head with the sound up loud enough for the cr to hear it adjust the volume by checking it on your own ears first making sure the sound isn’t too loud or too low #don’t leave the headset on for more than a half hour at a time to avoid a pressure area or sore from forming under the headpiece or earphones #visit with the cr regardless of the distracting noises when spending social time with the cr remove the headset so the cr can focus on you as much as possible even if the cr can’t focus and you can’t be patient with the cr’s noises for long take a few minutes to remove the headset and let the cr have the chance to hear the sound of your voice or feel the touch of your hand without distraction #often making continual vocal noises is part of a condition causing progressive brain damage as a caregiver anger frustration grief and exhaustion may be close to the surface but don’t allow your feelings to punish the cr who can’t control the behavior

Materials: Headset with built in radio additional batteries

Categories: Behavior Challenging, Mobility, Needs Much Assistance, Immobile, Independence, Maximum Supervision, Hearing, Good Hearing, Poor Verbal Comm, Cognitive Awareness, Somewhat Aware, Unaware

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #a caregiver concerned about food hoarding should be able to describe the hoarding behavior for example the cr keeps leftovers in a dresser drawer versus the cr has bugs in the apartment #in preparing a response to hoarding it is useful to know when the behavior began is it new and perhaps a symptom of dementia or has the cr stockpiled food for decades hoarding food is sometimes a behavior of people who have survived severe deprivation a conversation with family members may be useful ask what behaviors are the same and which have changed #if a caregiver thinks the cr is at risk of falls food poisoning or harm from pests make a call to the closest senior services agency for a home assessment or a call to the cr’s doctor can be made outlining the problem and requesting a mental health evaluation #if hoarding is a symptom of dementia or a psychiatric illness it is possible medication or counseling can decrease the problem #if the cr and the caregiver can negotiate over the hoarding they can make a plan that includes storing food safely and getting rid of outdated food perhaps in exchange for new food #if the cr’s hoarding is part of advanced dementia and involves hiding half-eaten food the caregiver may have to keep an eye out for hiding places cleaning them out when the cr is absent some caregivers suggest giving the cr a clear plastic box with a lid to be used specifically for modified hoarding behaviours if the cr is willing or able to agree to keep individually wrapped foods such as crackers in it negotiating this with a cr will depend on the cr’s mental health and relationship with the caregiver

Materials: Small individually wrapped crackers food items clear shoeboxes medication if helpful a food management plan if helpful a caregiver a home services or senior services assessment

Categories: Behavior Challenging, Cognitive Intellectual, Emotional Psychological, Independence, Maximum Supervision, Cognitive Awareness, Fully Aware, Somewhat Aware, Long-Term Memory, Good L T Memory, So-So L T Memory, Poor L T Memory, Short-Term Memory, Good S T Memory, So-So S T Memory, Poor S T Memory

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: Let the cr know that you understand that the items in the environment clutter are important to him or her you don’t have to share your attitude about the items however make sure the cr knows that he or she is important and that you care help prioritize all of the cr’s items place high priority items in the storage bins the rest of the items go in the garbage can explain to the cr the need to limit the amount of items due to the environment lived in size of house apartment room and so on limit the amount of items to only the two storage bins or whatever is appropriate for the cr’s living situation teach the cr about multi-use items for example a bottle of shampoo with conditioner already in it may take up less space than a bottle of shampoo and a bottle of conditioner set a regular to work with the cr on managing clutter always be respectful of the cr’s feelings about his or her items remove garbage quickly before the cr can act on regrets and begin removing things from the trash if necessary remove trash and dispose of it elsewhere so the cr cannot retrieve it

Materials: Two eighteen-gallon storage bins garbage can

Categories: Behavior Challenging, Communication, Emotional Psychological, Maintenance, Social, Some Supervision

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: When preparing dried beans soak them overnight rinsing the soak water off before cooking them when preparing canned beans drain liquids from the can and consider rinsing the beans otherwise the water in the can will add to the carbohydrate content of the dish or meal include high-fiber foods in every day’s meals aiming for five full cups of fruits of vegetables daily of those five full cups make most vegetables and limit beans to only half a cup vary the kinds of fruits and vegetables served by preparing and re-measuring half-cup servings of a several different fruits and vegetables peel and cook vegetables that cause gas for many people this includes beans carrots broccoli cauliflower bell peppers etc try using ginger or tumeric to flavor foods some people find these spices reduce post-meal gas aid the body in moving food through the digestive system by daily walking swimming or stretching to prevent gas from food that might cause it take a dose of an over-the-counter gas preventive these are available in drug stores pharmacies and many grocery stores

Materials: High fiber foods such as fruit vegetables and beans vegetable peeler daily walk or other exercise over-the-counter gas preventative sold in drug stores

Categories: Behavior Challenging, Medical Physical, Personal

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #don’t argue with the cr arguing will just lead to more agitation #it is possible the cr can’t find a particular item because he or she hid it to keep it safe and then forgot the hiding place #keep or make duplicates of personal items such as glasses grooming utensils purses and favorite photos and any other item that are usually hidden #offer to help hunt for the item and validate the cr’s frustration at not being able to find it

Materials: n/a

Categories: Behavior Challenging, Communication, Emotional Psychological, Mobility, Needs Some Assistance, Independence, Some Supervision, Long-Term Memory, So-So L T Memory

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #when picking places to go out consider ones familiar to the cr where the cr is perhaps already known and understood by staff volunteers or others and where the cr may be able to call on past habits to reinforce appropriate behavior #when planning a trip to a new place call ahead of time and see what kind of environment the cr will be entering is the place so chaotic the cr’s difficult behavior will be triggered is the place so quiet the cr’s odd behavior might be particularly noted is there a quiet space if the cr needs a break from a tour concert or meal is there an easy way to exit if the cr feels overwhelmed #when odd behavior begins remember that the cr’s behavior is not something the caregiver has to be ashamed of it is a symptom to be managed as best as possible by the cr and the caregiver #do not try to hold a cr against his or her will in any setting if the cr wants to leave and the caregiver can safely manage a departure it is wise to do so an exception would be a medical setting where there may be legal and insurance-related consequences to leaving against medical advice #a caregiver who knows in advance what kinds of inappropriate behavior a cr is likely to show loudness inappropriate touching paranoid accusations etc can make a plan in advance and discuss it with the cr the plan should outline without judgment what will happen under certain conditions and it can be framed lovingly for example i know that sometimes you believe other people are trying to hurt you when we are out i don’t want people to hurt you if someone tries to hurt you we will leave does that sound like a good plan to you #if the cr later makes a public accusation the caregiver can say we are going to leave remember we discussed this and we agreed we would leave if someone tried to hurt you similarly nonjudgmental language can be used to explain that the cr must leave the setting if he or she is going to be loud or touch him or herself inappropriately we are leaving because we agreed that if you were loud we would go where it is ok to be loud it’s not ok here we agreed on that before we came so we are going to leave now

Materials: List of places familiar to cr and caregiver information about destination before arriving caregiver who will informally rehearse appropriate behavior plan for responding to prolonged inappropriate behavior

Categories: Behavior Challenging, Mobility, Needs Some Assistance, Independence, Some Supervision, Verbal Communication, Good Verbal Comm, Cognitive Awareness, Somewhat Aware, Long-Term Memory, So-So L T Memory, Short-Term Memory, So-So S T Memory

Information: n/a

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed

Try: #make a plan related to day care and post it in the cr’s house where it is easily seen the plan should include the schedule of days and times the cr will attend as well as the times the cr needs to be ready to leave the house to attend if more than one person is assisting in transportation write down the name of the person or service providing the ride each day include on the plan any meals or snacks the cr will have while at the program and the time the cr will be picked up from the program #make two copies of the plan and give one to the supervisor of the program and one to the cr #help a cr get comfortable with attending adult day care by attending the program with the cr for the first several visits staying with the cr for less time each visit #consider having the cr attend for short periods of time for the first week gradually increasing the length of time the cr stays #if the cr asks repetitive questions gently remind the cr of the plan for the day today you are eating lunch here and your spouse son ride is coming at 2 00 p m to take you home #if the plan is too much for the cr to understand make sure it is shared with caregivers and staff so all of them can provide consistent answers to the cr #consider having a staff member write on a card the name of the caregiver providing a ride home and the time the person is expected to arrive at the program and give the card to the cr to hold and refer to when episodes of asking questions about leaving begin #make sure the card matches the correct

Materials: Plan consistent caregiving paper pen

Categories: Behavior Challenging, Cognitive Intellectual, Emotional Psychological, Independence, Some Supervision, Maximum Supervision, Vision, Good Vision, So-So Vision, Cognitive Awareness, Somewhat Aware, Long-Term Memory, So-So L T Memory, Short-Term Memory, So-So S T Memory

Information: For each day #be patient and continue to offer verbal reassurance and distraction information

References: n/a

Keywords: n/a

*This information is listed as a Tip and is not explicitly medically licensed