This presentation discusses comfort-focused behavior management for people with dementia. It begins by outlining the session objectives and noting that human behavior and communication are connected. Two common dementia behaviors are identified as resisting care and refusing medication. The presentation then explores what these behaviors may be communicating, such as pain, fear, or not wanting to complete a task. It suggests remedies for addressing the underlying causes, like pain medication, slowing down interactions, or identifying personal routines. Overall, the presentation emphasizes making comfort the primary goal and observing behaviors for clues about an individual's needs and state of mind.

1. Comfort-focused
Behavior Management
Tena Alonzo, MA
Director of Research
Co-director Palliative Care for Advanced Dementia
Beatitudes Campus

2. Session Objectives
1. Describe and discuss the connection between
human behavior and communication
2. Identify two types of dementia-specific behavior
that can occur
3. Compare and contrast at least two types of
remedies that can be used to decrease/eliminate
resistance to care
4. Describe the importance of making comfort the
goal of everything that we do

3. What dementia-specific
behaviors do you see?

4. Facts about Human Behavior
 We begin to develop individual patterns of behavior at
birth
 Generally we know what others mean by listening to
what they say and watching what they do
 In the absence of verbal communication we possess the
ability to understand what others are communicating
 If we lose the ability to speak our actions become the
way we can communicate

5. How dementia impacts human
behavior-Moderate Dementia
 Difficulty with short and long –
term memory. Struggles to
learn new things
 Difficulties with understanding
and being understood
 Knows comfort and discomfort
 Can’t self regulate emotions
 Often easily upset or frustrated
 Can become fearful
 May misinterpret the actions
of others

6. How dementia impacts human
behavior-Advanced Dementia
 Limited/no short and long-term
memory-often lives in the
moment
 Can’t learn new information or
pick up new routines
 Unable to carry on meaningful
conversation
 May appear withdrawn and
can have difficulty interacting
or responding to surroundings

7. The great myth…
“Dementia and challenging
behavior go together-there
really isn’t anything that can
be done about it!”

8. Recognizing Strength
 The five senses are not adversely impacted by dementia
 During the dementia process the five senses continue to
carry information from the world into our brain
 The information from the five senses can create positive
or negative responses with our emotions
 People with dementia know when they’re comfortable
and when they are not
 Human actions/behavior are a legitimate form of
communication that gives us insight into a person needs

9. Common dementia-specific
behaviors
 Resists care
 Refuses medication
 Irritable or aggressive
 Delusional-believes things that aren’t
factual
 Tries to rise without assistance

10. Resists care/service road map
Dementia-specific What is the person Possible remedies
behavior communicating?
Resists care/service Physical pain Pain medication,
repositioning , bed rest,
ambulation
Fearful Slow down, soft
approach, back off,
Don’t reason or confront
Doesn’t want to Identify personal
routine, back off

11. Refuses medication road map
Dementia-specific What is the person Possible remedies
behavior communicating?
Refuses to take Tastes bad or has Give with food or fluids
medication trouble with consistency
Scared by the Slow down, soft
experience approach, don’t confront
or reason
Doesn’t think they need Have another staff
it or they are being member try, re approach
poisoned later, don’t reason or
confront

12. Irritable or aggressive road map
Dementia-specific What is the person Possible remedies
behavior communicating?
Irritable or aggressive Physical pain Pain medication,
repositioning , bed rest,
ambulation
Hungry/thirsty Give food and fluid-
preferably soft & sweet
Acute illness/delirium Screen for illness and
treat according to
advanced directive

13. Delusional road map
Dementia-specific What is the person Possible remedies
behavior communicating?
Believes/sees/hears This is real to me Validate the belief and
things that are not real distract using at lease
one of the 5 senses
Acute illness/delirium Screen for illness and
treat according to
advanced directive
Physical pain Pain medication,
repositioning , bed rest,
ambulation

14. Tries to rise unassisted road
map
Dementia-specific What is the person Possible remedies
behavior communicating?
Tries to rise Need to use the toilet Escort to bathroom even
unassisted/fall risk if incontinent at times
Physical pain Pain medication,
repositioning , bed rest,
ambulation
Needs to reposition Stand up or ambulate
short distance, assist to
bed, change seating
arrangement

15. Comfort-focused behavior
management tips
1. Make comfort the goal-people who are
comfortable don’t hit, yell, curse or
express other challenges
2. Don’t confront or reason
3. Go slow
4. Validate beliefs
5. Report evidence of physical pain

16. Develop/implement a plan
Comfort-focused behavior management plan
1. Identify the behavior and the possible causes
2. Identify what probably triggered the behavior and
eliminate it
3. Think what would make this person the most
comfortable
4. Ensure your teams know what you know
5. Re evaluate as needed

17. Summary Points
 Human behavior is a valid method of
communication
 All behavior has meaning and if we become
detectives we can identify what it is
 We have the power to reduce dementia-specific
behaviors by adopting a culture that makes
comfort the goal of everything we do

18. Questions & Discussion

19. Thank you!
Contact Information
Tena Alonzo, MA
Director of Research
Beatitudes Campus
talonzo@beatitudescampus.org