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A social interactional model for understanding behavior among people with dementia. Linda J. Garcia, Ph.D. (Ottawa) Jean Kozak, Ph.D. (Vancouver) Michèle Hébert, Ph.D. (Ottawa) Neil Drummond, Ph.D. (Calgary) Jocelyn Charles, M.D. (Toronto). Which behavior?. Physical and verbal aggression

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A social interactional model for understanding behavior among people with dementia

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A social interactional model for understanding behavior among people with dementia

Linda J. Garcia, Ph.D. (Ottawa)

Jean Kozak, Ph.D. (Vancouver)

Michèle Hébert, Ph.D. (Ottawa)

Neil Drummond, Ph.D. (Calgary)

Jocelyn Charles, M.D. (Toronto)

Dementia Net:

Bridging Gaps in Service Provision


Which behavior?

  • Physical and verbal aggression

  • Wandering

  • Suspiciousness/Paranoia

  • Agitation

  • Stereotyped vocalizations or screaming

  • Uncooperative behaviour

Dementia Net:

Bridging Gaps in Service Provision


Recommendations(Day et al., 2000)

  • Small size units Physical

  • Remove non-cognitively impaired Social

  • Offer respite care Social

  • Relocate in units not individually Social

  • Noninstitutional design Physical

  • Moderate levels of environmental stimulation Physical/Social

  • Incorporate higher light levels Physical

  • Use covers over panic bars and door knobs Physical

  • Outdoor areas with therapeutic design features Physical

  • Make toilets more visible Physical

  • Eliminate factors that increase stress in bathing Physical/Social

Dementia Net:

Bridging Gaps in Service Provision


Social Environments

  • May ease the burden of care and help improve quality of life.

  • Notion of place and importance of congruence with that space. (Diaz Moore, 1999)

  • Morgan & Stewart (1999)

    • Optimal stimulation

    • Human Contact

    • Safety and Supervision

    • Individualized Care

    • Flexibility

Dementia Net:

Bridging Gaps in Service Provision


The importance of communication

  • Communication as an avenue to social environments.

  • “Whilst the importance of communication in the care of older people with dementia has been recognised, there has been very little study of the ways in which residents with a cognitive impairment seek each other and socially interact.” (Hubbard et al., 2003, p. 101)

Dementia Net:

Bridging Gaps in Service Provision


Communicating your intention

http://www.mullein-fields.org/

Dementia Net:

Bridging Gaps in Service Provision


Conversation and Dementia

  • Turn taking

  • Repair strategies

  • Topic management

http://www.hc-sc.gc.ca/english/media/photos/index.html

Dementia Net:

Bridging Gaps in Service Provision


Communication as an ability

  • “Literature = use small words, use one-step commands, use appropriate pitch, have little background noise, etc. The literature seldom expands beyond helpful communication hints to include interactive theories or frameworks. ” (Touzinsky, 1998)

  • Communicating one’s intention reflects something much more fundamental than turn taking and analyses of conversational breakdowns. (Goldwaithe, 1997)

Dementia Net:

Bridging Gaps in Service Provision


Goals of communication(Simmons-Mackie & Damico, 1995)

Transactional:

convey information

Interactional:

establish/maintain

interpersonal relationship

http://www.niapublications.org/pubs/portfolio/html/aspects.htm

http://www.hc-sc.gc.ca/english/media/photos/index.html

Dementia Net:

Bridging Gaps in Service Provision


Transactional or Interactional?

  • Which is impaired in dementia?

  • Which should we concentrate on?

  • Whose perspective determines these answers?

http://www.hc-sc.gc.ca/english/media/photos/index.html

Dementia Net:

Bridging Gaps in Service Provision


Communication as a life habit

  • Four social levels on which people communicate: (Verderber, 1984). First two still there in later stages (Kelley 1997).

    • Sheer pleasure of interaction (topic unimportant);

    • To demonstrate ties with other people;

    • Build and maintain relationships; and

    • Define the nature of the relationship – how they stand in the relationship (power and affection).

  • Residents have active conversations when staff not there. (Hubbard et al 2003)

Dementia Net:

Bridging Gaps in Service Provision


Dementia Net:

Bridging Gaps in Service Provision


Dementia Net:

Bridging Gaps in Service Provision


Functional communication

  • How can the person use his environment to achieve his goals?

  • How do the social environmental factors hinder the attainment of his goals?

  • Communication social phenomenon; as a tool for social integration.

  • To intervene, need to isolate the role of the environment

Dementia Net:

Bridging Gaps in Service Provision


Ecological Model of Aging

(Lawton, M.P., & Nahemow, L., 1973)

Positive affect & adaptive behaviour

High

marginal

ZONE OF MAXIMUM PERFORMANCE POTENTIAL

Negative affect & maladaptive behaviour

marginal

ZONE OF MAXIMUM COMFORT

Negative affect & maladaptive behaviour

COMPETENCE

Low

Weak

Strong

ENVIRONMENTAL PRESS

Dementia Net:

Bridging Gaps in Service Provision


Gibbs-Ward & Keller 2005

Dementia Net:

Bridging Gaps in Service Provision


Disability Creation Process :

An explanatory model of the causes and consequences of disease, trauma and other disruptions to a person’s integrity or development.

Risk Factors

Cause

Personal Factors

Environmental Factors

Organic Systems

Capabilities

Integrity Impairment

Ability Disability

Facilitator Obstacle

Interaction

Life Habits

Social Participation Handicap Situation

Dementia Net:

Bridging Gaps in Service Provision

  • RIPPH / SCCIDIH 1998


A picture over time

T1

T2

Tn

  • Model flipped upside down.

  • Individual and social/physical environment.

  • Interactions elements CHANGE over time.

Dementia Net:

Bridging Gaps in Service Provision


INTERACTION

Using the social context to explain behavior

Life Habits

Social interactions – problem behavior

Personal Factors

Environmental Factors

Social context

Organic Systems

Capabilities

Communication and

memory problems

Organizational context

Brain malfunction

Physical context

Risk Factors

Fougeyrollas et al. (1998)

Dementia Net:

Bridging Gaps in Service Provision


Different points of view

Dementia Net:

Bridging Gaps in Service Provision


Conclusions

  • The DCP model can be used to reflect on the impact of social environments and behavior.

  • Must focus on life habits.

  • Look at communication from an interactional perspective.

  • Isolate the environmental factor and deal with this – obstacle to whom?

  • « In conversations where pleasure and interpersonal connectedness are the goal, it is not necessary to « fine-tune » the content. » (Kelley)

  • the Life Habit has been accomplished.

Dementia Net:

Bridging Gaps in Service Provision


References

  • Linda.garcia@uottawa.ca

Dementia Net:

Bridging Gaps in Service Provision


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