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Behavior Management - Antecedent Strategies

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Several variations of antecedent strategies have been used in nursing homes and community settings. Strategies that have been researched include altering the general physical and/or social environment of elders, teaching communication skills to caregivers, and providing auditory stimulation for elders.

Early work in this area emphasized altering the physical environment in nursing homes to reduce disorientation, provide sensory stimulus variation, and increase social interaction. Disorientation, understimulation, and infrequent social interaction contribute to problem behaviors such as repetitive questions and wandering, as well as to psychopathologies such as depression and anxiety. Procedures for altering the physical environment include creating a more homelike environment and constructing environments that reduce unnecessary environmental stimuli while providing adequate variation of sensory stimuli. Planned environments consisting of a very large central area with bedrooms on the periphery (to reduce disorientation), individualized personal areas, and soothing colors have been used effectively for increasing interest in the environment and increasing the frequency of pleasurable activities, such as reading. With the specific goal of increasing social interaction, other effective antecedent strategies include rearranging furniture; adding plants, pictures, and other decorations; providing conversational partners such as peers, children, or pets; and offering group activities. Another antecedent strategy to promote social interaction is the use of communication books. These handheld books contain pictures of relatives and friends, along with descriptions of the pictures, and are designed to promote and enhance the conversations of nursing home residents with other individuals in their environment. In the community, similar strategies have been used effectively to address the common and stressful problem of repetitive questions and statements. The use of environmental cues, such as signs, labels, color codes, and calendars that help the individual interact with the environment, without asking repetitive questions, has been particularly useful.

The effects of teaching nursing home staff and family caregivers about effective communication skills has also been researched. The verbal interactions of nursing staff and family caregivers can strongly influence the occurrence of behavioral problems among individuals with dementia. Caregivers can be taught to announce care activities (e.g., bathing) to reduce disorientation and anxiety, and thus also reduce the likelihood of physical aggression by the individual with dementia during a care activity.

Auditory stimulation strategies have been used effectively to decrease disruptive vocalization, the most common form of agitation in the nursing home. These strategies include the use of relaxing music and comforting sounds or voices. Specifically, environmental sounds (e.g., gentle ocean, country stream) and relaxation audiotapes have been used, as well as audiotapes that contain conversations about cherished memories, anecdotes about family, and other treasured experiences of the resident's life.

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