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Behavior Management - Consequent Strategies

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Although providing consequences, such as relocating a resident to his/her bedroom after agitation occurs, has been used successfully, most consequent strategies involve the use of verbal praise or planned ignoring, and are integrated into a treatment plan that focuses on antecedent techniques. Planned ignoring involves terminating caregiver attention when it is believed that attention is reinforcing the problem behavior. For example, caregivers are taught never to argue with a dementia patient because, although arguing may appear aversive, this response can actually reinforce a patient's contentious behavior (e.g., insisting that this is not her home). Planned ignoring of the patient's statements, combined with getting him/her onto another topic (an antecedent strategy), is often effective in diverting an unpleasant verbal interaction.

Another example of consequent strategies combined with antecedents is the use of prompted voiding for urinary incontinence. In prompted voiding, patients with dementia are verbally prompted (i.e., reminded) to use the bathroom every one or two hours. Verbal prompting is an antecedent to using the bathroom. However, an important component of prompted voiding is the provision of verbal praise after the patient uses the toilet appropriately (reinforcing consequence).

Behavior management techniques are considered by many to be the most effective form of treatment for the unique problems and psychopathologies associated with dementia. Other forms of behavioral therapy, including problem-solving skills training and cognitive-behavioral therapy are used commonly among older adult populations without dementia-related impairments.

LOUIS D. BURGIO SUSAN E. FISHER

See also ALZHEIMER'S DISEASE; ANXIETY; CONGNITIVE-BEHAVORIAL THERAPY; DEMENTIA; DEPRESSION.

BIBLIOGRAPHY

ALLEN-BURGE, R. S.; STEVENS, A. B.; and BURGIO, L. D. "Effective Behavioral Interventions for Decreasing Dementia-Related Challenging Behavior in Nursing Homes." International Journal of Geriatric Psychiatry 14 (1999): 213–232.

BANDURA, A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N.J.: Prentice-Hall, 1986.

BURGIO, L. D., and FISHER, S. E.. "Application of Psychosocial Interventions for Treating Behavioral and Psychological Symptoms of Dementia." International Psychogeriatrics 12 (2000): 351–358.

BURGIO, L. D., and STEVENS, A. B. "Behavioral Interventions and Motivational Systems in the Nursing Home." In Annual Review of Gerontology and Geriatrics. Edited by R. Schulz, G. Maddox, and M. P. Lawton. New York: Springer, 1998.

KENNET, J.; BURGIO, L. D.; and SCHULZ, R. "Interventions for In-Home Caregivers: A Review of Research 1990 to Present." In Handbook of Dementia Caregiving: Evidence-Based Interventions for Family Caregivers. Edited by R. Shultz. New York: Oxford University Press, 2000. Pages 69–98.

LAWTON, M. P. "Environmental Approaches to Research and Treatment of Alzheimer's Disease." In Alzheimer's Disease, Treatment, and Family Stress. Edited by E. Light and B. Lebowitz. Rockville, Md.: National Institute of Mental Health, 1989. Pages 340–362.

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