There’s 'always a reason behind every behaviour,' says DOC
Psychotropic meds aren’t always the answer
Friday November 30, 2007 -- Deron Hamel
When Kelly Davies became director of care at Almonte Country Haven in March, there was a resident with dementia at the Ottawa-area long-term care home who would yell constantly throughout the day.

Staff members were perplexed. None of their attempts to ease the woman’s agitation was working. Supportive measures, such as playing soft music or showing her a movie, didn’t work. In fact, the resident showed extreme sensitivities to any type of treatment.

The psychiatrist who visits once every two weeks to tend to residents had prescribed the woman various psychotropic medications, but none of these would calm her.

With supportive measures and psychotropic medication failing, Davies suggested to staff members that pain might be at the root of the behaviours.

At the time, the resident was only on a low dose of Tylenol, which was being administered on an irregular basis. 

Davies approached the home’s physician and asked about prescribing the resident pain medication. The physician recommended a medication for the resident to try, and, as a result, the resident’s agitation diminished.

Addressing the resident’s pain, rather than her agitation, has improved other aspects of the resident’s life.

“Now the family can come in and enjoy their visits with their mother, and she’s not screaming and it’s not upsetting her,” says Davies. “She can be brought out more and involved in larger group activities because she’s comfortable doing it.”

Davies underscores the importance of re-educating staff members in the area of pain issues. In the past, staff members in long-term care homes would “normalize” behaviours, and believe that the agitation exhibited was just a part of a resident’s personality.

“And that’s wrong,” says Davies “There is always, always, always a reason behind every behaviour. And if we haven’t found the answer, we’re not looking hard enough.”

Davies urges staff members to continually be on the lookout for signs that residents might be in pain. Facial grimaces and fist clenching are two common signs of pain in residents with dementia, she points out.

To help ensure residents are as comfortable as possible and to help curb agitation, Davies says staff members need to regularly look at the residents’ list of medications to see if painkillers are a part of their regime.

Citing a study suggesting that psychotropic medications can cause early mortality in people 65 and older, Davies notes that psychotropic medications “should not always be our first choice” when addressing agitation in residents with dementia.