Question
Can you explain the two care models that address behaviors in persons with dementia?
Answer
The first is the Progressively Lowered Stress Threshold Model. According to this model, adults are less able to manage stress as the disease progresses. Their threshold for stress is lower thus resulting in anxiety and dysfunctional behaviors. Stressors include fatigue; changes in routine, caregiver or environment; demands that exceed their ability; multiple and competing stimuli; perception of loss; physiologic factors such as pain, illness, discomfort or medication side effects.
It is based on six principles of care: Modify the environment to ensure safety, provide unconditional positive regard, use anxiety as a gauge of activity and stimulation levels, teach the caregiver(s) to listen for behaviors, modify the environment to support losses and enhance safety, and provide education and support to the caregiver(s).
The second model is called the Need-Driven Dementia-Compromised Behavior Model. Developed in 1993, this model changes the view that behaviors are disruptive and instead are needs that, if responded to correctly, can enhance the quality of life. Behaviors are a result of “background” factors and “proximal” factors. Background factors, which are stable individual and disease-related characteristics include: dementia compromised functioning (language issues, memory, etc), poor overall health status, demographic variables (e.g., marital status), psychosocial variables (e.g., personality traits)
Proximal factors, meaning those inducing a need state include unmet physiologic needs, unmet psychological needs (e.g., contact with family), disturbing environmental factors (e.g., cold room), and uncomfortable social surroundings (e.g., too many people in the room).
It is the proximal factors that we can control and those that will guide our interventions.
