Special Section—Behavioral symptoms of dementia: their measurement and intervention. Caregiver interventions for passive behaviors in dementia: links to the NDB model

Abstract

Passive behavior (PB) in persons with Alzheimer's disease (PWAD) has been overlooked despite recognition that it occurs on a daily basis and is often resistant to interventions. The purpose of this study was to describe how the experience of passivity was for the caregiver and the PWAD, factors that precipitated PB, caregiver responses that promoted engagement, and caregiver responses that intensified PB, as well as activities initiated by caregivers over the past month that reduced passivity in the person with dementia (PWD). Fifty caregivers of community-dwelling persons with mild (n = 15), moderate (n = 16), and severe (n = 19) Alzheimer's disease participated in a semi-structured interview. Data were analyzed using Colaizzi's Phenomenological Thematic Extraction and descriptive statistics. Caregivers identified decreased levels of activity, decreased verbalization, withdrawal, less socialization, and decreased interest in activities as examples of PBs. For caregivers, the experience of coping with PBs engendered frustration with their loved ones' cognitive deterioration, difficulty in watching and accepting loss of function, fatigue, sadness, and using coping skills. Paradoxically, both being alone and increased environmental stimuli precipitated PB. Feelings of helplessness and loss of control by the person also caused PB. The most successful interventions to promote engagement were: giving cues and assistance, initiating the task, giving guidance, and providing enjoyable activities. Responses that hindered engagement included: 'correcting' or putting stress on the person, rushing activities, and repeating directions. Faith, humor, patience, and contact with friends and family were identified as positive approaches. Caregiver interventions demonstrated synchrony with selected background and proximal variables in the Need-driven Dementia-compromised Behavior (NDB) model.

Transferring from an acute hospital and settling into a subacute facility: the experience of patients with dementia

“…Some of the participants reported feeling powerless and left out of the decision‐making about their care, although not all of them fought against this. As discussed by Colling (2004), passive behaviour can also be a potential reaction to unanticipated events or stress and can be in itself a form of protest. Some participants were less accepting of the loss of control and battled against it with various means including voicing their anger or resisting interventions from the staff.…”

Risk assessment of wandering behavior in mild dementia

“…This contrasted with another study (Song and Algase, ) that reported motor busyness and negative verbalization as negative predictors of eloping behavior (study participants in the latter study were, however, more cognitively impaired and from long‐term care facilities). Passivity in persons with dementia may “reflect needs associated with loss of control and feelings of helplessness” (Colling, ). Hence, the possibility that eloping behavior is a manifestation of this helplessness in them versus “active coping,” a theory congruent with the need‐driven dementia‐compromised behavior model (Algase et al ., ).…”

“I’ve learned to just go with the flow”: Family caregivers’ strategies for managing behavioral and psychological symptoms of dementia

“…Consistent with this perspective, research has found that caregivers manage BPSD in part by adapting the social or physical environment in ways that minimize the PLWD's exposure to stressors (Moore, Ozanne, Ames, & Dow, 2013). Similarly, other studies show that caregivers with nonconfrontational approaches to BPSD that are sensitive to the PLWD's level of functioning (e.g., not challenging his or her understanding of events or situations) report more effective management of these symptoms and less decline in feelings of competence than those who use corrective or punitive tactics which could amplify stress within the care dyad (Colling, 2004;de Vugt et al, 2004;Harvath, 1994).…”

“…It is important to further enhance understanding of caregivers’ views about how they manage BPSD for at least three reasons. First, the few studies on this topic have limitations including a focus on behavior-specific management (e.g., wandering, passivity) (Colling et al, 2004; Dodds et al, 1994) and the consideration of general response orientations (e.g., being calm, patient, or positive) more than distinct strategies (e.g., using written prompts) (de Vugt et al, 2004; Harvath, 1994; Huis in het Veld et al, 2016; Turner et al, 2015). As a consequence, much remains unknown about particular approaches that caregivers use to manage a range of behaviors.…”