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March 5, 2008
By Adrienne Goetz
Being able to communicate with the world around us is a basic human need. A challenge in the lives of persons with dementia is that they lose the ability to communicate in ways that are familiar to those around them.
Professor Jane Fisher in the University’s Department of Psychology and doctoral student Merry Sylvester have been studying the interaction of the environment and the behavior of persons with dementia in the hope of providing family and professional caregivers with effective ways of understanding the needs of persons with dementia.
“Someone with Alzheimer’s disease will eventually have difficulty verbally tell us what they want, whether they’re bored, in pain, afraid, lonely or hungry,” Sylvester said. “We are studying the behavior of persons with dementia in different situations to find out how to best understand what their behavior communicates.”
Through a fellowship funded by the National Institute of Mental Health (NIMH), Sylvester has been examining data on a variety of behaviors including repetitive vocalizations, wandering and resistance to care and has analyzed them hoping to find patterns. The data were collected from four nursing homes in Chicago and Nevada. The study included 70 elderly participants that matched the criteria for Alzheimer’s disease.
“We are hoping to develop methods of effectively determining the motivation behind the behaviors of persons with dementia,” Fisher said. “Individual persons with dementia respond differently to the environment based on their individual histories. Two patients may engage in the same behavior but for very different reasons.
“For example, a person who was socially outgoing before developing Alzheimer’s disease might make a repetitive vocalization because they are bored and want company while a shy patient may make a very similar repetitive noise because they are afraid or would prefer less social contact. Based on the different motivations for the behaviors, you would want to respond to these two patients in very different ways, by providing more stimulating social experiences for the first patient and eliminating what is making the second patient afraid.”
The most effective treatments for persons with dementia are those that preserve their abilities, including the ability to communicate, according to Fisher.
“You never want to intervene in a way that eliminates a patient’s behaviors because the progressive degenerative effects of dementia will eventually take its toll,” she said.
The idea is wrapped up in individualized care that looks at each patient’s history and current environment individually and seeks to find solutions that works for that particular individual.
“People with dementia tend to be stigmatized in that all of their behavior is attributed to disease once they have been labeled an ‘Alzheimer’s patient,’” Fisher said. “By teaching caregivers how to use continual and careful monitoring of changes in a care recipient’s behavior, then we can hopefully catch the changes that are due to reversible factors such as pain, medication side effects, or an under-stimulating or over-challenging environment.
“Our goal is always to reduce or prevent excess disability by helping caregivers to provide the most appropriate and supportive environment for an individual person with dementia. We believe this approach promotes a higher quality of life for persons with dementia and their family caregivers.”