Intent:
To identify the frequency of behavioral symptoms during the last three days that cause distress to the person, or are distressing or disruptive to others with whom the person lives. Such behaviors include those that are potentially harmful to the person or disruptive to others. These items are designed to pick up problem behaviors exhibited by the person that may be considered as “combative or agitated” by some health professionals. Acknowledging and documenting behavioral symptoms provides a basis for further evaluation, care planning, and delivery of consistent, appropriate care towards ameliorating the behavioral symptoms.
Definitions:
Wandering — Moved about with no discernible, rational purpose, seemingly oblivious to needs or safety. A wandering person may be oblivious to his or her physical or safety needs. Wandering behavior should be differentiated from purposeful movement (e.g., a hungry person moving about the apartment in search of
food). Wandering may be by walking or by wheelchair. Do not include pacing as wandering behavior. Pacing back and forth is not considered wandering.
Verbal abuse — e.g., others were threatened, screamed at, or cursed at.
Physical abuse — e.g., others were hit, shoved, scratched, or sexually abused.
Socially inappropriate or disruptive behavior — e.g., made disruptive sounds or noises, screamed out, smeared or threw food or feces, hoarded, rummaged through other’s belongings.
Inappropriate public sexual behavior or public disrobing
Resists care — e.g., taking medications/injections, pushed caregiver while assisting with ADLs, eating or changing position. This category does not include instances where the person has made an informed choice not to follow a course of care (e.g., the person has exercised his or her right to re-fuse treatment, and reacts negatively as others try to reinstitute treatment.)
Signs of resistance may be verbal or physical (e.g., verbally refusing care, pushing caregiver away, scratching caregiver). These behaviors are not necessarily positive or negative, but are intended to provide information about the person's responses to interventions and to prompt further investigation of causes for care planning purposes (e.g., fear of pain, fear of falling, poor comprehension, anger, poor relationships, eagerness for greater participation in care decisions, past experience with medication errors and unacceptable care, desire to modify the care being provided).
Process:
Ask the family member caregiver if each specified problem behavior occurred. Take an objective view of the person's behavioral symptoms, and focus on the person's actions, not intent. It is often difficult to determine the meaning behind a particular behavioral symptom. The fact that some family members have become used to the behavior or minimize the person's presumed intent (“He doesn't really mean to hurt anyone -- He's just frightened”) should not be considered in coding items. Rather, code each item based on whether the person manifested the behavioral symptom.
Observe the person and how the person responds to attempts by family members or others to deliver care. Ask caregivers if they know what occurred throughout the day and night for the past 3 days. If possible, try to do this when the person is not in the room. Recognize that responses given with the person present may need to be validated later. Also the presence of multiple caregivers during the assessment may discourage individuals from answering accurately.
Coding:
0. Not Present
1. Present but not exhibited in last 3 days (Note: this code indicates that while the assessor knows the
condition is present and active, it was not physically manifested over the last 3 days.)
2. Exhibited on 1-2 of last 3 days
3. Exhibited daily in last 3 days
Examples
Mr. W has dementia and is severely impaired in making daily decisions. He wanders all around the apartment throughout the day. He is extremely hard of hearing and refuses to wear his hearing aid. He is easily frightened by others and cannot stay still when anyone visits. Numerous attempts more than a week ago to redirect his wandering resulted in him hitting and pushing family. Over time, family members have found him to be most content while he is wandering within the structured setting of the apartment. Code as follows:
Wandering = 3
Verbally abusive = 0
Physically abusive = 1
Socially inappropriate = 0
Resists care = 0
Mrs. N’s daughter states she has found her mother going through the daughter’s closet in the middle of the night. This has happened on two of the last three nights. When she tried to get her mother to return to her own room and bed, the mother be-came angry and continually shouted at her daughter. She accused the daughter of stealing her things. Code as follows:
Wandering = 0
Verbally abusive = 2
Physically abusive = 0
Socially inappropriate = 2
Resists care = 0