Preventing agitative behaviors and encouraging positive emotions among elders with memory-loss who live in an Assisted Living Residence

Background: A subset of elders with Alzheimer's disease or a related dementia experience high levels of negative emotional states and agitative behaviors on a continual basis. Behavioral problems are one of the most challenging aspects of the disease for direct care staff in long-term care residences. Only a paucity of research has been conducted on this topic in Assisted Living Residences (ALRs). The current study aimes at identifying care staff strategies that prevent negative emotional states and behaviors and promote positive emotions among the residents.;Methodology: Two special care units (SCUs) of an ALR designed for persons with memory-loss were studied over a 10-month period. A sample of 12 residents who experienced negative emotional states and/or behaviors on a continual basis received special attention. The primary data collection strategy consisted of unstructured direct observation, complemented by semi-structured interviews with care staff members. Grounded Theory informed by Miles & Huberman's approach was used as the analytic framework.;Findings: Three major themes were identified: being-left-alone as a risk factor for anxiety and agitation; positive impact of organized activities; and aggressive behaviors between residents. A substantial portion of the reported negative and positive emotional states and behaviors were situational-reactive (i.e., circumstance-driven), and therefore potentially modifiable. Many of the negative emotional states and behaviors were a result of unmet needs, which is consistent with the Need-Driven Dementia-Compromised Behavior Model.;Conclusion: Agitative behaviors can be prevented and positive emotions can be encouraged through regular implementation of a variety of effective care staff strategies whose effectiveness has already been established. The study highlights the importance of having sufficient number of staff present throughout the day and evening to attend to residents, sensitivity of staff to prevention of agitation, and development of staff skills in effective intervention. The need for management to be creative in involving care staff, recreation staff, and volunteers in vigilant and sustained efforts to recognize early warning signs of agitative behaviors and to assume responsibility for intervening is discussed. Strategies for effective prevention of agitative behaviors on the part of the staff members can be incorporated with training programs.