Geriatric Mental Health Services

Geriatric Guide - Section - A

For Assessing Changes in Behavior in Residents of Long Term Care Facilities and.......
Getting Help When Needed


From time to time some residents in all types of long term care facilities may exhibit puzzling and troublesome behavior. Often this behavior becomes difficult other residents and staff to deal with. Sometimes a resident becomes dangerous to himself or abusive to others. This guide is intended to:

  • Present some fundamental principals to guide staff in addressing such changes in behavior.
  • Provide guidelines for preparing for such changes, before they occur.
  • Offer a step-by-step process to follow when such changes occur. This process will help staff determine whether the situation:
    • Is an emergency and should be referred to Crisis Intervention
    • Can be dealt with internally, by existing staff
    • Requires the services of an outside consultant This guide will provide detailed steps to follow in each case.

Fundamental Principles

Behavior has meaning. The meaning may not be immediately obvious, even to the person acting out the behavior. The challenge to the caregiver is to remain open minded and to seek to understand the meaning of the behavior. To facilitate that, assessment of troubling behavior should include some individuals who are not directly involved in caring for the person who is exhibiting that behavior. People who are not experiencing the problem should be able to provide an objective look at the situation and therefore should be involved in assessing the problems.

Over half the time, sudden changes in behavior have a physical or medication-related cause. Research indicates that at least 54% of the time, such changes are found to be caused by physical issues or by medication. So, it is important to have a complete and comprehensive medical evaluation when there is a sudden or rapid change in the individual's behavior.

Your facility not only represents the least restrictive environment for this person but, and much more importantly, it is their home. It is, therefore, important to do everything reasonable to assure that their lives have quality and as little stress as we can manage.

Medical Evaluation

The purpose of this evaluation is to rule out physical and/or medication-related causes for the change in behavior. At a minimum this medical evaluation should include a physical assessment, blood work, and a urinary tract assessment. Based on the medical providers impression, it could also include a CT scan or other diagnostic tests.
Be sure to request a hearing and vision assessment as well as a medical and physical exam.
Reduce to the lowest possible doses all existing medications (strictly under physician direction).Have a mini-mental status exam administered by a qualified person.