Table 2 Background information of each case
Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 | |
|---|---|---|---|---|---|---|---|
Gender, age | Man, 75 years old | Woman, 87 years old | Man, 78 years old | Woman, 89 years old | Woman, 89 years old | Man, 81 years old | Woman, 86 years old |
Duration of institutionalization | 22 months | 21 months | 18 months | 24 months | 27 months | 29 months | 18 months |
Department | Psychogeriatric unit, small-scale | Psychogeriatric unit, small-scale | Psychogeriatric unit, small-scale | Psychogeriatric unit, small-scale | Psychogeriatric unit, small-scale | Psychogeriatric unit, large-scale | Psychogeriatric unit, small-scale |
Medical problems | Parkinson’s dementia Morbus Parkinson Atrial Fibrillation Lower urinary tract symptoms | Dementia Heart failure Hypertension Osteoporosis Depressive disorder | Dementia with leukoencephalopathy Depressive disorder (2007) Rectal bleeding | Dementia Hip fracture (2016) | Vascular dementia COPD Heart failure Hypertension Atrial Fibrillation Cerebrovascular incident (2010) Recurrent urinary tract infections | Vascular dementia Hypertension Kidney failure Transient ischemic attack | Alzheimer’s disease Several transient ischemic attacks Hypothyroidism Osteoporosis |
Description of behavior | Unpredictable moments of transgressive behavior and aggression (hitting, pushing, kicking, grabbing firmly) directed towards care staff and other residents | Yelling and screaming accompanied by fear and sadness Angriness | Verbal (yelling) and physical aggression (hitting, kicking, spitting, throwing with feces, squeezing breasts of care staff) directed towards care staff especially during personal care | Agitation Restlessness Attention seeking behavior (experienced as agitation) accompanied by fear and sadness Aggression directed towards care staff and other residents | Restlessness and yelling during the nights | Physical (hitting, kicking, grabbing) and verbal (cursing, insulting) aggression directed towards care staff, volunteers, family and other residents | Restlessness and angriness Beating on doors and windows Hitting directed towards other residents or care staff Slamming on tables Making noises |
Interventions described in the medical files | Family Family consultation | Family Family consultation | Family Family consultation Involving family in behavioral consult | Family Making a voice recording with family | Family | Family Family consultation Visits from family member | Family Family consultation |
Resident Personal care with as little stimuli as possible and dosing stimuli by decreasing activities and offering more rest Relaxation massages Compulsory treatment (locking the door) Camera surveillance and emergency buttons on phones | Resident Offering rest (in living room) Changing the place at the table Offering personal attention, physical contact and safety by volunteers and trainees Daytime activities on a care farm Physical exercise (walking (outside)) Enclosure bed during the nights Accounting for the resident’s perception of the environment | Resident | Resident Offering adequate stimuli and familiar voices and noises Distraction Offering personal attention Giving foot baths | Resident Offering rest in the afternoon (in bed) Displaying picture of the resident’s wife in the resident’s room to create feeling of safety Giving tea or warm milk in the evenings Structurally notifying the resident of performed actions during care Structured day program Offering daily activities | Resident Personal care with as little stimuli as possible Offering rest (in the resident’s room) Structured day program Offering personal attention Offering daily activities as reading the newspaper, playing games Physical exercise (walking and swimming) | Resident Offering time-outs and rest by separating the resident from other residents Offering personal attention (also during meals) and physical contact Singing songs with the resident Handing a doll or a cuddle cat Offering multisensory stimulation (‘snoezelen’) Aromatherapy Transfer to another, quieter ward | |
Nursing home staff Behavioral consult and crisis intervention plan by psychologist Self-defense course care staff Multidisciplinary team meetings Changing medication | Nursing home staff Behavioral consult and crisis intervention plan by psychologist Video-recordings of the behavior Advice regarding sitting comfortably Consulting internal consultation team External consultation psychiatrist Deployment of extra staff Moral deliberation session Changing medication | Nursing home staff Behavioral consult by psychologist Using wrist guards during personal care Training using video-feedback Observing colleagues during care provision Rotation of care staff Involvement of occupational therapist Multidisciplinary meetings Changing medication | Nursing home staff Behavioral consult by psychologist Expressive therapy Recruiting a nurse An employee working in the living room Deployment of extra staff Changing medication Drug holiday Applying intermittent palliative sedation | Nursing home staff Behavioral consult by psychologist Advice regarding stimuli Education and skill training of care staff about dementia and depression Changing medication | Nursing home staff Behavioral consult by psychologist and functional analysis of the behavior through the care programme ‘Grip on challenging behavior’ [29] Consult of an expressive therapist to be in line with the resident’s level of alertness Deployment of extra staff Changing medication | Nursing home staff Observation behavior and behavioral consult by psychologist Changing medication | |
Relevant medication (name, dosage) | Clozapine 25 mg bid Levodopa/carbidopa 50/12.5 mg bid Valproic acid 300 mg bid Clonazepam 0.5 mg as needed | Midazolam 15 mg qd Mirtazapine15 mg qd Oxazepam 10 mg qd Oxazepam 5 mg qd Oxazepam 5 mg as needed Venlafaxine 37.5 mg bid | Clozapine 50 mg qd Escitalopram 10 mg qd Mirtazapine 30 mg qd | Haloperidol 2 mg/ml 5drops qid Oxazepam 10 mg as needed Citalopram 10 mg qd | Levetiracetam 500 mg bid Oxazepam 10 mg as needed | Pipamperone 40 mg bid Citalopram 20 mg qd Memantine 5 mg qd Temazepam 10 mg as needed | Haloperidol 2 mg bid Citalopram 20 mg qd Pregabalin 75 mg bid Oxazepam 5 mg as needed |