1. Maximize safe function by sup-
porting losses.
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Use an unhurried, consistent, and familiar routine. Avoid attempts to reason or asking the person to “try harder.” Avoid attempts to teach new skills. Alternate high- and low-level stimulation activities. Limit choices on the basis of ability. Schedule planned rest periods during the day. Adjust levels of activity and stimulation on the basis of stress responses. Evaluate for possible physical stressors (e.g., urge to empty bladder or bowels, hunger, pain).
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2. Provide unconditional positive
regard.
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Use uncomplicated, comprehensible language. Use gentle touch. Eliminate negative comments or corrections. Make use of distraction or acceptance rather than argument. Allow the person to complete self-care activities as able with minimal directions or taking over.
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3. Use anxiety and avoidance to
gauge activity and stimulation
levels.
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Look for early signs of anxious behavior (e.g., toe tapping, pacing, worried expression). Keep records of activities and times of day with increased anxiety.
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4. Teach caregivers to observe and
listen to patients.
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Listen carefully to repeated phrases or jargon. Attend to repeated behaviors as expressions of anxiety (e.g., searching for lost items).
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5. Modify environments to support
losses and enhance safety.
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Assess the environment for hazards or barriers. Remove access to potentially dangerous items (e.g., guns, power tools, cleaning products, motorized vehicles). Simplify the environment to reduce stimulation and potential misinterpretation (e.g., mirrors, pictures, clutter, television). Provide environmental cues to increase orientation (e.g., large clocks, signs).
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6. Provide ongoing education, sup-
port, care, and problem solving.
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Provide referrals to community resources for health education (physical and mental), assistance with physical care, respite, and support groups.
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