Table 3. Recognition and Management Recommendations for Psychological and Behavioral Symptoms in Severe Dementia. Adapted of Kales (2015) ⁵⁸ .

In the patient	In the caregiver	In the environment	Recommendations
Pain			Caregivers’ training;
			Health education;
	Lack of knowledge	Poor positioning	Identification and elimination of causal factors in patients and the environment;
	Health education	Excessive noise	Promotion of physical comfort;
	Lack of education in dementia	Abrupt movements	Information to the responsible physician and members of the health team;
			Elimination of excessive noise;
			Gentle patient mobilization.
Urinary infection		Inadequate hygiene	Caregivers’ training;
			Health education;
	Lack of knowledge		Optimization of fractional hydration (1.5-2L/day) or at medical discretion;
	Stress		Double incontinence;
			Hygiene, body, and environmental measures.
Respiratory Infection	Lack of knowledge	Dark, closed or dirty environment	Caregivers’ training;
		Cold temperature	Preventive measures;
			Passive exercises.
Constipation	Lack of knowledge	Adequate bathroom hygiene, security, and privacy	Training in hygiene measures and health education to caregivers;
			Medical and nutritional approach;
			Fractioned hydration.
Refusal of care	Inadequate communication and conducts	Environment adaptation and care	Training of caregivers and health education;
			Caregivers must be careful with all stimulus and approaches.
Sleep disturbances	Lack of recognition concerning pain, hunger, coldness, heat, mobilization in bed, and previous sleep problems	Observation	Training and health education;
		Change in patients’ behavioral patterns	Adequacy of auditory environmental stimuli;
			Medical evaluation.

* All caregivers must be trained in all activities proposed by the health team to offer their consent and understand the importance of each proposed intervention. Elaborated by Ferretti (2021).