Functional Behavior Assessment for the Elderly

Last updated Thursday, August 09, 2012   |   comments
Functional Behavior Assessments (FBA) are the primary tool of behavior consultants employed here at Butterfly Effects. And while we cannot teach caregivers how to employ FBA by way of a few paragraphs of instruction, we can give you a better understanding that may help you perform your own more simple assessments.

Just understanding that they have a tool at their disposal, can make all the difference for caregivers.
Rather than be left to wallow in their frustration, it gives them a systematic way to understand problem behaviors. We may not always be able to resolve those behaviors, but often when we understand them, the solutions can  become self-evident.

ABC: Antecedent - Behavior - Consequence
The ABC model helps us to see the behavior in adequate context. By recording the actions that occur before a behavior (the Antecedent)  and what occurs after the behavior (the Consequence), we begin to see patterns of cause an effect.

At Butterfly Effects, we believe that when confronted with a problem behavior it is always best to employ a Functional Behavior Assessment to determine what is causing the behavior or what the individual in hoping to achieve.

During the FBA,  a  Butterfly Effects Behavior Consultant will:
  1. Collect information from family, staff, and others about the behavior.
  2. Observe the client in his or her natural setting to determine the antecedents that may be triggering the behavior and the consequences of the behavior that may reinforce it.
  3. Develop a theory as to why the behavior is occurring.
  4. Test the theory to assure its validity.
  5. Develop a strategy to modify or replace the problem behavior using tools of constant encouragement and positive reinforcement.
  6. Apply the strategy consistently, and when possible, partnering with the client who is often as unhappy about the behavior as others.
  7. Train caregivers and family to support the behavior intervention.
  8. Look at ways to generalize the behavior modification to other situations involving the client.

Behavior Analysis in Action

The science of behavior follows its own sort of algebraic logic with interdependent ABC variables.
If we don't want to change the Antecedent, we can get a different Behavior by changing the Consequence or a different Consequence by changing the Behavior. Change the Antecedent, then  the Behavior and Consequence are not likely to remain as is.

Examples
We can calm the seemingly mid-afternoon ritualistic vocalization of a man with Dementia (Behavior) by medicating him every mid-afternoon or spend time observing him in his natural setting. If he is observed, we discover that the man's excessive light sensitivity is triggered when the setting sun lines up with his window and throws shards of light between the slats of the blinds. (Antecedent).  

We can tranquilize the 90 year-old woman who is constantly crying (Behavior) or we can do a functional assessment and discover that she quiets every time someone comes running after she does cry. (Consequence) .  

Now the solutions become evident. We provide better blinds for the light-sensitive man. We encourage caretakers to act proactively and visit the woman's room at least once every two hours to engage her in brief conversation

FBA's are a great way to find solutions, but they aren't always as simple as the two examples above. The better we know the individual (a great advantage to family caregivers) the easier it is to understand the reason behind a behavior. Often you will discover with seniors that the behaviors have to with trying to reclaim or adjust to dramatic changes in their lives or coping with complexities of their health. The crying women written about above is trying to cope with the loss of her husband, a life-long companion who provided her with all the connection she needed. The man above has recently become exceptionally light sensitive due to recent eyesight issues and medication.

Bereavement, loss of independence, loss of a sense of usefulness, loneliness, getting used to a new unfamiliar home, depression, and physical discomfort are probably the most common reasons to consider. Sometimes there can even be more than one reason.

Your older uncle repeatedly elopes -- not as a way to annoy you -- but because he is trying to demonstrate his independence and also because he enjoys the extra hugs when he is found. Your grandmother stops bathing adequately because she has a diminished sense of smell and / or feels that she can't effectively engage others in social conversation as easily she once did.

Sometimes the solutions are as easy as more hugs and a couple of three-minute phone calls every day. Other times, you will have to dig a little deeper and sometimes, you have to deal with moving targets.

If a behavior proved effective for meeting one need, it may be employed to help meet another.
That older uncle who ran off for lack of independence stops eloping when you allow him to navigate when the two of you go to the shopping mall. You may even let him wander a bit rather than constantly remind him of the limitation through constant restriction. But then around the holidays, he starts to wander again, and then elopes. When we observe him, we notice he is much more apt to take off after someone asks him about his home. It may be that he misses the comfortable and familiar surroundings of his old home and the memories it contains.   So, we hang pictures, paint the room a familiar color, and make his bed with familiar linens; even using his old blankets. Even if they have an odd odor, for him i's the odor of home and security.. Now when he starts thinking about home, instead of looking to elope, he goes to his room with its familiar trappings.

Charting Behavior -- the example of Annie
Creating an ABC data sheet is designed to be an objective exercise. You report what you observe and nothing more. Byt stripping a behavior down to the raw facts, it becomes easier to spot whatever behavioral mechanisms are in operation.

    Functional Behavior - ABC Data Sheet

Date

Time

Antecedent (What happened before the behavior)

Behavior (clear description of the behavior)

Consequence (What happened right after the behavior)

 4/27/2012

 8:05am

Mrs. A asks Annie to tidy up her room.

 

 

 

 

 

 Annie Shuts down, sits in her chair and refuses to move.

Staff is assigned to watch Annie. Staff tells Annie not to worry and begins to tidy her room.

In the above example Annie who was once a fabulous housekeeper now has dementia.  Cleaning up her room used to be an activity that she enjoyed even as her disease progressed.  Now when she is asked, thoush she is still quite physically capable, she simply shuts down when  the request is made. Mrs A, or other staff, will then come into Annie's room to keep an eye on her, and while there, staff begin to clean up. 

Motivation - Annie is beyond frustrated.  She wants to tidy up her room, but as her dementia has progressed, she has a hard time organizing her actions to meet a goal, She learns quickly that if she does not try at all, her room will end up being cleaned for her.

Behavior Solution -  We need to turn the main task of cleaning the room into a manageable task. Taking a page from work analysis, we break the activity of cleaning the room into much smaller tasks.  We may be able to get away with asking Annie to hang up her clothes, or we may have to be more specific and instruct her one garment at a time. In the end the goal is to allow Annie to be useful and achieve the satisfaction of a tidy living space.

For an explanation of another ABC data sheet  in action,
visit Ask Heather our advise column on behavior interventions.



References
AoA, 2011. Who are the Abusers. Administration on Aging, National Center on Elder Abuse. Retrieved from http://www.ncea.aoa.gov/ncearoot/Main_Site/FAQ/Basics/Abusers.aspx

Elder Assistance Daily, 2010. Elder Abuse Data and Statistics. Elder Assistance Daily. Retrieved from http://www.eadaily.com/15/elder-abuse-statistics/



 
 
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