Understanding Understanding The GPEP Model The GPEP Model

Geropsychiatric Education Program Geropsychiatric Education Program (GPEP)(GPEP)

Vancouver Coastal HealthVancouver Coastal Health

Learning ObjectivesLearning Objectives

Identify four types of influences on Identify four types of influences on behaviours:behaviours: PsychiatricPsychiatric PhysiologicalPhysiological PsychosocialPsychosocial Environmental: social, physical environmentEnvironmental: social, physical environment

Discuss the GPEP Model as a tool for Discuss the GPEP Model as a tool for understanding behaviour and planning understanding behaviour and planning individualized careindividualized care

Psychiatric Psychiatric Influences on Influences on

BehaviourBehaviour

Psychiatric InfluencesPsychiatric Influences

DementiaDementia DepressionDepression DeliriumDelirium Other:Other:

SchizophreniaSchizophrenia Bipolar DisorderBipolar Disorder Personality disorderPersonality disorder Obsessive Compulsive DisorderObsessive Compulsive Disorder

Physical Physical Influences on Influences on

BehaviourBehaviour

1. Aging: A Universal 1. Aging: A Universal ProcessProcess

Affects everyone Affects everyone Occurs in every Occurs in every

system of our bodysystem of our body Individual – no fixed Individual – no fixed

patternpattern

2. Physical Illnesses 2. Physical Illnesses and Behaviourand Behaviour

Arthritis Diabetes Parkinson’s Disease Chronic Obstructive

Pulmonary Disease Emphysema High Blood Pressure Visual disturbance….

Normal

Cataracts

Normal

DiabeticRetinopathy

Normal

Glaucoma

Normal

MacularDegeneration

3. Medications and Side 3. Medications and Side EffectsEffects

All medications have All medications have

possible side-effectspossible side-effects Your role: Your role:

to notice if there is a sudden change to notice if there is a sudden change in behaviourin behaviour

REMEMBER: role of medications in REMEMBER: role of medications in deliriumdelirium

4. Pain 4. Pain

What percentage What percentage of elders in the of elders in the community have community have significant pain?significant pain?a. 10 – 25 %a. 10 – 25 %

b. 45 – 60 %b. 45 – 60 %

c. 70 – 85%c. 70 – 85%

Why Elders May Not Why Elders May Not Report PainReport Pain

Fear of being called a complainer Think no one would listen Think pain is a normal part of aging Cannot tell you because of dementia Fear of consequences May express pain differently

Psycho-Social Psycho-Social Influences on Influences on

BehaviourBehaviour

Who is this Person?Who is this Person?

Psychosocial InfluencesPsychosocial Influences

Personal routinesPersonal routines Early life eventsEarly life events Life roles/work historyLife roles/work history Important relationshipsImportant relationships Coping strategiesCoping strategies CultureCulture Spiritual values/beliefsSpiritual values/beliefs Personality style…Personality style…

The Physical The Physical Environment’s Environment’s Influence on Influence on BehaviourBehaviour

How does the Physical How does the Physical Environment affect Environment affect

behaviour?behaviour? Level of

stimulation Private space Lighting / Glare Room temperature Signs & labels Poor colour

contrast Safety concerns

The Social The Social Environment’s Environment’s Influence on Influence on BehaviourBehaviour

How OUR communication and approach How OUR communication and approach affects the client/residentaffects the client/resident

Parts of OUR Parts of OUR CommunicationCommunication

Only 7-10% of Only 7-10% of our message is our message is found in our found in our WORDSWORDS

Verbal Verbal communication – communication – the actual words the actual words we say…we say…

Parts of OUR Parts of OUR CommunicationCommunication

But…90% of our But…90% of our message is found in message is found in our NON-VERBALSour NON-VERBALS

Non-verbal Non-verbal communication – communication – how we say what we how we say what we say:say: ToneTone VolumeVolume Body language…Body language…

Do WE have Good Do WE have Good Listening Skills:Listening Skills:

Not interruptingNot interrupting Being non-judgmentalBeing non-judgmental ValidatingValidating Allowing for silenceAllowing for silence Using supportive body Using supportive body

languagelanguage Are we paying attention…Are we paying attention…

Understanding Understanding Responsive Responsive BehavioursBehaviours

What is a Behaviour?What is a Behaviour? Something someone is doing that Something someone is doing that

you can see or hearyou can see or hear DescriptiveDescriptive SpecificSpecific Non-judgmental / not labelingNon-judgmental / not labeling

Understanding Understanding BehavioursBehaviours

Refusal, agitation, and aggression Refusal, agitation, and aggression always has a cause/trigger:always has a cause/trigger: Protecting oneselfProtecting oneself Unmet needsUnmet needs Broken brainBroken brain

When cognition and communication are When cognition and communication are impaired it is the way in which people with impaired it is the way in which people with dementia tell us that something is wrongdementia tell us that something is wrong

Very often starts with anxietyVery often starts with anxiety Has a patternHas a pattern

Tools to Describe Tools to Describe Behaviours:Behaviours:

1.1. Identify the behaviour: Identify the behaviour: • Identification of Behaviours and Identification of Behaviours and

Guidelines for Intervention*Guidelines for Intervention*

2.2. Document the Behaviour: Document the Behaviour: • Behaviour Pattern Record*Behaviour Pattern Record*

3.3. Care Planning: Care Planning: • Behaviour Assessment Tool (BAT)Behaviour Assessment Tool (BAT)

* Cohen-Mansfield, 2004

Tool to help with describing behaviour and

classify types of behaviour

IDENTIFICATIONOF BEHAVIOURS & GUIDELINES

FOR INTERVENTIONSCohen-Mansfield

Behaviour Pattern Behaviour Pattern RecordRecord

Care StrategiesCare Strategies

Goals of Care StrategiesGoals of Care Strategies The resident will:The resident will:

feel safefeel safe feel physically feel physically

comfortablecomfortable experience a sense experience a sense

of controlof control experience optimal experience optimal

stressstress experience meaning experience meaning

and pleasureand pleasure