MDS Alert

Simple strategies can keep people on their feet and at peace with each other.

Residents who have trouble communicating their basic needs and poor impulse control can be an accident waiting to happen, literally.

Below, behavioral expert Michael Partie describes a couple of common ways in which that can occur.

Scenario No. 1: A ravenous resident who can't communicate his basic needs heads to the dining hall for a meal. Unable to wait another minute to eat, he grabs another resident's tray. The next thing you know, fists and food are flying--or the resident trying to get another resident's tray may lose his balance and fall. And the facility is probably going to end up with an F323 tag on its plate.

Tips: Riverview Hospital in Port Coquitlam, British Columbia, Canada, has found that "line-ups" for meals create situations that can lead to aggression for geriatric residents with dementia. "So we have eliminated lines wherever possible," reports Howard Smith, a caregiver there. "You can do this in the dining room in creative ways--for example, consider extending the length of the mealtime." Some nursing facilities are offering residents a drink and appetizer while they wait to be served, and have someone sit with them to provide conversation,  which helps prevent residents with dementia from becoming agitated, notes Annette Kobriger, RD, CD, MPH, MPA, a consultant in Chilton, WI.

Scenario No. 2: A resident who tends to eat poorly at breakfast and skips the protein develops blood sugar changes later in the day that make her irritable and unable to handle stress. The result can be an altercation or fall. Solution: Assess people's patterns and devise a dietary plan to offer snacks between meals, advises Partie, director, Therapeutic Options in Newark, DE. Also, if a person tends to get irritable at a certain time of day, adjust her schedule to reduce environmental stressors, Partie suggests.