Behaviours of Concern and Intervention Strategies

Any behaviour that causes a problem for the person – or for other people by interfering with their rights – or has the potential to cause harm to the person themselves or to others is a behavior of concern. Behaviours of concern range in seriousness from behaviors that transgress social norms and result in embarrassment or emotional distress, to behaviors that result in physical injury or damage to people and property.

General behaviors of concern include:

• Self harm or harm to others, including suicidal ideation
• Refusal to follow instructions
• Destruction of property or belongings
• Verbal or physical aggression
• Repetitive behaviour that is harmful such as biting, hitting, scratching
• Hiding or running away
• Wandering or intrusiveness
• Sleep deprivation
• Problems with eating

Dementia can be associated with various behavioral changes, which can include agitation, aggression, wandering, and resistance to care. These changes can be distressing for both the person with dementia and their caregivers.

Here are some common behavior of concerns and intervention strategies for managing them:

1. Agitation and aggression: People with dementia may become agitated or aggressive due to frustration or confusion. Intervention strategies may include creating a calm and reassuring environment, identifying and addressing triggers for agitation, using distraction techniques, and providing opportunities for physical activity.
2. Wandering: People with dementia may wander away from their home or care facility, which can be dangerous. Intervention strategies may include monitoring the person's whereabouts, providing safe wandering areas, using door alarms or locks, and providing identification bracelets.
3. Resistance to care: People with dementia may resist bathing, dressing, or other aspects of personal care. Intervention strategies may include providing a consistent routine, explaining each step of the process, using positive reinforcement, and adapting the environment to meet the person's needs.
4. Sleep disturbances: People with dementia may experience sleep disturbances, such as waking frequently during the night or sleeping during the day. Intervention strategies may include establishing a consistent bedtime routine, limiting caffeine and alcohol intake, and providing a comfortable sleep environment.
5. Communication difficulties: People with dementia may have difficulty communicating their needs or understanding others. Intervention strategies may include using simple language, avoiding distractions, using nonverbal cues, and maintaining eye contact.

It's important to note that intervention strategies for managing behavioral changes in dementia should be tailored to the individual's needs and preferences. Healthcare professionals, including geriatric psychiatrists, can provide additional guidance on managing challenging behaviors in dementia. A behaviour of concern is any behaviour which causes stress, worry, risk of or actual harm to the person, their carers, staff, family members or those around them. The behaviour deserves consideration and investigation as it is an obstacle to achieving the best quality of life for the person with dementia and may present an occupational health or safety concern for staff. -Dementia Behaviour Management Advisory Services.

Triggers and other contributing factors

Assessment is a crucial stage in managing behaviours of concern and reducing their impact on the person and others around them. When you are assessing behaviours of concern, it is important to take a holistic approach and consider all possible triggers and contributing factors, including:

• Physical health
• Medication
• Environment
• Social and emotional history
• Communication

Triggers

A behavioural ‘trigger’ can be any event, action, experience/sensation, thought or emotion that elicits a particular behavioural response. You can identify a behavioural trigger by observing what usually or consistently happens immediately before the behaviour (taking baseline recordings).

For example, if the person consistently cries or shouts immediately after hearing a loud noise, it is likely that loud noises trigger the shouting. If the person usually or consistently becomes agitated when asked to carry out a specific task or activity, it is likely that particular activity triggers their agitation. Triggers can also be identified and used to elicit desirable behaviour. We use verbal requests and reminders, or non-verbal physical prompts to remind or cue the person to do something, for example, touching a person’s arm to remind them to lift their arms when they are dressing; or showing the person a fork with food on it to remind them to open their mouth at mealtimes.

Triggers in Physical Environments

Many people living with dementia become agitated and confused, and exhibit behaviours of concern when features of the physical environment change or disturb them. Bright lights (or darkness), loud noises (or absence of familiar, enjoyable sounds), heat or cold, high levels of activity and lots of people can all trigger behaviours of concern.

Some forms of dementia can make people hypersensitive to changes in light or noise levels, or the presence of too many people. Moving furniture out of familiar positions can also have this effect, as dementia can lead a person to experience confusion about where they are and their surroundings, and changes in the appearance of surroundings can be hard to comprehend and lead to feelings of insecurity.

Triggers in Social Environment

Changes within the person’s social environment, including meeting new people, being in crowded places or unfamiliar social situations, and being expected to conform to social norms that the person may have forgotten, can all contribute to behaviours of concern. Forgetting or being unfamiliar with social expectations, forgetting people’s names and relationships, and being surrounded by too many people can result in feelings of fear, insecurity, confusion, embarrassment and shame, which can lead to behaviours of concern.

Internal Physical Triggers

Behaviours of concern can be elicited by physical discomfort or pain caused by hunger, thirst, cold or heat, pain and nausea. In this case, the behaviour of concern is often directed at getting physical needs met. Dementia itself can affect the body’s physical health, and changes to the brain can also result in a range of symptoms.

Delirium

Delirium is a state of confusion in which a person becomes detached from reality and can experience vivid sensations and events that are not actually happening. Delirium can result from a range of factors and conditions, including infection, dehydration, sleep issues, depression , chronic pain ect.

Emotional and Psychological Triggers

Emotional and psychological triggers include strong feelings, such as anger, frustration, despair, humiliation, insecurity, fear and grief. These emotions may result from the person’s awareness of their deteriorating capacities, loss of significant roles and loss of relationships; and from the responses and reactions of people around them. Distress arising from such emotions can lead to the display of behaviours of concern.

Communication

Communication can be a key factor in behaviours of concern. The person living with dementia may experience barriers to communication such as short term memory loss, language difficulties (being unable to ‘find the right word’), sensory losses and loss of motor control over speech organs. These barriers can lead to frustration, which can be expressed in behaviours of concern. The way in which other people communicate with the person living with dementia is also a key factor. Being spoken to as if the person were a child, or lacked intelligence, or were unimportant, can trigger angry outbursts or withdrawal into depression and despair. Being asked to do a task that is outside the person’s ‘comfort zone’ can have a similar effect. Negative attitudes are often expressed through non-verbal means, so you will need to be aware of the non-verbal messages that you send to your clients.

Resource

Read about identifying the causes of behaviours of concern related to dementia at the following links: ‘Finding the Causes of Challenging Behaviour: Part 2’ from the Challenging Behaviour Foundation 

Unmet needs

Unmet needs can be defined as any need or desire that is not being adequately met by the person's current care or environment. Here are some ways in which unmet needs can contribute to the progression of dementia:

• Behavioral symptoms: People with dementia may experience behavioral symptoms such as agitation, aggression, and wandering, which can be challenging to manage. These behaviors may be a result of unmet needs such as pain, hunger, thirst, or boredom. Failure to address these needs can exacerbate these behaviors and lead to further decline in cognitive and functional abilities.
• Psychological symptoms: People with dementia may also experience psychological symptoms such as depression, anxiety, and social withdrawal. These symptoms can be a result of unmet needs such as social interaction, meaningful activities, or a sense of purpose. Failure to address these needs can lead to further psychological distress and cognitive decline.
• Caregiver burden: Caregivers of people with dementia may experience significant burden and stress, which can lead to burnout and physical and mental health problems. Unmet needs of the person with dementia can contribute to caregiver burden by increasing the demands of care and reducing the caregiver's ability to meet their own needs.

It's important for caregivers and healthcare professionals to identify and address the unmet needs of people with dementia, as this can improve their quality of life and reduce the progression of the condition. This can involve a person-centered approach that takes into account the individual needs, preferences, and abilities of the person with dementia and involves the person in decisions about their care and support.

Case study on Analysing and Managing unmet need of an 80 year old client

Mrs. Smith is an 80-year-old woman with moderate dementia who lives in a residential aged care facility. Over the past few weeks, she has been increasingly agitated and restless, often wandering around the facility and becoming upset when staff members try to redirect her. She has also been refusing meals and becoming combative with caregivers during personal care activities.

Analysis

Mrs. Smith's behavior is an indicator of unmet needs. Her agitation and restlessness may be a result of unmet needs such as a lack of social interaction, meaningful activities, or purpose. She may also be experiencing pain or discomfort, which is causing her to wander and become upset when staff members try to redirect her. Her refusal of meals and combative behavior during personal care activities may be a result of unmet needs such as hunger, thirst, or a desire for more control over her daily activities.

Intervention

To address Mrs. Smith's unmet needs, a person-centered approach should be taken. This involves identifying and addressing the individual needs and preferences of the person with dementia.

The following interventions may be appropriate:

1. Increase social interaction: Encourage Mrs. Smith to participate in group activities and spend time with other residents. This can help to reduce her restlessness and provide her with a sense of purpose.
2. Address pain and discomfort: Ensure that Mrs. Smith's physical needs are being met, such as providing adequate pain management and addressing any medical issues that may be causing her discomfort.
3. Provide choice and control: Allow Mrs. Smith to make choices about her daily activities and routines, as this can help to reduce her feelings of frustration and increase her sense of control.
4. Address hunger and thirst: Ensure that Mrs. Smith is receiving adequate nutrition and hydration, and consider offering her smaller, more frequent meals throughout the day.
5. Provide individualized care: Work with Mrs. Smith's caregivers to develop a care plan that takes into account her individual needs and preferences, and involve her in decisions about her care and support.

By addressing Mrs. Smith's unmet needs, it is hoped that her behavior will improve, and she will experience an improved quality of life.

The impact of environment on people with dementia

The environment plays a significant role in the well-being and quality of life of people with dementia. Environmental factors can impact cognitive and behavioral symptoms, as well as the ability of people with dementia to perform daily activities and maintain social connections.

Here are some ways in which the environment can affect people with dementia:

1. Orientation: People with dementia may experience confusion and disorientation, which can be exacerbated by environmental factors such as poor lighting, unfamiliar surroundings, and a lack of visual cues. An environment that is familiar, well-lit, and provides clear visual cues can help to reduce confusion and disorientation.
2. Safety: People with dementia may be at risk of falls, wandering, and other safety hazards. The environment should be designed to minimize these risks, with features such as clear pathways, secure exits, and non-slip flooring.
3. Social interaction: Social isolation can contribute to cognitive and functional decline in people with dementia. The environment should provide opportunities for social interaction, such as communal living spaces and activities that encourage engagement and socialization.
4. Privacy and autonomy: People with dementia may experience a loss of privacy and autonomy, which can be compounded by environmental factors such as a lack of personal space and overstimulation. The environment should provide opportunities for privacy and autonomy, such as private bedrooms and spaces for personal belongings.
5. Sensory stimulation: People with dementia may experience sensory changes, such as a reduced ability to perceive visual and auditory cues. The environment should be designed to provide appropriate sensory stimulation, such as contrasting colors and textures, and avoid overstimulation.

By designing environments that are supportive of the needs of people with dementia, it is possible to improve their quality of life and reduce the progression of the condition.

There is a wide range of strategies available to address and manage behaviours of concern and to minimise their impact on the person and others. As mentioned earlier, using a holistic approach and selecting evidence-based interventions is important for ensuring that the strategies you choose are effective, improving the person’s quality of life and reducing the impact of the behaviour on others. Promoting the wellbeing of the person living with dementia should be your primary consideration.

Key considerations in choosing management strategies:

• Choosing the best approach to meet persons needs
• Setting realistic goals 
• Using a combination of interventions such as pharmacological and psychological interventions
• Monitoring, reviewing and evaluating progress

De-escalation Strategies

De-escalating situations where there is aggression and conflict is a basic BOC management strategy. De-escalation means acting to reduce the degree of aggressive behaviour and prevent or resolve conflicts. Communication is a key element in de-escalation strategies and techniques, with a strong focus on nonverbal communication.

Guidelines for de-escalating aggressive behaviour and conflict:

• Use the person’s name and speak calmly, reassuringly. Keep instructions or requests simple and use assertive communication techniques, such as stating directly how you feel and what you want, while showing respect for the other person and their rights.
• Avoid verbal confrontation – avoid saying ‘no’ or ‘you can’t do that’, and do not challenge the person.
• Try to have only one person speaking at a time. Do not shout or raise your voice.
• Acknowledge the person’s feelings.
• Treat the person with respect.
• Address or try to rectify whatever caused or triggered the aggression.
• Redirect the person’s attention to a more pleasurable activity, such as going for a walk, having a cup of tea or engaging in an activity that the person enjoys. Keep yourself safe – stay out of reach if you feel threatened. If necessary, remove yourself and others at risk and leave the person alone to calm down.
• Check and use management strategies already in use with the person, and make sure others also know which strategies to use.
• Use non-aggressive body language – stand at an angle to the person, not squarely in front of them.
• Maintain appropriate eye contact, but do not stare.
• Breathe calmly.

In addition, the Dementia Behaviour Management Advisory Service (DBMAS) helps staff and carers to support people living with dementia experiencing changes to their behaviour by providing assessment, clinical support, care planning, mentoring, linking to current research and a 24-hour help line.

They partner with:

• Dementia Support Australia who is the national provider of DBMAS
• Dementia and Aged Care Services Fund; and
• The Severe Behaviour Response Teams

Restrictive practices in dementia refer to the use of physical, chemical, or environmental restraints to manage challenging behaviors in people with dementia. A restrictive practice is any practice that restricts a person's freedom of movement or choice, and can include the use of physical restraints, sedatives, bed rails, or other devices. These practices can have negative effects on a person's well-being and quality of life, and therefore should be used only as a last resort when all other options have been exhausted.

Here are some examples of restrictive practices in dementia:

1. Physical restraints: This can include the use of bedrails, chair alarms, or other devices to prevent a person with dementia from getting out of bed or chair.
2. Chemical restraints: This involves the use of medications, such as antipsychotics or sedatives, to control behavior or calm a person with dementia.
3. Environmental restraints: This can include the use of locked doors or gates to prevent a person with dementia from wandering.

It's important to note that these practices are generally not recommended in the care of people with dementia, as they can cause physical and psychological harm. Instead, healthcare professionals should use a person-centered approach that focuses on identifying the underlying causes of challenging behaviors and developing individualized strategies to manage them.

Legislative, regulatory requirements and ethical considerations for restrictive practices

In Australia, the use of restrictive practices in aged care is governed by legislative and regulatory requirements. These requirements are designed to protect the rights and dignity of people receiving care and to ensure that any use of restrictive practices is necessary and appropriate.

Here are some key legislative and regulatory requirements for restrictive practices in Australia:

1. Aged Care Quality Standards: The Aged Care Quality Standards set out the expectations for quality care and services in residential aged care. Standard 3 requires that providers ensure that the care and services provided are safe and free from abuse and neglect, including the inappropriate use of restrictive practices.
2. Aged Care Act 1997: The Aged Care Act 1997 provides the legislative framework for the provision of aged care in Australia. The Act includes provisions that restrict the use of restrictive practices and require providers to have policies and procedures in place for the use of such practices.
3. National Framework for Action on Dementia: The National Framework for Action on Dementia provides a framework for improving the quality of care and support for people with dementia in Australia. The framework emphasizes the importance of person-centered care and the need to avoid the inappropriate use of restrictive practices.
4. State and Territory Legislation: Each state and territory in Australia has its own legislation and regulations governing the use of restrictive practices in aged care. For example, in Victoria, the Use of Restraints in Residential Aged Care Facilities Policy sets out the requirements for the use of restraints and the need to use them as a last resort.

It's important for aged care providers and staff to be aware of these legislative and regulatory requirements and to ensure that any use of restrictive practices is necessary and appropriate, and in compliance with these requirements.

Ethical considerations

The use of restrictive practices in Australia for people living with dementia raises several ethical considerations. Restrictive practices refer to any intervention that restricts an individual's freedom of movement, access to goods or services, or their ability to make choices. These practices are often used to manage difficult behaviors in individuals with dementia, such as wandering, aggression, or agitation.

1. One ethical consideration is the potential violation of human rights. Restrictive practices can impede an individual's autonomy and dignity, as they limit their ability to make decisions and move freely. People with dementia have the same rights as any other individual, including the right to dignity, privacy, and freedom from abuse or neglect. The use of restrictive practices must be carefully considered and implemented to ensure that these rights are not violated.
2. Another ethical consideration is the potential for harm. Restrictive practices can be physically and emotionally harmful to individuals with dementia. For example, physical restraints can cause pain, injury, and even death. The use of chemical restraints can lead to sedation, confusion, and other adverse effects. These potential harms must be carefully weighed against the benefits of using restrictive practices.
3. Furthermore, there is a risk that restrictive practices may be overused or used inappropriately. In some cases, these practices may be used simply as a convenience for staff or caregivers, rather than as a last resort to manage difficult behaviors.

It is essential to ensure that restrictive practices are only used when absolutely necessary and that less restrictive alternatives are considered first. In conclusion, the use of restrictive practices in Australia for people living with dementia requires careful consideration of ethical principles. The potential violation of human rights, potential harm, and the risk of overuse must all be taken into account when deciding whether to use restrictive practices. It is essential to ensure that individuals with dementia are treated with dignity, respect, and compassion and that their rights are protected at all times.

Organizational policies and procedures relating to restrictive practices

Here are common requirements that govern the use of restrictive practices across all jurisdictions in Australia.

1. Informed consent: Before any restrictive practice is applied, the person receiving care must provide their informed consent, or the consent of their substitute decision-maker if they are unable to provide consent. This includes being informed of the risks and benefits of the practice, as well as any alternatives.
2. Use of least restrictive alternative: Restrictive practices should only be used when no other alternative is available, and the practice should be the least restrictive alternative that is appropriate for the person's needs.
3. Monitoring and review: Any use of restrictive practices must be closely monitored and regularly reviewed to ensure they are still necessary and appropriate. This includes ensuring that the practice is achieving its intended purpose and that it is not causing harm or distress to the person.
4. Training and education: All staff involved in the use of restrictive practices must receive appropriate training and education on the risks and benefits of these practices, as well as alternatives and how to implement them.
5. Reporting and recording: Any use of restrictive practices must be reported and recorded in the person's medical records, and this information must be accessible to relevant staff and authorities as needed.
6. Rights and advocacy: People receiving care have the right to access advocacy and support services to assist them in making decisions about their care, including decisions about the use of restrictive practices.
7. National guidelines: In addition to state and territory legislation and regulations, there are also national guidelines and codes of practice that provide guidance on the use of restrictive practices in healthcare, such as the National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector. Organisational policies and procedures should reference the above requirements in relation to use of restrictive practices.

Organizational policies and procedures related to restrictive practices should outline the circumstances in which these practices may be used, the types of restrictive practices that may be used, the conditions under which they may be used, and the monitoring and review processes that must be followed.

Here is an example of such a policy:

Policy on the Use of Restrictive Practices in Aged Care Facilities Purpose: To provide guidance to staff and caregivers on the use of restrictive practices in managing the behavior of residents in aged care facilities.

Scope: This policy applies to all staff and caregivers involved in the care of residents in aged care facilities.

Policy Statement: The use of restrictive practices should be avoided wherever possible. Restrictive practices may only be used when all other less restrictive alternatives have been tried and have failed.

Types of Restrictive Practices:

• Physical Restraints: Physical restraints may only be used as a last resort and only when necessary to protect the safety of the resident or others.
• Chemical Restraints: The use of psychotropic drugs as a form of restraint should be avoided wherever possible. If used, they must be prescribed and monitored by a qualified healthcare professional in accordance with relevant legislation.
• Environmental Restraints: The use of environmental restraints such as locked doors or gates must be minimized and only used when necessary to protect the safety of the resident or others.

Conditions for Use:

1. The use of restrictive practices must be authorized by a qualified healthcare professional.
2. The use of restrictive practices must be documented and reviewed regularly.
3. The resident or their representative must be informed of the use of restrictive practices and their right to appeal against their use.
4. All staff and caregivers involved in the use of restrictive practices must be appropriately trained and qualified.

Monitoring and Review: The use of restrictive practices must be regularly reviewed to ensure that they are being used appropriately and that less restrictive alternatives have been considered.

Documentation

Policies and procedures should outline the documentation required when using restrictive practices, including the reasons for their use, the alternative strategies considered, and the ongoing monitoring of their use. This documentation should be kept in a secure and confidential manner and should be available for review by regulatory bodies as required. Organizations that are carrying out restrictive practices for people living with dementia in Australia are required to keep accurate and up-to-date records to ensure compliance with relevant legislation, standards, and guidelines. Here are some of the documents that may be required:

1. Policy and Procedure Manual: This manual should outline the organization's policy and procedures relating to the use of restrictive practices. It should include information on the types of restrictive practices that may be used, the conditions under which they may be used, and the monitoring and review processes that must be followed.
2. Consent Forms: Before any restrictive practice is used, the resident or their representative must provide informed consent. Consent forms should be completed and signed by the resident or their representative, and a copy should be kept on file.
3. Risk Assessment and Management Plan: A comprehensive risk assessment and management plan should be completed for each resident who is at risk of exhibiting challenging behavior. The plan should include information on the types of restrictive practices that may be used, the conditions under which they may be used, and the less restrictive alternatives that have been tried.
4. Incident Reports: Any incidents related to the use of restrictive practices, such as falls, injuries, or adverse reactions, should be documented in an incident report. The report should include details of the incident, the date and time, the individuals involved, and any action taken.
5. Medical and Medication Records: Medical records should be kept for each resident, including details of any medications prescribed and administered. This information should be used to monitor the use of chemical restraints and ensure compliance with relevant legislation.
6. Staff Training and Qualification Records: Staff members involved in the use of restrictive practices should be appropriately trained and qualified. Records of staff training and qualifications should be kept on file to ensure compliance with relevant standards.
7. Review and Evaluation Reports: The use of restrictive practices should be regularly reviewed and evaluated to ensure that they are being used appropriately and that less restrictive alternatives have been considered. Review and evaluation reports should be completed and kept on file.

These documents should be kept in a secure location and made available for inspection by relevant regulatory bodies. It is essential to ensure that all documentation is accurate, up-to-date, and compliant with relevant legislation, standards, and guidelines.

Implementation of positive strategies

Overall, the goal of using restrictive practices in dementia care should always be to ensure the safety and wellbeing of the individual with dementia, and to minimize their use as much as possible through the implementation of positive strategies. The use of restrictive practices in dementia care should only be considered as a last resort and in accordance with strict ethical and legal guidelines. However, in situations where they are deemed necessary, there are positive strategies that can be used to minimize their impact and ensure the safety and wellbeing of the individual with dementia. Some positive strategies for the use of restrictive practices in dementia care in Australia may include:

1. Developing a comprehensive care plan: A care plan should be developed for each individual with dementia that outlines their specific needs and preferences, as well as any potential triggers that may result in challenging behaviors. This will help to identify appropriate interventions and strategies to prevent and manage challenging behaviors, and to minimize the need for restrictive practices.
2. Implementing non-pharmacological interventions: Non-pharmacological interventions such as sensory stimulation, music therapy, and physical activity can be effective in reducing challenging behaviors and promoting relaxation in individuals with dementia. These strategies should be implemented before considering the use of restrictive practices.
3. Using least restrictive options: When restrictive practices are deemed necessary, it is important to use the least restrictive option possible. For example, instead of using physical restraints, a supportive chair or bed that limits movement may be a better option.
4. Regularly reviewing the use of restrictive practices: The use of restrictive practices should be regularly reviewed to ensure they are still necessary and appropriate. This can help to minimize their use over time and identify alternative strategies to manage challenging behaviors.
5. Providing training and support for staff: Staff working with individuals with dementia should be trained in appropriate communication techniques and strategies for managing challenging behaviors. They should also be provided with ongoing support and supervision to ensure they are using restrictive practices appropriately and ethically.

In people living with dementia it is crucial to ensure that they receive appropriate and timely medical care. Due to the cognitive and communication impairments associated with dementia, it can be challenging to identify these indicators, and it may require close observation and careful documentation.

Here are some processes for recognising and reporting indicators of injury, infection, illness, and pain and the impact on the person's behavior in relation to dementia:

1. Observing and Documenting Behaviors: Staff and caregivers should observe the resident's behavior and document any changes in their behavior, such as increased agitation, restlessness, confusion, or aggression. These changes may be indicative of pain, infection, or illness.
2. Identifying the Source of Discomfort: Staff and caregivers should work to identify the source of the resident's discomfort by conducting a physical examination and assessing the resident's pain levels. They may also review the resident's medical history, medication use, and any recent changes in their environment or routine that may be contributing to their discomfort.
3. Consulting with Medical Professionals: Staff and caregivers should consult with medical professionals, such as doctors, nurses, or pharmacists, to determine the appropriate course of action in response to the resident's indicators of injury, infection, illness, or pain. 4. Reporting to Supervisors: Staff and caregivers should report any indicators of injury, infection, illness, or pain to their supervisors or designated point person immediately. Supervisors should ensure that appropriate medical care is provided, and documentation is maintained.
4. Implementing Care Plan: Once the source of discomfort has been identified, staff and caregivers should implement the appropriate care plan, including medication administration, wound care, or infection control measures.
5. Monitoring and Evaluation: Staff and caregivers should monitor the resident's response to the care plan and evaluate its effectiveness in addressing the indicators of injury, infection, illness, or pain. If necessary, adjustments should be made to the care plan to ensure that the resident's needs are adequately addressed.

In summary, the processes for recognising and reporting indicators of injury, infection, illness, and pain in people living with dementia require careful observation and documentation, consultation with medical professionals, reporting to supervisors, implementing the appropriate care plan, and monitoring and evaluation of the resident's response.

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