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Section 3
Track #3 - Catastrophic Reactions

Question 3 found at the bottom of this page
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On the last track we discussed analyzing behavior.  In order for the caregiver to continue with an ongoing assessment of the patient’s dementia and associated behavior, the following five steps are useful when analyzing behavior.  These five steps regarding analyzing behavior are deciding if the behavior is a problem, what the problem really is, with whom the problem occurs, where the problem occurs, and when the problem occurs.

On this track we will discuss catastrophic reactions.  With Valerie, three methods were beneficial to her as a caregiver regarding dealing with her husband Sam’s catastrophic reactions.  These three methods for dealing with catastrophic reactions are avoiding catastrophic reactions, preparing for catastrophic reactions, and managing catastrophic reactions.

#1  Avoiding Catastrophic Reactions
For Valerie, it was productive to learn about avoiding catastrophic reactions.  Valerie’s husband, Sam, age 68, had dementia.  Sam’s independence often led to frustration as his dementia progressed.  More frequently, Sam’s frustrations began to lead to a catastrophic reaction.  Valerie stated, “Sam always used to drive me everywhere.  Now he gets upset because I have to do the driving.  On the way home from church last week, he blew up.  Sam started arguing with me about my driving.  Then he grabbed the wheel.  I thought I was going to crash.  Instead, I stopped the car, but Sam got out and walked off.  It took me two hours to get him home.”  Would you agree that avoiding a catastrophic reaction is easier for a caregiver than actually having to deal with one?  I have found that communicating with and frequent assessment of the client is key to avoiding a catastrophic reaction.  I stated to Valerie, “If you see Sam frowning, looking anxious, or wringing his hands, don’t wait to see what happens.  Try to manage the situation before it gets any worse.  You can use positive interaction skills and difficult behavior approaches to avoid catastrophic reactions.”  Think of your Sam.  Does he or she show warning signs prior to a catastrophic reaction?  How could positive interaction skills and difficult behavior approaches, as discussed on the last two tracks help the caregiver of your client regarding avoiding catastrophic reactions?

#2  Preparing for Catastrophic Reactions
For Valerie, the second method for dealing with Sam’s catastrophic reactions was to prepare.  When discussing preparing for catastrophic reactions with Valerie I stated, “Because you have experienced Sam wandering, you may find it helpful to be prepared the next time that happens.  Consider educating friend and neighbors in case you need their help.  By keeping a cell phone, you can act quickly to get the help you need.  Also, some caregivers use cards that state, ‘The person I am looking for has dementia or Alzheimer’s.  I need help.  Please call me if you have any information.’”  Then, Valerie I also suggested to Valerie that, in addition to educating friends and neighbors, keeping a cell phone, and using cards, she could consider registering with the Alzheimer’s Association Safe Return Program.  Do you agree?

#3  Managing Catastrophic Reactions
Though Valerie worked toward avoiding catastrophic reactions and though she prepared for catastrophic reactions, it was productive to help her learn to manage Sam’s catastrophic reactions.  As you listen to the 9 steps for managing catastrophic reactions, consider ways to apply the information to the caregiver of your client.  Here is step 1 as I explained to Valerie. 
“Reassure Sam.  Act, look, and sound relaxed and calm.  If he is acting violent, reassure him from a distance.” 
2.  “Reduce as many outside stimulations and hazards as possible.  Irritating noises can exacerbate a catastrophic reaction.  Removing harmful objects like scissors or hot coffee can help ensure everyone’s safety.”
3.  “If you can’t reduce stimulation or remove hazards, consider removing Sam, if possible, without agitating him further.”
4.  “Reassure Sam again.  If you can, use a gentle touch.”
5.  “Redirect Sam to an easy, soothing activity in a quiet area.”
6.  “Be patient.  Waiting on Sam’s catastrophic reaction to stop can seem to take forever.”
7.  “If you are unable to stop Sam’s catastrophic reaction, or if his anger is directed at you, leave Sam alone if it is safe.  Preferably, when you leave Sam alone, he should not be able to detect your presence, but you should still be able to monitor his activities.  The point is to remove yourself enough so that you don’t  become part of the problem or a greater part of the problem.” 
8.  “When Sam calms down, don’t address his catastrophic reaction.  Asking questions like ‘Why were you angry?’ or ‘Why did you yell at me?’ may only confuse Sam.  I know it hurts when you are doing your best and Sam lashes out at you.  However, try to keep in mind that it is the disease talking.  Sam can’t help it and may not even remember the incident afterwards.”
9.  “After Sam’s catastrophic reaction is over, think about it.  Analyze the reaction to discover the causes and decide it there is anything you can do to prevent it from happening again.” 

In addition to explaining the 9 steps for managing catastrophic reactions, I also stressed to Valerie the importance of ensuring the immediate well-being and safety of both her and Sam during a catastrophic reaction.  Think of your Sam.  If your aging client has experienced a catastrophic reaction, could the 9 steps for managing catastrophic reactions help eliminate the dangerous aspects of the reaction?  Could playing this track for the caregiver of your client benefit him or her? 

On this track we have discussed catastrophic reactions.  With Valerie, three methods were beneficial to her as a caregiver regarding dealing with her husband Sam’s catastrophic reactions.  These three methods for dealing with catastrophic reactions are avoiding catastrophic reactions, preparing for catastrophic reactions, and managing catastrophic reactions.

On the next track we will discuss excess disability.  Key factors regarding excess disability concerning dementia related cases are understanding excess disability and how to avoid excess disability through identifying problems and finding the right approaches.

QUESTION 3
What are 9 steps for managing catastrophic reactions? To select and enter your answer go to Answer Booklet