Staff Perceptions of Successful management of severe behavioral problems in dementia special care units

Factors that promote successful management of persons with severe behavioral problems in special care units (SCUs) for dementia were evaluated. Using qualitative data from staff interviews conducted in 36 nursing home SCUs, the study examined the relationships among demographic and behavioral characteristics of 70 residents, management techniques of the staff, and family participation in the management of persons with severe behavioral problems. Problem behaviors were often managed successfully in SCUs, although unpredictable aggression was particularly difficult to control and was a common reason for discharge. Use of multiple non-pharmacological techniques was associated with a greater likelihood of successful management, and physical restraints were used as a last resort. SCU staff members also reported that large, physically aggressive men and residents with real or suspected psychiatric comorbidity were especially difficult to manage. Finally, family involvement and support were critical to resident success and often buffered against resident discharge.