AC FFC Tidbit of the Week: DICE–An Approach to Behavior Assessment & Management in Patients with Dementia

As you care for patients with dementia, learning what can trigger challenging behaviors such as aggression, agitation, and yelling out can go a long way towards helping to prevent them. This week we are introducing “DICE,” a tool you can use to assess and manage behavior change in people with dementia. DICE stands for:

  • Describe the behavior
  • Investigate the influence of things like cognitive status, environment, caregiver approach, physical/medical disorders, and psychiatric symptoms
  • Create a person-centered plan to address the behavior
  • Evaluate if the plan works

(Kales, Gitlin, Lyketsos, 2014, JAGS)

It helps to approach this process as a detective would approach an unsolved mystery.  Just like detectives, nurses and nursing assistants sometimes receive vague and incomplete information, they manage multiple responsibilities, they have developed a good intuition based on experience and familiarity, and may have to prove their case to others in order to move forward with an intervention.

The first step, effectively describing a person’s behavior, is critical as it sets the foundation for the investigation. A detailed description of a resident’s behavior should include:

  • Frequency (every week, day, hour, 10 minutes?)
  • Duration (Does the behavior go on for an afternoon? An hour? A few minutes? When does it stop?)
  • Setting (In common area? Shower room? Bedroom?)
  • Who is involved? (Specific caregivers? Other patients? Other staff?)
  • What was happening right before the behavior began?
  • Be specific…just saying someone is “impatient and often agitated” is not enough. Instead, “Patient repeatedly hits call bell before each meal every day, and when the nurse arrives, just mumbles and complains about the food” is far more helpful information. You can probably come up with a few theories of what the problem could be just based on those few details!

We’d like you to spend some time this week discussing with staff how they describe behaviors of patients that need to be addressed. How does being more specific offer additional clues as to the cause of the behavior? Next week we’ll focus on the second step of DICE, Investigation.

Have a great week!

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