Association for Behavior Analysis International

The growing aging population in the United States is accompanied by an increase in both number of older adults with neurocognitive disorder and the number of people experiencing behaviors changes associated with neurocognitive disorder (NCD). Behavioral Gerontology is the "application of behavior analysis and therapy to older adults, ranging from basic behavioral research to clinical applications to organizational issues in service delivery (Adkins & Mathews, 1999; Burgio & Burgio, 1986)" (LeBlanc et al., 2011, p. 472). This symposium will focus on the practice of behavioral gerontology with older adults with NCD, including talks covering data-based interventions to support older adults with NCD, as well as discuss models for behavioral consultation and for informed consent/assent. Intervention studies will include caregiver implemented trial-based functional analysis and function-based treatment, as well as an individualized antecedent-based interventions to increase showering. The importance and future directions for clinical applications with adults with NCD, as well as needs for future research, will be discussed.

Masters level practitioner experience, BCBAs considering expanding into different practice areas

Up to 80% of older adults with neurocognitive disorder engage in behavioral and psychological symptoms of dementia (BPSD; e.g., verbal or physical aggression, wandering) in nursing home facilities (Toot et al., 2017). In nursing home facilities, health professionals often use a medical model to provide behavioral support. The medical model, however, does not consider the environmental factors that may be evoking and maintaining behaviors; it is also likely that pharmacological interventions are often prescribed to manage the behaviors (Baker et al., 2015). Given the adverse effects of pharmacological interventions, researchers have advocated for behavioral and function-based interventions for the management and treatment of BPSD (Dyer et al., 2017). Unfortunately, the behavioral approach to treatment is not widely adopted in nursing home settings. Thus, behavioral gerontologists are faced with having to provide behavioral consultation in a medical model setting. The purpose of the current study is twofold: 1) to provide a framework for providing behavioral consultation in these settings and 2) to provide examples and data related to the different decision points in the model.

The behavioral gerontology literature to date has focused heavily on research with participants living in long term care facilities, yet the vast majority of people diagnosed with dementia live at home in the community. The purpose of this talk is to share the process and results from clinical work conducted in the home of a 79 year old woman living with Alzheimer’s disease who was supported by her 81 year old spouse. The client was referred for behavioral services due to a failure to shower for multiple months. Her spouse was supported to implement a simple and effective prompting procedure that utilised subtle verbal discriminative stimuli that resulted in increased showering behavior and preserved the client’s dignity. Maintenance probes demonstrated that the changes were generalized over time. I will discuss the changes that were made to data collection procedure and the method to ensure good contextual fit along with the importance of flexible and compassionate practice when working clients in the community living with dementia. This research demonstrates real-life behavior-analytic practice with older adults with dementia living in their own homes with a focus on practice that has strong contextual fit.

Alzheimer's disease is the most common form of dementia. It accounts for 60% to 80% of all dementia cases. Over 80% of dementia sufferers exhibit at least one or more troublesome behaviors. Individuals are frequently medicated to manage such behavioral problems or agitation. These medications often come with severe side effects and risks of mortality that may make their use contraindicated and often do not address the need served by behavioral problems. Initial research suggests that functional assessment methodology may be viable for assessing problem behavior, leading to nonpharmacological treatment and more effective function-based intervention with this population. Additionally, many problem behaviors only occur in the presence of caregivers and staff. Therefore, the current study aimed to extend the Trial-Based Functional Analysis (TBFA) procedures to challenging behaviors in older adults with Alzheimer’s disease or other dementias. Caregivers were trained to implement the TBFA procedures and received in situ feedback as needed. The results suggest that caregiver training in TBFA procedures was effective and demonstrated behavioral functions for the challenging behavior of all four participants. This study adds to the small but growing body of evidence supporting the use of functional analysis technology with adults with dementia, specifically Alzheimer’s disease.