Online Intervention on Challenge Behaviors of People with Dementia

Abstract

Behavioral interventions based on functional analysis are considered the first-line non-pharmacological treatment for challenging behaviors in people with dementia (PwD), yet they are not widely available, particularly in middle- and low-income countries with limitations in public healthcare infrastructure. Telehealth interventions may offer an accessible alternative, but few studies have evaluated this type of care. This study aimed to test an online intervention for managing challenging behaviors in PwD, targeting their caregivers. A multiple-baseline design across behaviors, replicated across participants, was employed. Three female caregivers (aged 31 to 50; daughters and daughter-in-law of PwD) participated in an online intervention protocol that included initial interviews, selection of target behaviors, baseline recording, intervention planning, implementation, and follow-up. Three target behaviors were selected per participant. For Case 1: repeated requests to leave, refusal to bathe, and aggression; for Case 2: self-injurious behavior and agitation followed by requests to leave; and for Case 3: refusal to bathe, repetitive questioning, and asking who family members were. All target behaviors were considered behavioral excesses, and the intervention aimed to reduce their frequency. Interventions focused on altering antecedents to prevent the occurrence of the target behaviors. Caregivers recorded the frequency of target behaviors during baseline and intervention phases, sending this data to the researcher via text messages. The interventions lasted between 19 and 33 sessions and included, in addition to initial interviews, changes in the way caregivers made requests, offering meaningful activities during times when challenging behaviors typically occurred, and creating a memory book with biographical and household routine information. A reduction in the frequency of all target behaviors was observed, except for repeated questioning about family members (Case 3) and requests to leave (Case 2). Caregivers demonstrated engagement with the proposed procedures and expressed satisfaction with the results. The online intervention proved effective in training caregivers to manage most challenging behaviors. However, it is crucial that such interventions are implemented in a way that does not further burden caregivers’ routines. Moreover, maintaining an open channel of communication between the therapist and caregiver is essential to promptly address any questions or difficulties that may arise.