Tessa Perrin - Problem Behaviour and Care Of Elderly People
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Winslow Press Limited, Telford Road, Bicester, Oxon OX6 0TS, UK T Perrin, 1996
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission in writing from the copyright owner.
002-1789/Printed in the United Kingdom
British Library Cataloguing in Publication Data
Perrin, Tessa Problem behaviour and the care of elderly people I. Aged - Care 2. Aged - Psychology 3. Aged - Mental health I.Title 362.6
ISBN 0-86388-148-3
Page iii
CONTENTS
Preface
v
Introduction
vii
Part One
1 Operant Conditioning
3
2 Applied Behaviour Analysis
6
3 Behaviour Modification
9
4 The Constructional Approach
14
5 Individualized Treatment
20
6 The Individual Care Plan
23
7 Single System Methodology
26
Part Two
Introduction to Methodology
35
8 Observation & Data Collection
40
9 Inter-observer Reliability
56
10 Formulation of a Hypothesis of Functional Relationship
66
11 Design of Analogue Conditions
89
12 Intervention
100
13 Inspection, Maintenance & Evaluation
112
Conclusion
125
Bibliography
129
Index
134
Page iv
ABOUT THE AUTHOR
Tessa Perrin is employed by Essex County Social Services Department as senior practitioner occupational therapist, Services to Elderly People. She is currently on secondment to the University of Bradford Dementia Group, where she is undertaking a three-year research project investigating the role and value of occupation in advanced dementia.
Page v
PREFACE
It is an exciting time to be working in the psychological care of elderly people. Today, in contrast to 20 or even 10 years ago, there is a sense of purpose and hope alive amongst those who deal in their care.
My introduction to this field, as a volunteer visitor to elderly people during the mid-1960s I found shocking and rather harrowing. It was my first experience of geriatric hospitals and wards, some of which had progressed but little from workhouse days. One hospital I visited had in fact been the local workhouse for the area. Even the course of years and progress had not enabled it to shed its Victorian institutional mentality: barn-like wards of 40 beds, with maybe 18 inches between them; two nurses, rarely in evidence; high windows; British Rail-coloured walls; no occupational therapy; no day room. I well remember, too, the profound emotional impact at this time of reading Sans Everything: A Case to Answer (Robb, 1967), an expos of abuse of elderly people in institutional care, much of which endorsed my own experience.
Thankfully, we have moved on. Whilst I am sure that there are still pockets of abuse of elderly people in both health and residential care, I do believe that quality of care over the intervening years has changed out of all recognition. By and large, the harshness of custodial care has given way to a humanitarian concern and compassion. In particular, the increased prevalence of dementia in recent years has forced us to look hard at ways of managing the problems of confusion, disorientation and behavioural disorder. There has been a dramatic increase in research, not only into the ageing process itself, but also into methods of treatment and management of the problems of ageing. New treatment strategies have been proposed, developed and evaluated. Occupational therapy and clinical psychology have begun to take a greater interest in research and treatment than ever before. And the last decade has seen a new demonstration of governmental recognition of individual rights in health care.
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