Appendix E

Physiological Causes for Behavior Problems

 Sometimes an elderly patient’s problem behavior is caused by non-psychiatric reasons.  To avoid the unnecessary use of an antipsychotic or other psychotropic medication that has deleterious effects on the elderly, use the following checklist to determine if there is any cause for the resident’s behavior other than psychosis or another psychiatric disorder. Keep a copy of this checklist in your three-ring binder.

Physical Conditions:
 
       Pain
       Fracture
       Recent injury due to fall or trauma (major/minor)
       Chronic disease (arthritis, peptic ulcer disease, chronic obstructive pulmonary disease)
 
Bowel/Bladder:
 
         Toileting
         Drying
         Impaction
         Catheter discomfort/pain
        Abdominal distention
        Bladder enlargement
 
      Disease States:
 
        Diabetes (low glucose, high glucose)
         Thyroid abnormalities
       Urinary tract infection
       Respiratory tract infection
       Chronic obstructive pulmonary disease/asthma
       Congestive heart failure
       Peptic ulcer disease
 
    Prescription Medications:
 
       Antianxiety medications (Examples: Valium, Ativan)
       Cardiovascular agents  (heart medications e.g., Digoxin)
       Antidepressants
       Digitalis glycosides (heart medication)
       Xanthines (caffeine)
       Narcotic and non-narcotic analgesics
       H2 blockers (heart medication)
       Recent change in medications
       Antipsychotics/anticholinergic agents (Examples: Risperdal, over-the-counter allergy medications)
 
    Over-the-Counter Medications:
 
       Anticholinergic agents
        Antihistamines
 
    Environmental Factors:
 
       Change in environment/strange environment
      Change in roommate
      Death/absence of a spouse
      Stress
      Too much noise/light
 
    Nutrition:
 
     Hunger
     Thirst
 
     Eyes, Ears:
  
     Decreased vision
     Decreased hearing
  
        Metabolic States:
 
      Abnormal electrolytes (sodium, potassium)
      Blood gases (CO2)
 
       Neurological Deficits:
 
      Stroke
      TIA (mini-stroke)
      Seizure activity
      Tumor
      Trauma
 

       Depression:
 
      Agitation
      Irritability
      Isolation (wish to be left alone)
      Insomnia
      Rule out causes such as caffeine intake, poor sleep habits
 
       Positioning:
 
      Cramped
      Uncomfortable
      Restraints

 

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Taking Charge: Good Medical Care for the Elderly & How to Get It. A Caregiver's Manual in How to Detect, Manage, and Prevent Six Common, Fatal Conditions in the Elderly Patient | Home |Table of Contents | Delirium | Medication Errors | Adverse Drug Reactions | Falls | Dehydration | Protein-Energy Malnutrition | How to Avoid Problems Caused by Under-Staffing in Nursing Homes | How to Handle End-of-Life Decision-Making | Appendices |   Disclaimer

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