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March 05, 2021 Behaviour Supports for Seniors: A Spoonful of Sugar
By Marilyn White Campbell – Behaviour Support Addictions Specialist
The Behaviour Supports for Seniors program (BSSP) for TC-LHIN , housed at Baycrest, is a provincially funded program which recognizes that all behaviour has meaning and that responsive behaviours are often a form of communication of an unmet need.
Disturbances of perception, thought content, mood, or behaviour form, define behavioural and psychological symptoms of dementia (BPSD). It is estimated that up to 90% of people living with dementia will experience BPSD during the course of the disease. BPSD can include aggression, irritability, and anxiety, and have been shown to increase caregiver burden and stress, as well as higher utilization of healthcare services.
Throughout the pandemic the Behaviour Support clinicians at TC-LHIN have continued to provide support virtually and physically within the community, in acute care and in nursing home environments to support clients with dementia and their families, as well as coach staff in managing these challenging situations.
Marilyn White is a BSO Addictions Specialist in long-term care homes (LTCHs). She supports homes in managing responsive behaviours related to addictions. She has been instrumental in helping LTCHs through the COVID-19 pandemic manage smoking cessation - especially with clients who suffer from dementia. Below, she shares an example of how her work is helping people who suffer from dementia cope during the pandemic.
Residents of LTCHs who smoke and are required to be in isolation due to COVID-19 present a particular challenge. Those who are able to self-regulate their nicotine intake by taking hourly smoke breaks are being asked to not take smoke breaks and instead isolate in their rooms.
Jane* had a 43-year history of smoking before she moved to a LTCH. She was able to cut down from 25 cigarettes per day to five. When she became COVID positive, she was no longer able to go out to smoke. Her smoking levels were quite low and she was offered a variety of options to support smoking cessation while she was in quarantine. Some of the nicotine replacement products were discussed with Jane, including use of sugar to help with cravings.
Jane was neither diabetic nor was she overweight. It was suggested that having a lollipop would help her cope with the hand-to-mouth repetitive motion which she got from smoking, while the sugar would help curb her craving for nicotine. In the end, Jane was able to stay in isolation without smoking by using lollipops. She had social interaction with the staff, as they would drop by to see how she was doing and to ask if she wanted a lollipop. This “spoonful of sugar helped the medicine go down in the most delightful way” and without negative consequences for the resident.
Other residents, while in isolation, have seen success using nicotine spray, lozenges, or gum as long as they can self-administer and self-regulate with direction on dosing.  
*A pseudonym has been used to protect the privacy of the resident.
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