“TADA!” Tolerate, Anticipate, Don’t Agitate

“T-A-DA”stands for Tolerate behaviors that are challenging, but not dangerous; Anticipate needs of patients who are unable to communicate their needs; and Don’t Agitate patients who are cognitively incapable of processing the reasons why caregivers want to provide care for them which might be misunderstood. It’s taken from a paper written by Dr. Joseph Flaherty on assessment and management of delirium but is applicable to managing challenging behaviors in other age groups with a variety of neuropsychiatric disorders including dementia [1].

Tolerating challenging behaviors can be counterintuitive. Sometimes allowing patients to respond naturally to their environment while watching them can be helpful to give them a sense of control and to get clues about what could be upsetting them.

Anticipating behaviors, like pulling on lines, can be dealt with, for example, by taping a false intravenous (IV) attachment to the nondominant arm as a decoy, or discontinuing lines and catheters that aren’t necessary.

Don’t agitate is a rule that comes from the recognition that there are many agitating events and objects in a hospital. Even reorienting can make a patient mad. So if it doesn’t seem to help—stop doing it. Distracting or humoring the patient may be more helpful.

A video illustrating the clinical application of the principles in hospitalized older patients at risk for delirium can be viewed below:

A similar video for managing older nursing home residents is next;

  1. Flaherty, J. H. (2011). “The evaluation and management of delirium among older persons.” Med Clin North Am 95(3): 555-577, xi. Abstract: This article reviews the pathophysiology, prevalence, incidence, and consequences of delirium, focusing on the evaluation of delirium, the published models of care for prevention in patients at risk of delirium, and management of patients for whom delirium is not preventable. Evidence on why physical restraints should not be used for patients with delirium is reviewed. Current available evidence on antipyschotics does not support the role for the general use in the treatment of delirium. An example of a restraint-free, nonpharmacologic management approach [called the TADA approach (tolerate, anticipate, and don’t agitate)] is presented.