No Easy Solutions But Improvement Is Usually Possible
As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.
Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.
If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.
But I hope this information will enable you to make more informed decisions. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.
To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors
And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.
Coping With Agitation And Aggression In Alzheimer’s Disease
People with Alzheimers disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless or worried. He or she doesnt seem to be able to settle down. Agitation may cause pacing, sleeplessness, or aggression, which is when a person lashes out verbally or tries to hit or hurt someone.
What To Do About It
Family members or caregivers in these situations are the best ones to observe the patient and try to take steps to keep him or her from injuring themselves or others. At the same time, they also are closest target which puts them at a higher risk for physical or verbal harm.
Consider taking some of these steps to minimize possible disruptive aggressive behavior:
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The Rules In Relationships Change With Dementia
If youre spending time with someone whos experiencing dementia, you can avoid the dementia anger stage , but only if you become more aware of whats causing it. When dementia comes into a relationship, the rules change. A relationship including dementia is different from any youve experienced before. You will need to understand the cognitive skills we all normally useand then which ones we continue using when were experiencing dementia.
In my first article in this series , I described our two thinking systems and explained the most frustrating rational thinking losses caused by dementia. I also described our intuitive thinking skillsthose that we continue using. It will be helpful to read that article first if you havent yet.
Tips For Managing Alzheimers Aggression
Getting to the root cause of outbursts can help caregivers manage dementia-related behaviors more effectively and may lessen the frequency of agitation and aggression.
The advantage family members have when they become caregivers for their aging parents is knowing their likes and dislikes. Things that annoyed or frustrated them in the past will most likely continue to do so. These known triggers are then complicated by new challenges caused by the progression of the disease.
Learning to redirect their attention and having open and honest conversations with other family members and health care providers can be of great assistance. Support groups can offer an outlet for frustrations as well as new information on this condition and creative ideas on how to deal with common behaviors and situations.
Most importantly, patience is key for everyone involved. Providing care for someone with dementia is hard work. When frustration mounts, look to the advice of experienced caregivers to help you cope: Dementia Caregiving Tips from Teepa Snow.
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In The Aftermath Of These Momentsself
These aggressive moments with someone with Alzheimers can be stressful for a caregiver. In the aftermath of these moments, remember to find the time for yourself as a caregiver, to retreat, to reflect, and to decompress from the height of the event. Such time will give you the chance to find the calm and self-assurance to continue doing the important work you do for your care recipient.
* The names and details were changed to protect privacy.
- Resources
Body Languagestop And Face Them
Next, we have to think about posture. When someone lacks memory skills, it changes how they interpret gesture and posture. Suppose Im making sandwiches for lunch and my husband walks into the kitchen and asks what Im doing. If he isnt experiencing dementia, I dont need to stop and turn around to face him. I can simply direct a brief answer over my shoulder, because if hes not experiencing dementia our previous conversations and exchanges will be there in his mind to temper my lack of attention during this moment.
However, if hes experiencing dementia, he will by default interpret my posture as dismissive, because for him its our first interaction and for him my posture will speak louder than my words. So, if my husband is experiencing dementia I need to pause and turn to look at himand make eye contactto avoid inadvertently hurting his feelings.
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What Are The Final Stages Of Dementia Before Death
Will Care Homes Take Aggressive Dementia Patients
Some residents with advanced dementia may exhibit challenging behaviors, such as aggression. We understand these behaviors can occur that is why we have trained our caregivers on how to support this. people with Dementia, care homes play a vital role of offering expert care as well as providing a range of services such as support for family.
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Understanding Alzheimers Or Dementia Behavior Problems
One of the major challenges of caring for a loved one with Alzheimers or another dementia is coping with the troubling behavior and personality changes that often occur. Aggressiveness, hallucinations, wandering, or eating or sleeping difficulties can be upsetting and make your role as caregiver even more difficult. Whatever problems youre dealing with, its important to remember that the person with dementia is not being deliberately difficult. Often, your loved ones behavioral issues are made worse by their environment, their inability to deal with stress, or their frustrated attempts to communicate.
As you try to identify the causes, its important to remember that a patient with dementia responds to your facial expression, tone of voice, and body language far more than the words that you choose. So, use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. And rather than take problem behaviors personally, do your best to maintain your sense of humor.
Common Changes In Behaviour
In the middle to later stages of most types of dementia, a person may start to behave differently. This can be distressing for both the person with dementia and those who care for them.
Some common changes in behaviour include:
- repeating the same question or activity over and over again
- restlessness, like pacing up and down, wandering and fidgeting
- night-time waking and sleep disturbance
- following a partner or spouse around everywhere
- loss of self-confidence, which may show as apathy or disinterest in their usual activities
If you’re caring for someone who’s showing these behaviours, it’s important to try to understand why they’re behaving like this, which is not always easy.
You may find it reassuring to remember that these behaviours may be how someone is communicating their feelings. It may help to look at different ways of communicating with someone with dementia.
Sometimes these behaviours are not a dementia symptom. They can be a result of frustration with not being understood or with their environment, which they no longer find familiar but confusing.
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Aggressive Behavior By Stage Of Dementia
The middle stages of dementia are when anger and aggression are most likely to start occurring as symptoms, along with other worrying habits like wandering, hoarding, and compulsive behaviors that may seem unusual.
In most types of dementia these issues develop in the mid-to-later stages. You might see aggression spike at the same time as the person starts needing more hands-on help with activities of daily living like getting dressed and eating. About half of people diagnosed with dementia become so agitated that theyll strike back with physical abuse or verbal threats. Fortunately, these behaviors that challenge, if theyre not characteristic or normal for your loved one , have been known to fade. It may take years, but the change is not permanent, and things will probably calm down.
That said, when recall starts to fade in later stages, family and friends become harder to remember and the lack of recognition can also cause aggression. A person who cant remember people becomes confused or outright scared by the company. Paranoia can be common. This is why maintaining routine and using smart strategies to communicate are important.
Five Ways To Help Identify The Causes Of Problem Behavior
Common Causes of Problem Behavior
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What Causes Aggressive Behaviour In People With Dementia
As human beings, we all have the same basic needs. These include physical, psychological and social needs. We do things consciously and unconsciously to meet these needs. The symptoms of dementia can make it more difficult for someone to do this.
For example, people with dementia can find it hard to understand whats going on around them. This can be confusing and frightening for them. It is likely that they are trying to stop feeling distressed and to feel calmer again. For example, if someone they do not know well or who they no longer recognise is trying to help them undress, they may feel threatened and try to push the person away. Aggressive behaviour may be:
- caused by the person feeling agitated because of a need that isnt being met
- the persons attempt to meet a need
- the persons attempt to communicate a specific need to others .
See below for examples of how different types of needs may cause a person with dementia to act aggressively.
Physical needs
Psychological needs
Consider whether they may benefit from psychological therapies with professionals, such as cognitive stimulation therapy or counselling.
Social needs
The persons aggressive behaviour may be their response to feeling theyre not able to contribute or are not valued by others. Try to encourage the person to have a daily routine and to do as much as they can for themselves. Support them to be as independent as they are able to be.
Dementia Connect support line
Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
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Tips To Reduce Nighttime Restlessness
Improve sleep hygiene. Provide a comfortable bed, reduce noise and light, and play soothing music to help your loved one get to sleep. If they prefer to sleep in a chair or on the couch, make sure they cant fall out while sleeping.
Keep a regular sleep schedule. Be consistent with the time for sleeping and keep the nighttime routine the same. For example, give the person a bath and some warm milk before bed.
Tips To Ease Alzheimers Aggression
Once you understand the triggers for Alzheimerâs aggression, you can take steps to prevent it. A few things to try:
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Dealing With Aggressive Behaviors In The Late Stages Of Alzheimers
When someone you love has Alzheimers disease, there are many challenges to contend with. Loss of independence, memory loss, increasing reliance on caregivers, greater difficulty performing everyday tasks, limited mobility, and a change in living circumstances can all be very difficult. In addition to these aspects of Alzheimers disease and often related to them are behaviors exhibited by patients that can compromise quality of life, and pose challenges for caregivers. Understanding the source of these behaviors and responding to them appropriately can help make the work of caregiving easier, and increase your loved ones comfort and well-being.
Edison Home Health Care is happy to advise and assist you or any loved one who seek appropriate care of Alzheimers disease. Give us a call at 888-311-1142, or fill out a contact form and we will respond shortly.
Five Tips For Safely Managing Aggressive Behavior In Someone With Alzheimers
Kathleen Allen, LCSW, C-ASWCM
Senior Care Management Services, LLC
- Expert Advice
Learn the possible reasons for aggressive behavior and some helpful tips for managing the immediate situation.
Mr. and Mrs. Sanchez* , currently living in an assisted living facility, are both in their 80s, and have been married for over 60 years. During the last decade, each has had health issues, but they always work hard to maintain their highest level of independence. They each use a walker for balance and safety take daily medications for various conditions and gave up driving without needing too much convincing. They ask very little of their nearby children.
Alzheimers is changing that. Mrs. Sanchezs behavior has changed with her Alzheimers. While the children have watched the behavior changes, especially during the last year, Mr. Sanchez, after becoming fully aware of what was happening, only then revealed other unusual behaviors that his spouse exhibited when the children were not around. Behaviors included screaming at him in the hall of the facility where they live and in the emergency room, or shaking her cane at him It was so out of character for her. Mr. Sanchez would just carry on, letting the emotional storm pass.
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Tips For Coping With Agitation Or Aggression
Here are some ways you can cope with agitation or aggression:
- Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.
- Allow the person to keep as much control in his or her life as possible.
- Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
- Build quiet times into the day, along with activities.
- Keep well-loved objects and photographs around the house to help the person feel more secure.
- Try gentle touching, soothing music, reading, or walks.
- Reduce noise, clutter, or the number of people in the room.
- Try to distract the person with a favorite snack, object, or activity.
- Limit the amount of caffeine, sugar, and junk food the person drinks and eats.
Here are some things you can do:
- Slow down and try to relax if you think your own worries may be affecting the person with Alzheimers.
- Try to find a way to take a break from caregiving.
Residents With Combative Behavior In Long Term Care
Residents who exhibit combative behavior in long term care pose care challenges to staff and other residents. Combativeness is not usually directed at the individual caregiver nor is it a personal attack on the caregiver as a person, but, usually, a mechanism the resident uses to communicate a need, want, or desire, when they cannot articulate this verbally.
Caregiver education and training can enhance knowledge in identification of certain behaviors, which may preclude an actual combative episode. By understanding extrinsic and intrinsic factors and triggers, which may contribute to the residents escalation in behaviors, caregivers can implement strategies that will address the residents predisposition to certain triggers, which in turn can potentially minimize the risk of injury to resident and staff.
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What Do You Do With Violent Dementia Patients
Take appropriate steps to ensure the safety of you and the person. Others can assist a person who is having difficulty calming down. During an emergency situation, you should always call 101. A number to call in case of dementia is 911, which you can alert your staff of so you can minimize aggressive behavior by the patient.