Aggressive Behaviour In Dementia
In the later stages of dementia, some people with dementia will develop what’s known as behavioural and psychological symptoms of dementia .
The symptoms of BPSD can include:
- increased agitation
- aggression
- delusions
- hallucinations
These types of behaviours are very distressing for the carer and for the person with dementia.
It’s very important to ask your doctor to rule out or treat any underlying causes, such as:
- uncontrolled pain
- infection, such as a urinary tract infection
- side effects of medicines
If the person you’re caring for behaves in an aggressive way, try to stay calm and avoid confrontation. You may have to leave the room for a while.
If none of the coping strategies works, an antipsychotic medicine can be prescribed as a short-term treatment. This should be prescribed by a consultant psychiatrist.
When People With Dementia Become Withdrawn
When a person with dementia doesnt seem to be aware of other people or is quite unresponsive, we may describe them as being withdrawn. It can be difficult to know what to do in these situations. If someone seems to be spending much of their time disconnected from social interaction and activity, it is important to explore why this is happening and investigate any possible unmet needs. It may be that the person is tired or it may be because they are feeling bored or cut off from others. This feature explores some of the reasons why a person with dementia may appear withdrawn and what we can do to help.
My hiding place now is one that I can stretch out to and run away to for a while.
Extract from From my hiding place, a poem by a person with dementia published in You are words
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
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Tips For Managing Dementia Wandering
The No. 1 priority is to keep your loved one safe, Hashmi says. He suggests the following actions:
- Secure all doors. Be especially vigilant about doors that lead outside.
- Use technology. Tracking devices and surveillance systems are widely available and affordable.
- Enlist a team. Neighborhood watch groups and local police are often happy to help keep an eye out for your loved one.
Understand Why Someone With Dementia Says Mean Things
First, its important to understand why this hurtful behavior is happening.
Dementia is a brain disease that causes parts of the brain to shrink and lose their function, resulting in cognitive impairment.
These different parts control functions like memory, personality, behavior, and speech. Dementia also damages the ability to control impulses, which means actions arent intentional.
Even though its difficult, do your best to remember that they truly dont intend the mean things they say.
These mean comments and hurtful accusations often happen because the person is unable to express whats actually bothering them.
It could be triggered by something in their environment that causes discomfort, pain, fear, anxiety, helplessness, confusion, or frustration.
Working to accept the fact that theyre not doing this on purpose helps reduce stress and makes their behavior easier to manage.
The overall strategy is to take a deep breath, remind yourself that its not personal, take care of immediate discomfort or fear, and try to find the cause behind the behavior.
Next, look for long-term solutions that will help you get the support and rest you need to keep your cool in challenging situations like these.
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Following A Partner Or Carer Around
Dementia makes people feel insecure and anxious. They may “shadow” their partner or carer as they need constant reassurance they’re not alone and they’re safe.
They may also ask for people who died many years ago, or ask to go home without realising they’re in their own home.
Try to:
- have the person with you if you’re doing chores such as ironing or cooking
- reassure them that they’re safe and secure if they’re asking to go home
- avoid telling them someone died years ago and talk to them about that period in their life instead
What You Can Do For Your Loved One
As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.
One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.
Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.
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The purpose of these actions are to defend against fears and to compensate for mistakes that are made.
Their need is to feel competent and as able to function as well as they were before.
Strategies for dealing with this stage are to use non-critical verbal reminders, lists, reassurances.
At this point, you may consider having an assessment done and although it would be impossible to diagnose Alzheimers at this point, other causes for the symptoms might be found.
2. Early Confusion-Mild Dementia
Has concrete thinking leaves out of substitutes words. Has increased short-term memory loss. May get lost. May withdraw socially. Denies forgetting. Is more self-centered and defensive.
The purpose of these actions are to avoid embarassment and cope with helplessnes.
Their needs are to have their fears dealt with, to have their defensive reactions understand and to address any depression that may be present.
Strategies for dealing with this stage are to allow the person to talk about their fears validate their feelings, use simple directions, and avoid confrontations. There are also some memory enhancement techniques that may be used if the person is will to try them.
3. Moderate Dementia
The purpose of these actions are an attempt to orient himself/herself, to organize their thoughts and to maintain a sense of self .
4. Advanced Moderate Dementia
Do Make Sure That The Dementia Patient Gets Enough Rest Food And Water
Fatigue, hunger and thirst may cause combativeness. Ensure that the person with dementia is well fed, hydrates enough, and gets adequate sleep and rest. In line with this, they should also have enough bathroom breaks. Research also shows that it may help to reduce loud noises as well as clutter in the space where the patient spends most of his/her time, as both loud noises and clutter tend to over-stimulate people with dementia.
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Do Not Keep Correcting The Patient
People with dementia do not like it when someone keeps correcting them every time they say something that may not be right. It makes them feel bad about themselves and can make them drift out of the conversation. Discussions should be humorous and light and one should always speak slowly and clearly using simple and short sentences to capture and keep the interest of the dementia patients.
Biological Perspective: The Effect And Consequences Of Neuropathological Changes In Dementia On Pain
Both neuropathological and neuroimaging studies have described interconnected brain areas that are important in the mediation of pain processing.,, Most studies describe two neuronal networks, the medial and lateral pain systems. The medial pain system comprising the amygdala, medial thalamus, hippocampus, anterior cortex cinguli, and prefrontal cortex is a pathway that mediates cognitiveevaluative and motivational-affective aspects of pain. In addition, autonomicendocrine aspects are also mediated by the medial system., The lateral pain system comprises, among others, the primary somatosensoric areas and the lateral thalamic nuclei. The sensorydiscriminative aspects are mediated by the lateral pain system. Overlap of the two systems might occur in the insula. Recently, the existence of a third pathway mediating other critical aspects of pain has been proposed. This is thought to be a rostral, or limbic, pain system, which mediates behavioral aspects of pain for example, agitated behavior as a reaction to pain.
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Make Time For Yourself
You may feel guilty about needing or wanting time out for rest, socialization, and fun. However, everyone deserves regular and ongoing breaks from work, including caregivers. âRespiteâ providers can give you the opportunity to take the breaks you need. Respite breaks may be provided by in-home help, adult day care, âfriendly visitorâ programs, friends and neighbors, or other means. The important point is to allow yourself to take a break from caregiving. See Resources at the end of this fact sheet for organizations that might help you give yourself time off from caregiving.
Where To From Here
Limited awareness of frontotemporal dementia and the diversity of its symptoms often lead to misdiagnosis or delays in diagnosis. Behavioural changes tend to be mistaken for symptoms of depression or psychiatric disorders.
Educating the general public and health professionals about the different types of dementia and the variety of symptoms is an important step in reducing the time it takes to reach a diagnosis.
In the absence of a cure, a major challenge is to develop appropriate and effective management strategies for those living with dementia. We hope this new research can help us find interventions for these often misunderstood symptoms.
If you know someone with frontotemporal dementia or would like to get involved in our research, you can find more information here or contact frontier@sydney.edu.au.
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More About Dementia And Being Mean
Understanding how dementia changes our thinking skills is the beginning of understanding why someone experiencing dementia might be mean, and how to avoid getting aggressive and combative dementia behaviors.
But this is not a simple problem, so theres more to think about. In my next article, Dementia Anger Stage, Ill explain how wethe companions of people experiencing dementiaare actually in control of their moods rather than them. This is one of the key reasons for why relationships that include dementia are different from anything weve ever experienced before.
What Are The Signs Of End
It is important for caregivers to know when an individual with dementia is close to the end of their life, because it helps ensure they receive the right amount of care at the right time. It can be difficult to know exactly when this time is due to the variable nature of dementias progression, but understanding common end-of-life symptoms of seniors with dementia can help. Below is a timeline of signs of dying in elderly people with dementia:
Final Six Months
- A diagnosis of another condition such as cancer, congestive heart failure or COPD
- An increase in hospital visits or admissions
Final Two-to-Three Months
- Speech limited to six words or less per day
- Difficulty in swallowing or choking on liquids or food
- Unable to walk or sit upright without assistance
- Incontinence
- Hands, feet, arms and legs may be increasingly cold to the touch
- Inability to swallow
- Terminal agitation or restlessness
- An increasing amount of time asleep or drifting into unconsciousness
- Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute
Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion. Once a patient begins experiencing any of the above symptoms, it is time to speak with a hospice professional about how they can help provide added care and support.
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Determining The Cause Of The Behavior
Taking the time to listen and assess the situation can help pinpoint the source of anxiety and intent of the behavior. Is there a pattern to the behavior? Has anything changed in the patient’s health, environment, treatment plan, or daily routine?
Ask these kinds of questions when determining the cause of violent behavior and remember: Don’t take it personally. It may seem like the dementia patient is attacking you, but really they are anxious and you happen to be around.
When behavioral disturbances occur, give the person space you may need to leave the room until you’re both calm, according to the Alzheimer’s Society. Showing your anxiety may make the dementia patient more agitated, so make sure you can approach them calmly. Tell the person you can see they’re upset.
How Do You Tell A Dementia Patient Someone Has Died
Telling About a Death
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How To Cope With Common Changes In Behaviour
Although changes in behaviour can be difficult to deal with, it can help to work out if there are any triggers.
For example:
- Do some behaviours happen at a certain time of day?
- Is the person finding the home too noisy or cluttered?
- Do these changes happen when a person is being asked to do something they may not want to do?
Keeping a diary for 1 to 2 weeks can help identify these triggers.
If the change in behaviour comes on suddenly, the cause may be a health problem. The person may be in pain or discomfort from constipation or an infection.
Ask a GP for an assessment to rule out or treat any underlying cause.
Keeping an active social life, regular exercise, and continuing activities the person enjoys, or finding new ones, can help to reduce behaviours that are out of character.
Read more about activities for dementia.
Other things that can help include:
- providing reassurance
- activities that give pleasure and confidence, like listening to music or dancing
- therapies, such as animal-assisted therapy, music therapy, and massage
Remember also that it’s not easy being the person supporting or caring for a person with behaviour changes. If you’re finding things difficult, ask for support from a GP.
The Aging Narcissist: Adding Dementia To The Mix
Despite what a narcissist will pontificate, even they are subject to the effects of getting older. Becoming elderly is a normal part of the developmental stage of life for most people, but not for the narcissistic. They view aging as an ultimate evil. Some will engage in ridiculous plastic surgery in an effort to look as young as they feel. Others will begin a new career while their peers are retiring. And still, others will take on far younger partners.
But what the narcissist cant do is dodge the effects of dementia. As a progressive indiscriminate disorder which sometimes transforms into Alzheimers or other disorders, dementia affects every area of the brain in random order. What seemed natural and habitual now becomes foreign and difficult. Memory becomes scattered and unreliable. Familiar people become strangers or even enemies that are out to get them.
For the narcissist, this is completely unacceptable. Most narcissists rely heavily on their cognitive abilities as a way of constantly demonstrating superiority over others in performance, influence, power, beauty, or money. Any sign that is is deteriorating or diminishing is out of the question, something that cannot and will not be tolerated. This is when the narcissist is most at risk for suicidal behavior.
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Tips For Managing Dementia End
Because individuals with advanced dementia will often have difficulty communicating, it is important that caregivers keep a close eye on their loved one for signs of pain or discomfort. These signs may include moaning or yelling, restlessness or an inability to sleep, grimacing, or sweating. This may also signal that its time to call hospice or a palliative care team to help with the pain management.
If an individual with end-stage dementia is having trouble sitting up without assistance, hospice can provide a hospital bed or other equipment to lift their head.
Perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focusing on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.