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How To Deal With A Combative Dementia Patient

Take Care Of Yourself Too

How to Deal with Aggressive Dementia Patients (4 Strategies)

Itâs not easy to care for a person with Alzheimerâs disease, especially when they lash out at you. Itâs completely normal to feel overwhelmed, isolated, or sad.

If you are a caregiver, do yourself and the person you care for a favor. Let someone know if you start to feel depressed, anxious, exhausted, or irritable. If you take good care of yourself, you can take better care of others.

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What To Do If You Think They Might Hurt Someone

Here are some things you can do to help keep everyone safe:

  • Keep dangerous things like guns, knives, glass, and sharp or heavy objects out of the house or locked away.
  • Try to distract them by going for a walk, having a snack, playing music they like, or asking them to help you with something.
  • If you canât calm them, give them space.
  • Don’t hold the person back, unless you must to keep everyone safe. Holding them back could hurt you or them, and could make them angrier.
  • If you must hold them back, get help from someone else, if possible. Ask someone nearby, like a neighbor, to be ready to help if needed.

Once your loved one is calm, check for bruises or cuts, and treat them if needed.

If this happens often, itâs a good idea to ask a doctor or counselor for guidance or tips, or get support from others. Your local Area Agency on Aging or Alzheimer’s Association chapter for caregiver groups might be able to help.

How To Deal With Dementia Behavior Problems

  • How to Deal with Dementia Behavior Problems: 19 Dos and Donts

Dementia is a disease that affects millions of people across the globe every year. It is often a highly misunderstood condition that is marred by numerous misconceptions, which make the condition difficult to understand and study.

You should know that dementia is not a name for an illness, rather it is a collective term that describes a broad range of symptoms that relate to declining of thinking, memory, and cognitive skills. These symptoms have deteriorating effects that usually affect how a patient acts and engages in the day-to-day activities.

In advanced dementia stages, affected persons may experience symptoms that bring out a decline in rational thought, intellect, social skills, memory, and normal emotional reactivity. It is something that can make them powerless when it comes to living normal, healthy lives.

Relatives, caregivers, spouses, siblings, children and anyone close to a person who has dementia need to know how to deal with behavioral problems that surface because of the illness. Examples of dementia problems may include aggressiveness, violence and oppositional behaviors. Find out some of the vital Do and Donts when dealing with a dementia patient.

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Pros And Cons Of Facilities For Combative Dementia Patients

Some care facilities may seem like they are more exclusive, and therefore better, if they will deny certain kinds of patients. But that isnt necessarily true.

Its important to remember here that how a care facility deals with an aggressive resident will be a sign of its worth to you, and your loved one.

For example, if a care facility says they deal with aggression by using frequent and heavy sedation then this is probably not the ideal place. This is because they are not really dealing with the aggression but rather are just knocking the patient out so they cant do anything.

This may lead to questions like well, how do you know exactly how the facility deals with it when you are not there?

There are a few ways you can make sure you are choosing the right nursing home care for your loved one who may become aggressive as their dementia progresses.

Five Ways To Help Identify The Causes Of Problem Behavior

How to Handle a Combative Dementia Patient
  • Look at your loved ones body language and imagine what they might be feeling or trying to express.
  • Ask yourself, what happened just before the problem behavior started? Did something trigger the behavior?
  • Are the patients needs being met? Is your loved one hungry, thirsty, or in pain?
  • Does changing the environment by introducing favorite music, for example, help to comfort the person?
  • How did you react to the problem behavior? Did your reaction help to soothe the patient or did it make the behavior worse?
  • Common Causes of Problem Behavior

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    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:

    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.

    Find Memory Care Near You For Aggressive Patients

    While finding care for a loved one who exhibits aggressive tendencies can seem difficult, A Place for Moms Senior Living Advisors can direct you to find memory care that fits your loved ones specific needs. These local senior living experts can help you consider your loved ones unique situation, your expectations for care, and your financial resources to find the right care for your senior loved one.

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    Helpful Tips For Caregivers

    To decrease agitation and aggression with dementia, caregivers can help their loved ones in the following ways:

    • Find a multidisciplinary team of specialists. This may include a psychiatrist to carefully consider the risks and benefits of medications for managing behavior, a geriatrician to optimize your loved ones medical situations, and an occupational therapist to consider modifications of a persons living environment and daily routine.
    • Go for a walk or on an outing for a change of scenery. Physical activity has additional benefits on mood, memory, and lowering anxiety.
    • Add massage and touch therapy, or just provide a calming hand massage.
    • Incorporate music into your loved ones daily routine.
    • Notice the first signs of agitation. Nondrug options work best the earlier they are used.
    • Get creative: discover what works and try using different senses. Aromatherapy, an activity such as folding laundry, brushing hair, or dancing can all be calming.
    • Consult with your physicians. Medications are often prescribed as first-line interventions despite what we know about the effectiveness of nondrug options.
    • Educate all the people caring for your loved one on the interventions that work best, and check in with them about how these approaches are working.

    Imagine These Common Scenarios In Dementia

    Aggressive Behavior in People with Dementia | Linda Ercoli, PhD | UCLAMDChat
    • Shower Time: Someone you don’t know or recognize approaches you and tells you it’s time to take a shower. She starts reaching toward you and tries to remove your clothes. You don’t feel like taking a shower and don’t know why she’s bugging you. It’s cold, you’re not getting out of your clothes, and you’re fine just the way you are.
    • Dinner Time: You’re peacefully dozing off in your chair when suddenly a stranger wakes you up and tells you that you have to eat now. You’re not hungry and you don’t want to get up, but he starts tying a belt around your waist and keeps telling you to get up. You try to push his hands away, but he persists in badgering you to get out of that chair. He then brings a bunch of food to you and starts trying to feed you. By now, you’re really irritated.
    • Getting Dressed: You put on your clothes for the day, unaware that these are the same ones from yesterday, and that they’re badly in need of washing and deodorizing. You recognize your daughter, but she starts to act as if she’s your boss and tells you that you have to change your clothes. You tell her “No”, but she doesn’t listen. She continues to repeat some baloney about why she wants you to change clothes. You’ve already told her, but she’s not listening to you. Then she comes up to you and starts taking your arm out of your sleeve. That’s the last straw.

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    Tips To Help Manage Dementia Sleep Problems

    There are ways to help your loved on get a better nights sleep, Hashmi says.

    Avoid things that disrupt sleep.

    • Limit caffeine, alcohol, and sugar near bedtime.
    • Avoid over-the-counter sleep aids. Instead, Hashmi suggests you talk to a doctor about whether melatonin might help your loved one sleep.
    • Remove electronics from the bedroom.

    Create a routine that supports sleep.

    • Make sure your loved one gets enough daytime light to help with circadian rhythms.
    • Change into comfortable clothing, signaling nighttime.
    • Consider warm milk, a hot shower, relaxing music or reading before bed.
    • Pick a bedtime not too late and stick with it every night.

    When Does It Happen

    Although combative behaviors can seemingly come from nowhere, do not assume it is a simply personality trait. Are the combative outbursts tied to particular activities? Do they occur at specific times, such as late afternoons or evenings? Finding a common denominator may help you understand what the underlying problem is. For example, outbursts that occur late in the day could signal that the care recipient is prone to being combative when he or she is tired. In dementia patients, it could be a sign of Sundowner’s Syndrome. If there doesn’t seem to be a common denominator, do what you can to make the care recipient more comfortable and improve his or her quality of life generalized unhappiness could be the culprit.

    For an inspiring story, read Kay Paggi’s memoir on her client Hank, who originally was deemed combative, and how she worked to enhance his quality of life.

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    Do Not Engage In Arguments

    One of the worst things a person can do to an individual who has dementia is to start an argument or even force them to do something that makes them upset or angry. When the discussion or argument is too heated, it may be better to walk away to create an environment where everyone can remain calm. Experts agree that one of the ways that can yield results when it comes to dementia behavior problems is to get rid of the word no when dealing with patients. Avoid forcibly restraining a dementia sufferer at all costs.

    Preventing And Managing Aggressive Behaviour In People With Dementia

    How to Deal with Aggressive Dementia Patients

    Find ways to prevent and manage aggressive behaviour in the future, to help both you and the person with dementia.

    Working out what might be triggering aggressive behaviour may make it easier to prevent it. Always try to see things from the persons perspective. Think about the situations where theyve become aggressive, and to try to find what has triggered this response.

    Think about what you know about the person and their life. Be aware of their beliefs and thoughts and try not to argue with them. For example, if the person has always valued their privacy and independence, then being helped with eating or washing might cause them to become angry.

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    Design And Environmental Strategies In Memory Care For Aggressive Patients

    Memory care communities are designed with de-escalation and relaxation in mind. Facilities promote a soothing environment by concentrating on these areas:

    • Music. Memory care staff members have long relied on the power of music therapy for dementia. Studies show that music can lower dementia patients stress levels and evoke positive memories. In particular, memory care communities often select classical music, church hymns, or cheerful sing-alongs to provide a sense of comfort.
    • Aromatherapy. Diffusing lavender twice a day can significantly reduce aggression among dementia patients, according to a recent study. Communities replicate this effect with essential oils.
    • Lighting. Harsh or fluorescent lighting can trigger aggression. Communities may use dimmers to alleviate this.
    • Clear signage. Individuals with dementia often experience difficulty navigating. Clearly marked restrooms, exits, and communal areas can prevent outbursts that result from residents being lost or confused.
    • Gardens and other outdoor spaces. Access to plants and naturecan boost seniors happiness, reduce feelings of being overwhelmed, and stave off the progression of dementia. For these reasons, many memory care communities feature what they call healing gardens.

    New Research Shows That Nondrug Therapies Are More Effective

    According to a new study looking at more than 160 articles, nondrug interventions appeared to be more effective than medications in reducing agitation and aggression in people with dementia. Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy.

    For physical aggression, outdoor activities were more efficacious than antipsychotic medications . For verbal aggression, massage and touch therapy were more effective than care as usual. As a result of this study, the authors recommend prioritization of nonpharmacologic interventions over medications, a treatment strategy also recommended by the practice guidelines of the American Psychiatric Association.

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    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.

    Tips For Handling A Seniors Aggression

    How to Deal with Aggressive Dementia Patients

    Most importantly, try not to take the aggressive behavior personally, Hashmi says.

    The classic line I always use is that this is the disease talking. It is not the person, Hashmi says. There is a lack of awareness in that moment. Its not your mom or dad or spouse saying that. Its the disease.

    When you are faced with a loved ones aggression, Hashmi suggests employing these 4 Rs:

  • Reassure. It can be difficult to do in the moment, but start by reassuring your loved one. For example, Hashmi suggests you might say something like, Im here for you. Im still here for you. Its OK.
  • Reorient. If they are disoriented, reorient them to their environment and with a familiar object. Say, Look, were at home. Heres a picture we have.
  • Redirect. Redirect your senior toward a familiar object, anything that gives them joy and comfort. It may be family photos, it may be a keepsake, it may be something that has great meaning and value to them, Hashmi says. It helps redirect and also helps reorient them.
  • Reminisce. Help them connect to a long-term memory. E.g., Remember when Joe was born?
  • When theyre feeling calmer, Hashmi says, you can try asking yes/no questions to help determine whether an unmet need is causing the behavior. Ask: Are you hungry? Are you thirsty? Are you in pain? Are you tired?

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    Dealing With Stubbornness In Parents Living With Dementia: 50 Expert Tips For Communicating Gaining Cooperation And Understanding Behavior

    Caring for aging parents gives adult children peace of mind to know they are providing loving care. It also allows for them to make more memories and spend more time with parents in the final chapter of their lives. But caregiving is far from easy, especially when loved ones are diagnosed with dementia. Resisting care and general stubbornness are two hallmarks of dementia, and they are among the most common reasons that adult children look for help as caregivers.

    If youre unsure how to deal with stubbornness in parents with dementia, youre not alone. Most family caregivers of loved ones with dementia struggle daily with getting them to the doctor, gaining their cooperation, convincing them to bathe and brush their teeth, and communicating with them. Read on for a comprehensive list of tips from other caregivers, medical professionals, gerontologists, and dementia experts. Tips are categorized and listed them alphabetically within each category, but are not ranked or rated in any way.

    If you need help caring for a parent or a loved one with dementia at home, learn more about Seniorlinks coaching and financial assistance program for caregivers of Medicaid-eligible friends and family members.

    Be Patient And Forgiving

    It is important to remember that your loved ones aggression and is due to their illness and not their personality or your fault. While it can be stressful and frustration for the caregiver themselves, you should always remain calm and patient in front of your loved one. If they say or do something hurtful, ignore it because it is possible that they dont know who they are talking to or what they are saying. Instead, try to divert the attention to something less stress inducing. Do not judge them or treat them badly in any situation. Remember, it is not their fault, it is the illness.

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    Understanding And Managing Difficult Dementia Behaviors

    By CRHCF – Published May 31st, 2016

    When providing care for a loved one with dementia, there are many challenges you face as a caregiver. As your loved ones condition worsens, so too does the ability to communicate, act and think clearly, and perform many of the common day-to-day tasks that we take for granted.

    … the anger and frustration you may feel as a dementia caregiver is normal and does not make you a bad person.

    Throughout this mental and physical decline, your loved one may begin to display difficult and sometimes dangerous behaviors that can put their safety, and sometimes the safety of others, at risk. By understanding the root causes behind the behaviors, what may trigger them, and how to best manage these behaviors when they arise, you can better care for your loved one and yourself.


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