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How To Deal With Abusive Dementia Patients

Handling Dementia Care And Abusive Behavior

Aggressive Behavior in People with Dementia | Linda Ercoli, PhD | UCLAMDChat

It is important to note that Alzheimers disease and other types of dementia can complicate difficult caregiving dynamics even further. Some dementia patients who have a history of being verbally and/or physically abusive may continue these patterns throughout their illness, while previously nurturing individuals may exhibit uncharacteristically violent or manipulative behavior as their cognitive status declines. There is no way of predicting how a loved one will act because these progressive conditions manifest differently in each person and the symptoms change over time.

Since memory loss and impaired logic, judgement and impulse control are hallmarks of many kinds of dementia, detaching with love may not be completely successful in these cases. This approach may help a dementia caregiver create healthy emotional distance with their parent, but it is unlikely that Mom or Dad has the cognitive ability to understand, remember or respect the adult childs boundaries. Dementia eventually renders individuals incapable of controlling their moods and behavior, making informed choices, and understanding the implications of their words and actions.

Ways To Reduce And Manage Mean Dementia Behavior

1. Calm the situation downThe first thing to do is reduce the tension in the room.

Start by limiting the distractions in the room, like turning off the TV or asking others to leave.

And if you stay calm, theyre also more likely to calm down.

It might help you to count to 10 or even leave the room for a short time to cool down. Repeat to yourself its the disease as a reminder that theyre not intentionally doing this.

If the current activity seemed to cause the agitation, try shifting to a more pleasant, calming activity. Or, try soft music or a gentle massage.

2. Comfort and reassure while checking for causes of discomfort or fearTake a deep breath, dont argue, and use a calm, soothing voice to reassure and comfort your older adult.

It also helps to speak slowly and use short, direct sentences.

Then, check for possible causes of agitation or fear, like:

  • Feeling disturbed by strange surroundings
  • Being overwhelmed by complicated tasks
  • Frustration because of the inability to communicate

It also helps to focus on their emotions rather than their specific words or actions. Look for the feelings behind what theyre doing as a way to identify the cause.

3. Keep track of and avoid possible triggersWhenever difficult behavior comes up, write down what happened, the time, and the date in a dedicated notebook.

Also think about what was going on just before the behavior started and write that down as a possible trigger.

Taking some time away can help both of you.

How To Cope With Caregiver Abuse

When it comes to handling an aging loved ones abuse, the best option is to remove yourself from the situation. But for many caregivers, that is not a possibility. Other family members may not be willing or able to assist. Some families may not be receptive or understanding when a caregiver is the one being abused. The family might lack the financial resources to hire a third party, such as a home care company, to take over, or the elder may vehemently oppose the idea. A mix of hope, love, fear, obligation and guilt typically compel the primary caregiver to continue seeing to their loved ones needs personally. In order to make this arrangement work and minimize its detrimental impact, caregivers must learn to set boundaries, detach from their care receiver, and prioritize their own well-being.

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Do Try And Identify The Trigger That Causes Behavior Change

After spending some time with a patient who has dementia, caregivers may be in a position to identify some of the things that make dementia sufferers yell, get physical, or change their mood. For some, it may be something simple such as taking a bath or even getting dressed.

The best approach to handle this is not to force the patient to do something that they do not want to do. Try and distract them with something else that allows them to relax and calm down. Once they are not a danger to themselves or anyone around them, try going back to the subject, but this time reassuringly and calmly.

Imagine These Common Scenarios In Dementia

Nursing Home Should Have Protected Employee from Patient
  • 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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The Many Benefits Of Pursuing A Dementia Diagnosis

For your mother, an assessment for cognitive changes means shell be checked for other health problems that might cause personality or thinking changes. After all, its possible that the problems youre observing are not due to dementia.

Its also common for dementia to be exacerbated by additional problems like electrolyte imbalances, medication side-effects, untreated pain, or even constipation which can be treated, even though a disease such as Alzheimers cant be cured. So you really want at least a preliminary clinical dementia evaluation to be completed.

If your mother ultimately is deemed to have dementia, you want that to be in her medical chart. Thats because this diagnosis has implications for how to manage the care of any other health problems she has.

A dementia diagnosis will also make it easier for you to get help as a family caregiver. Difficult behaviors are often managed with medications, but its true that these generally increase fall risk, so they should be avoided. If you are concerned about her behavior, this article will explain the pros and cons of the available medication options: 5 Types of Medication Used to Treat Difficult Dementia Behaviors.

Last but not least, a dementia diagnosis often helps a family focus on planning for further declines in decision-making and independence. This is obviously not easy, but trust me, things tend to go better later if families have done some planning earlier.

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.

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Look For The Underlying Factor

Once you have established your safety and that of the patient, you should then look at what could have triggered such violent behavior.

It is important that you try and understand what may have led the patient to suddenly become violent. Violent outbursts may be caused by:

  • Physical discomfort
  • Frustration
  • Environmental factors like loud noise

When you are able to identify the triggers, try and reduce them. Understanding the stressors will also help you avoid any future incidences of violent outbursts.

Do Not Engage In Arguments

Changes in Personality and Behavior of A Dementia Patient

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.

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The Message Behind The Behaviour

Because of the way dementia affects the brain, the person may have lost some of the inhibitions that would have prevented them from showing their feelings in this way previously. But the feelings being expressed now are important because they represent the persons way of saying something significant. And we need to understand the message. This could be, for example, I feel like a prisoner, Im frightened I dont understand whats going on, Im in pain, or Im so frustrated.

Try To Understand Their Point Of View

It can be difficult to accept the ageing process. Add to that the effects of dementia that your loved one is facing, and you can see how hard their life has become. Its best to approach discussions about securing care with compassion. Do your best to present facts about how this support will benefit not only your elderly loved one but also fellow family members. They may find comfort in hearing about how dementia caregivers will provide help with medication, chores, grooming and more all of which will help them to live a healthy life while staying at home.

Ask What Support They Need

Since everyones needs are different, your loved ones dementia may cause them to need support in some areas and not others. For example, they may need assistance with getting to and from their medical appointments but are still able to bathe and groom themselves daily. By collaborating with your loved one, you can arrange a care plan that provides support in areas where they need it most.

Practise Your Patience

Patients with dementia may have a wandering mind that makes it difficult for them to focus. As you talk about care options, be calm and patient as it may take time for them to really hear what you are saying. When they change the topic, engage in conversation and gently try to bring chatter back to discussing their care. A calm and comfortable environment for their conversations can also help to put the patient at ease.

Present More Than One Option

Take Your Time

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Do Not Shy Away From Asking For Help

No one may have all the answers especially when it comes to taking care of a person with dementia. Try doing research on how their behavior changes and what needs to be done to help them live their lives without too many complications. Hire help when it becomes too much as it also ensures that you do not become too frustrated or drained. When you have multiple family members who can help, ask everyone to pitch in and look after the patient so that you can get some personal space to breathe and re-energize when it is your time to look after the patient. When you feel like you can no longer look after your loved one at your own home, it may be time to consider assisted living. In such case, look into dementia care homes that can provide specially trained professionals.

How To Reduce The Instances Of Responsive Behaviour

Challenges Of Dementia Caregivers And How To Cope With Them?

Try one or more of these therapeutic approaches, especially if you and your doctor have ruled out biological causes of the behaviour and you have been unable to identify or resolve the trigger:

If you are caring for a senior with dementia who has negative outbursts the most important thing is to remember to seek help.

You dont have to deal with this extremely stressful and distressing situation on your own..

Dont be afraid to share what youre going through with your doctor, friends and family and ask for their help. Your local Alzheimers Society can also offer support, help and advice. Finally, your provincial government may provide caregiver respite to offer you a break from the stress of caring for your loved one.

Remember, that this is not abuse or aggression, but rather a behaviour stemming from a condition that creates tremendous frustration and emotional turmoil in our loved one. Be sure to take care of yourself so that you can better care for your senior.

Are you caring for a senior parent with emotional outbursts? How do you handle their behaviour? Share your suggestions with us in the comments below.

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Things To Do After Dealing With Aggressive Behavior In Dementia

1. Learn from what happenedAfter giving yourself a chance to calm down and de-stress from the episode of aggressive dementia behavior, take a step back to see what you can learn from the situation.

Analyzing the situation also helps you take it a little less personally and makes it easier to think about what you could do differently next time to try to avoid an aggressive reaction.

Think about possible triggers, which responses helped calm things down, and which responses seemed to make the situation worse.

It often helps to take notes on your observations to see if you can spot patterns or figure out new ways to try to prevent a similar outburst in the future or cool things down if it does happen.

2. Find sources of supportIts essential for your well-being to talk with people who understand and can help you cope with these tough situations and deal with the conflicting emotions.

Share your experiences with members of a caregiver support group, a counselor or therapist, or with supportive friends or family members.

Getting your feelings out is an important outlet for stress. Plus, you might get additional tips and ideas for managing aggressive dementia behavior from others who have dealt with it.

3. Consider medicationWhen non-drug techniques arent working and challenging behaviors become too much to safely handle, it might be time to work with their doctor to carefully experiment with behavioral medications.

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.

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Seniors With Strange Obsessions

Saving tissues, worrying if its time to take their meds, constantly picking at their skin, and hypochondria, are all types of obsessive behaviors that can disrupt the daily lives of seniors and their caregivers. Obsessions are sometimes related to an addictive personality, or a history of obsessive-compulsive disorder .

How To Handle A Senior Acting Out

HOW TO HANDLE PHYSICALLY AGGRESSIVE PATIENTS

In the moment, you should:

  • Take a deep breath and try to remember that this is not abuse or aggression toward you .
  • Adapt to the perspective and needs of your senior.
  • Remain calm, even if it means stepping out of the room.
  • Dont show anger, fear, alarm or anxiety, even if you feel it. Showing these emotions could increase the seniors agitation and escalate the situation.
  • Speak using a calm, reassuring voice.
  • Acknowledge the seniors feelings and listen to what they are saying. This will help you try to understand and determine the trigger while also showing that you want to help.
  • Maintain eye contact while you communicate.
  • Try to understand what is causing the behaviour.
  • If you cant resolve or eliminate the trigger, try to distract the senior from the problem.
  • Give them the space they need in the moment.
  • Afterwards, you should:

    • Focus on the person, not the behaviour
    • Dont punish the senior for their behaviour or try to revisit the incident with them
    • Remember that the senior may still feel upset, so try to be reassuring while carrying on as normal
    • Make sure you have someone you can talk to about the incident
    • Take care of your own emotional needs and seek the help of your doctor, family members, community support groups, counsellor or dementia support worker

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    What The Society Calls For:

    • Dementia training for staff in care homes and hospitals. Lack of training is an important cause of poor quality care. Staff may be unable to communicate effectively with people with dementia, involve people with dementia in decision-making following the principles of the Mental Capacity Act and care for people with dementia who experience behavioural and psychological symptoms. This can mean that people with dementia do not receive person-centred care, are deprived of their legal rights and receive inappropriate treatments, such as physical restraint and anti-psychotic drugs, that can exacerbate symptoms. Health and social care professionals should receive training to provide high-quality, person-centred care to improve dignity and quality of life even when communication has diminished. For more information, please see our position statement on anti-psychotic drugs and the Deprivation of Liberty Safeguards page.
    • Effective and robust enforcement. Abuse and mistreatment are too serious to be considered as part of a general complaints procedure. The Society believes that regulators, not providers, should deal with such complaints. For more information, please see our position statement on the regulation of dementia care.

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