Facial Expressionstry Not To Frown
They will see and respond to the briefest flash of irritation on our faces. They can sense that we are concerned or worried from the set of our shoulders or slight tension in our stride as we enter the room. They can tell if we are frustrated from the slightest of pauses before we answer them or the merest intonation in a word. They are always reading our emotions.
And so, we must become aware of what we are communicating nonverbally. All of us have a default facial expressionthe one we wear when were deep in thought or concentrating on a task or determined to solve a problem. For most of us thats a frown. But if our companions are experiencing dementia, they wont be able to remind themselves that were deep in thought, or concentratingthey will simply see the frown and take it personally.
If you spend time with someone whos experiencing dementia, ask your friends and family to tell you when they see you frowning. It takes awareness and practice, but you can teach yourself to look happy and at peace when your mind is wandering or occupied elsewhere. Learning just thisto simply put a true smile on your face the moment you enter your loved ones presencewill go far in changing the dementia anger stage back to peaceful, friendly interactions.
Preventing And Handling Anger In Alzheimers Care
The more you are able to understand your loved ones aggressive triggers, the easier it will become to avoid those triggers and prevent anger outbursts. That said, it isnt always possible to avoid certain triggers. Because of this, it is important that you know how best to handle outbursts of anger, including both verbal and physical aggression.
Here are some guidelines for managing anger outbursts in Alzheimers care recipients:
- If you can determine the cause of their distress, see if it is possible to alleviate or solve the issue. This can stop an issue from becoming worse, and often helps dispel their anger.
- Avoid physical contact and NEVER react to violence with force, unless your personal safety or the safety of someone else is threatened. Trying to take physical control of a dementia sufferer often increases their anger and aggression.
- Use a calm tone of voice and avoid outward displays of distress, upset, anger, or fear. These signs are often detected by the angry person and will likely make their own distress and agitation worse.
- If possible, remove yourself from the room or situation. Give yourself and the person time to calm down. This will make it easier for you to react and may defuse or dispel their anger.
- Be kind and reassuring at all times. Do not attempt to argue or reason with the person. Instead, be sympathetic and accepting of their anger and frustration.
Tips For Common Behavior And Mood Changes
Aggressive & Threatening Behavior
Sometimes things can get out of control and feel very scary. These are tips and strategies for dealing with especially challenging behaviors. If you think that you or others may be in immediate danger, call 911.
The person with dementia is threatening you or acting physically violent, such as hitting, pushing, or kicking you
- Give the person space and time to calm down.
- Stay out of arms reach and position yourself near the exit.
- Avoid small spaces like kitchens, bathrooms and cars.
- Remove or secure objects that could be used as weapons.
- Reduce background noise .
- Keep a phone with you in case you need to call for help.
- Go outside, to a neighbors house, or public place if needed to stay safe.
- Take a deep breath and try to stay calm.
- Empathize/apologize: I am sorry this is so frustrating.
- Offer reassurance: I know this is difficult. It is going to be okay, or I am here to help.
- Give yourself a break take time to care for your own needs.
- Get help .
- Tell the dispatcher your name and location and that your family member has dementia. Tell the dispatcher if a weapon is involved.
The person with dementia is angry and accusing you of something that is not true, such as stealing from or cheating on them
The person with dementia is throwing fits or having emotional outbursts, such as yelling, screaming, or banging on things
Anxiety Related to Dementia
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Tips For Dealing With Aggressive Behavior In Dementia
1. Be prepared with realistic expectationsReminding yourself that challenging behavior and aggressive outbursts are normal symptoms of dementia helps you respond in a calm and supportive way.
Knowing that these episodes are a common part of the disease reduces your shock and surprise when it does happen and may also make it a little easier to not take the behavior personally.
2. Try to identify the immediate cause or triggerThink about what happened just before the aggressive outburst started. Something like fear, frustration, or pain might have triggered it.
For example, your older adult might start yelling at empty areas of the room and telling people to get out. Looking around, you might notice that the room is starting to get darker because its early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner.
After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help you older adult calm down. And, in the future youll know to turn on the lights before the room gets too dim.
In another example, you could have unintentionally approached your older adult from behind and startled them. In a sensitive moment, that could make them feel attacked and so they lash out in what they perceive as self-defense.
3. Rule out pain as the cause of the behaviorPain and physical discomfort can trigger aggressive behavior in someone with dementia.
Where To Live With Dementia
Eventually, caregiving for someone with dementia wont be appropriate anymore. The needs of a person with progressive dementia become overwhelming, and moving into a full-time residence with trained staff becomes necessary. You should plan for this well before it becomes necessary, by visiting communities and asking the right questions.
Depending on your loved ones stage of illness, different living options are available:
Assisted Living in Early StagesAssisted living residences combine room and board with medical and personal care, and are often sufficient for someone in the early stages of Alzheimers disease or related dementia. Full-time supervision means residents are safe, with living units like private studios or apartments so someone with mild dementia can still feel a sense of independence.
Services offered in assisted living include meals, help with activities of daily living , social activities, and transportation to and from doctors appointments. Before moving in, the residence will assess your loved one to make sure its a good fit.
Memory care residences have physical designs that are appropriate for people with dementia. Someone with Alzheimers, for instance, may become upset when encountering a wall, so memory care buildings have circular hallways. Because people with dementia are prone to wander, memory care residences have increased security and supervision, and special locks on doors.
Did You Know?
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What Are Specific Care Needs At Each Stage
An individual may not require care assistance after the initial diagnosis of dementia, but that will change as the disease progresses and symptoms become worse. There are about 16 million unpaid caregivers of people with dementia in the United States. While many caregivers are providing daily help for family members, they also hire someone to help. There are many options of care assistance, such as in-home care, adult day care, and nursing home care. There is also financial assistance available.
Early Stage DementiaAs mentioned above, in the early stage of dementia a person can function rather independently and requires little care assistance. Simple reminders of appointments and names of people may be needed. Caregivers can also assist with coping strategies to help loved ones remain as independent as possible, such as writing out a daily to-do list and a schedule for taking medications. Safety should always be considered, and if any tasks cannot be performed safely alone, supervision and assistance should be provided. During this period of dementia, its a good idea for caregivers and loved ones to discuss the future. For example, a long-term care plan should be made and financial and legal matters put in place.
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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Remember: Your Needs As A Caregiver Matter Too
Dealing with dementia behaviors can quickly wear out a caregiver or family member, causing caregiver burnout.
If your loved ones dementia behaviors have progressed to the point where you cannot manage them alone, help is available. Senior care options like home care or memory care can help relieve some of the caregiving burden while also helping to keep your loved one safe.
If you are feeling resentment, anxiety, or depression, seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.
Other families, other caregivers, are going through the same thing, Hashmi says. They have a lot of common challenges and common solutions to share. And often those are the most effective, because theyre going through exactly the same process.
Do Not Contradict Your Loved One
Sometimes your loved one will exhibit aggressive behavior due to frustration. The reason for their frustration could be many. They may want to do something but cant. It could be due to a variety of reasons such as they are not able to do it or they cant be allowed to do it anymore for fear for their safety.
The key to calming down your loved one in a situation like this is to show acceptance instead of refusal. Do not contradict them. Try to show them that you are there to help. Be part of the solution and try to insert your loved one in the solution. Try to convince them to do the thing they want to do later or provide alternatives and offer your company for it.
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What Are Some Other Typical Dementia Behaviors
In addition to aggression, confusion, sleep problems and wandering, symptoms of dementia can also include delusions, hallucinations, paranoia, depression, apathy and sexual inappropriateness. And, behavioral dementia symptoms tend to occur more frequently as the dementia progresses.
Up to 90% of patients have one or more of these symptoms during the course of their disease, studies show. It is important to discuss all dementia symptoms with your loved ones physician to rule out or treat any medical conditions that could be causing the behavior.
Determine If It Is Possible To Alleviate The Issue
In certain circumstances, you may identify certain situations as resolvable. If you notice the person is expressing discomfort or distress, try to think about what happened right before the event to help identify the source of their anger, which may be causing them to feel sad or afraid.
It is important not to debate or explain, as someone suffering from dementia will have little context to use their reason but rather try to reorient and reassure them as much as possible to resolve the issue. If you are able to alleviate the issue, this can stop an issue from becoming worse, curbing the persons anger and aggression early.
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Stage : Slight Cognitive Decline
For Stage 2, signs of mild cognitive decline, also known as Age Associated Memory Impairment, are common. Caregivers and family members may notice slight forgetfulness from time to time, but memory issues may go undetected. For instance, familiar names may slip the persons mind, or the individual may forget where he or she left an object. During this period, lost keys or misplaced cell phones could become a common occurrence. This stage does not warrant a dementia diagnosis and signs of the disease would not be seen during any memory tests. The person would still be able to have a job and participate in normal social activities. Not all individuals with these signs will move on to the later stages of dementia.
Do Not Initiate Contact
This tip goes hand-in-hand with allowing the person space and remaining calm. For some, physical contact can be relaxing and reassuring. However, in periods where the person is angry, confused, and aggressive, contact can lead to physical aggression that will escalate the situation.
You should never react to violence with force as this can send the situation spiraling out of control, possibly leading to bodily harm for yourself or them. Unless your safety or the safety of somebody else is threatened, avoid physical force and contact at all costs.
At Iora, comprehensive care and treatment are priorities. When patients walk into our practice, our dedicated and passionate care teams work to treat the whole patient. Our care model seeks to empower our patients through extensive physical and behavioral care, putting the power of the patients health back in their hands.
Of course, we understand the hardships that come with caretaking can be quite stressful. However, we have several resources to help you be the best caregiver you can be.
Now that you understand more about the causes of dementia and anger, and how to talk to someone with dementia, check out the five main reasons for caregiver burnout.
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Aggressive Behavior In Memory Care / Assisted Living
The staff in an assisted living home for people with dementia should be uniquely capable at handling aggression in people with dementia. In fact, how a memory care community handles residents who have issues with aggression is a good gauge of whether its the right place for your loved one. If staff seem annoyed by aggression, or disdainful, then they arent good for mom or dad.
To know if a memory care home can handle your loved one with dementias aggression issues, look for these signs: Staff gets to know residents, becoming like friends. If they form a connection or bond to residents, employees at memory care homes will have a better understanding of what triggers aggression and how to cool it down. Communication with loved ones outside the community is encouraged. A memory care home that handles aggression well will want loved ones to be accessible. They should take your phone number so you can be reached quickly to help if the person with dementia decides they need to speak with you. Incidents of aggressive behavior should be documented in reports. This can identify causes of outbursts, and show patterns unique to individuals.
Ask about training. Is there regular training and continuing education for employees, and do they learn techniques to deal with aggressive behavior in residents?
Did You Know?
If You’re Looking After Someone With Dementia
Your needs as a carer are as important as the person you’re caring for.
To help care for yourself:
- join a local carers’ support group or a specialist dementia organisation â for more details, call the Carers Direct helpline on 0300 123 1053 lines are open 8am to 9pm Monday to Friday, and 11am to 4pm at weekends
- call Dementia UK’s Admiral Nurse Dementia Helpline free on 0800 888 6678 to talk to a registered specialist dementia nurse lines are open 9am to 9pm Monday to Friday, 9am to 5pm at weekends
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Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
Are There Treatments To Help With Late Stage Dementia
Currently, there are no treatments that can slow or reverse late-stage dementia.
If your loved one with dementia is experiencing any pain, contact your doctor to see if they recommend any over the counter or prescription medication to help with this.
You can also work with an occupational therapist in your area specializing in dementia to help. Speech therapy may be an option to help with speech and movement issues.
There may be a time when hospice should be considered. If youre considering hospice care for your loved one, speak with your doctor and they can help you get this set up so that your loved one can be comfortable
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Feeling Out Of Control Results In Frustration And Aggression
In this article, well look at another key reason for combativeness and aggression with dementia: the feeling of being powerless or out of control. You can lower both your stress as a caregiver and your loved ones distress by learning how to help them feel more in control while you get through the day together.
When I teach families and caregivers how to provide person-centered dementia care with the DAWN Method®, I teach them how to support the persons strengthsfor we do not lose all our skills when dementia strikes . We continue to have strengths, and its through understanding those strengths that we can provide care without igniting belligerence and fight-or-flight responses.