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What To Do When Dementia Patients Become Violent

No Easy Solutions But Improvement Is Usually Possible

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

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.

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.

Residents With Combative Behavior In Long Term Care

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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 resident’s escalation in behaviors, caregivers can implement strategies that will address the resident’s predisposition to certain triggers, which in turn can potentially minimize the risk of injury to resident and staff.

Also Check: Senility Vs Dementia

Do Not Try To Stop A Person Who Wants To Leave A Room

Staying in one place for long periods may result in behavior problems in the dementia patient. It is essential to have a safe environment where they can enjoy the outdoors without any problem. When someone tries to leave a room, do not force them to stop. Doing this may result in an extreme reaction such as severe distress or injuries.

Instead, it is best to accompany the patient so that they are safe. You can even suggest going for a drive around the block so that they can experience a new environment for a short period. If they do not want company, just let them go but stay close by to make sure that the patient is safe at all times.

Paranoia Delusion And Hallucinations

In Practice: What to Do When Patients Become Violent ...

Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle.

Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.

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Causes Of Agitation And Aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause. If you deal with the causes, the behavior may stop. For example, the person may have:

Look for early signs of agitation or aggression. If you see the signs, you can deal with the cause before problem behaviors start. Try not to ignore the problem. Doing nothing can make things worse.

A doctor may be able to help. He or she can give the person a medical exam to find any problems that may cause agitation and aggression. Also, ask the doctor if medicine is needed to prevent or reduce agitation or aggression.

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.

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How To Help With Poor Judgment

The deterioration of brain cells caused by Alzheimers disease can lead to poor judgment and errors in thinking. Some of these symptoms are obvious and apparent, such as hoarding household items, accusing a family member of stealing, or forgetting how to do routine tasks.

Some signs are more subtle, making it difficult for your aging loved one to realize theyre struggling. If youre curious and dont want to ask, take a look at a heating bill, suggests Mariotto. Sometimes payments are delinquent, or bills arent being paid at all.

Its important to minimize frustration and embarrassment for dementia patients, so know what works for your loved one and incorporate it into your caregiving strategy.

  • Listen and offer subtle help.
  • Work together to fix the problem.
  • Simplify a task or routine by breaking it down into smaller steps.

This is what Napoletan did for her mother: As I sifted through records to complete her tax return, I gently mentioned noticing a couple of overdraft fees and asked if the bank had perhaps made a mistake. As we talked through it, she volunteered that she was having more and more difficulty keeping things straight, and knew she had made some errors. She asked if I would mind helping with the checkbook going forward. I remember her being so relieved after we talked about it. From there, over time, Napoletan was gradually able to gain more control over her mothers finances.

DONT:

If You’re Looking After Someone With Dementia

Dialogue on Dementia (2 of 5) Violent and aggressive behaviours

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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Do Not Try And Alter Undesirable Behavior

Lack of understanding may push one to try and change or stop any undesirable behavior from patients who have dementia. Keep in mind that it is almost impossible to teach new skills or even reason with the patient. Try instead to decrease frequency or intensity of the behavior. For instance, respond to emotion and not the changes in behavior. If a patient insists on always asking about a particular family member reassure them that he or she is safe and healthy as a way of keeping them calm and happy.

Do Keep Eye Contact When Speaking

Communicating with a dementia patient requires a lot of patience, especially during later stages of dementia. It is vital to ensure that you talk in a place that has good lighting, a place that is quiet and without too many distractions. Do not try and stand over the person you are talking to, but rather try to be at their level and keep eye contact at all times. Take care to make sure that body language is relaxed and open. Prepare to spend quality time with the person so that they do not feel rushed or like they are a bother.

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A Reaction Not A Symptom

Aggressive behaviour is by no means a common response from people with dementia. Only rarely is it actually a symptom of the dementia. If aggression does occur, the most likely reason is that the person is reacting to a distressing situation for example, they are being stopped from leaving their own home or being helped with bathing by a person they do not recognise who has not explained what they are doing. The starting point in understanding aggressive behaviour from a person with dementia is to consider what might be going on from their point of view.

Coping With Agitation And Aggression In Alzheimer’s Disease

What to Do When Alzheimers Patients Become Violent &  How ...

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.

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How To Respond To Delirium

  • Teach yourself about delirium and learn more about what brings it about, how to manage it and how to prevent it
  • Be careful about surgery and hospitalizations because these actions present the risks of Alzheimers turning violent
  • Learn to spot delirium in the hospital and address it when it appears.

It is quite unfortunate that at one point of the progression of Alzheimers, the disease will turn violent.

Devoted Guardians’ Response to COVID-19

Devoted Guardians is actively monitoring the progression of the coronavirus, COVID-19, to ensure that we have the most accurate and latest information on the threat of the virus. As you know, this situation continues to develop rapidly as new cases are identified in our communities and our protocols will be adjusted as needed.

While most cases of COVID-19 are mild, causing only fever and cough, a very small percentage of cases become severe and may progress particularly in the elderly and people with underlying medical conditions. Because this is the primary population that Devoted Guardians serves, we understand your concerns and want to share with you how our organization is responding to the threat of COVID-19.

We are following updates and procedures from the Centers for Disease Control State Department of Health, local and county authorities, the Home Care Association of America and other agencies and resources. Our response and plans may adjust according to the recommendations from these organizations.

Dont Be Afraid To Ask For Alzheimer’s Support

“Knowing how to detect, defuse, and prevent anger is one of the most important skills for Alzheimers care providers, says Larry Meigs, CEO of Visiting Angels. Its one of the skills we value most in our Alzheimers caregivers.

If you find that you need support in handling a loved ones dementia or Alzheimers care, help from an Alzheimers care provider can be invaluable. To discuss your options for professional, in-home Alzheimers care, call your local Visiting Angels office today.

If you are concerned about sudden changes in your loved ones behavior or have questions about caring for your loved one, please also contact your loved ones healthcare provider for information and support.

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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:

Do Not Engage In Arguments

How to Deal with Aggressive Dementia Patients (4 Strategies)

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.

Read Also: What Is The Difference Between Dementia And Senility

Strategies To Reduce Combativeness

At the time of admission, an assessment should be completed related to any prior history of combative behavior. This assessment should detail the type of behavior and any known triggers for this behavior. This assessment should be completed with a family member or the residents responsible party, if able.

A tool utilized in long term care is the Brøset Violence Checklist. The checklist can be used as part of the assessment upon admission to the facility or any time during the resident’s stay. The purpose of the checklist is to assist staff to determine in advance, if the resident is at risk for combative or aggressive behavior so appropriate interventions or strategies can be implemented.

  • Implement the resident care plan interventions and communicate patient needs to staff in order to minimize or eliminate behaviors. When formulating a plan for addressing combative behavior, consider:
  • Work closely with the entire care-giving team including family to develop a plan for successful management, containment and, where possible, prevention of combative incidents.
  • Make your goals realistic. You may not be able to stop all behavior problems, but you may be able to minimize or reduce them. Goals to consider:
  • Attend to safety of the resident with combative behavior.
  • Provide support by having all caregivers stay alert to give aid in combative behavior situations.
  • Increase awareness of behavior that may give clues to the onset of an aggressive act.
  • Seek Outside Help And Advice

    If you reach a point where the individuals aggression, rage, or violence is too much to handle, then it may be a good idea to reach out for help. You can speak with the individuals doctor or another professional in the field.

    It may also be beneficial to talk to other caregivers who have faced similar situations. They may be able to provide you with additional insight and help for your situation.

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    How To Deal With Manipulation

    Your loved one may have lost the ability to distinguish between truth and falsehoods, and they may no longer have a sense of morality around lying. These symptoms can be especially difficult for a caregiver to handle, as it may feel like a complete change in personality. In fact, a person with dementia may not realize theyre lying.

    Manipulation is often the root behavior for trust, control, and security. Sometimes, it can even be a cry for help.

    • Set limits when possible.
    • Remain aware of your personal responses. Do you feel angry, hurt, or frustrated? Acting on these emotions can bring more distress to an already stressful situation.

    DONT:

    • Hold dementia behaviors against your loved one.
    • Bring up events to prove or disprove statements.
    • Use accusatory language such as youre lying or youre being manipulative.
    • Engage in heated arguments.

    Dealing with dementia behaviors can quickly wear out a caregiver or family member. If you care for a person with dementia and are feeling resentment, anxiety, or depression, dont hesitate to seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.

    Although there are no treatments to stop dementia behaviors in the elderly, there are medications, dementia therapies, and memory care communities that may help.

    How Dementia Changes Our Thinking Skills

    How to Handle a Combative Dementia Patient

    Everyone agrees that people experiencing dementia are often unreasonable. But whether Im teaching families or professional caregivers, I rarely find anyone in the audience who understands that because dementia takes away our rational thinking skills, expecting people to use them and be reasonable or rational is no different than expecting someone who is blind to see or deaf to hear. Please think about this for a moment: if Ive lost my ability to use reasoning, why would it be helpful to explain to me why I should do something?

    It is also rare that I find someone who understands that we all have two separate and complete thinkingsystemsand that only the secondary one is lost to dementia.

    Yes, the rational thinking skills we lose to dementia comprise our secondary thinking system, not our primary thinking system. Our primary thinking system is our intuitive thinking skills. Its misleading to think of this complex and essential set of skills as intuition. These thinking skills provide us with the broad and unfiltered data that our rational thinking skills sort to help us make sense of the world around us. Without our intuitive thinking skills, our rational thinking skills would have nothing to work with and we could not function.

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    Our Very Active Intuitive Thinking Skills

    Focusing on the skills they wont lose can diminish mean dementia.

    Intuitive Thinking Skill #1Using our five senses.

    Dementia takes away our ability to analyze, label and interpret, but dementia does not take away our ability to see, hear, feel, taste and smell. Age might dull our senses, but to the degree theyre still available to us, our senses will provide us with raw data loud and cleardespite dementia. Mean dementia and anger result when caregivers and family members dont realize that their loved ones are still experiencing what they can no longer describe or interpret.

    Your loved one is experiencing everything around them and perceiving your emotions as much as ever , but they can no longer remember what happened moments ago or process any reasons for why youre doing what youre doing.

    Think about what this means: your loved one is experiencing everything around them and perceiving your emotions as much as ever , but they can no longer remember what happened moments ago or process any reasons for why youre doing what youre doing. Think of the mistaken assumptions they cant avoid. They need us to narrate and explain whats going on, without judgment. They need us to make sure that whatever sensory stimulation comes their way is pleasing and uplifting. They need us to do for them what they can no longer do for themselves: use memory and reasoning to avoid conflict.

    Intuitive Thinking Skill #2Feeling our own feelings.

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