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What To Do When Dementia Patients Get Aggressive

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How to Deal with Aggressive Dementia Patients (4 Strategies)

Unlike nursing homes, assisted living facilities generally dont have to document their efforts to provide care or demonstrate why they cant provide an adequate level of assistance. In most states, there isnt a clear path to appeal facilities decisions or a requirement that a safe discharge to another setting be arrangedrights that nursing home residents have under federal legislation.

Its very frustrating because state regulations dont provide sufficient protections, said Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care.

Sometimes, evictions are prompted by a change in ownership or management that prompts a re-evaluation of an assisted living centers policies. In other cases, evictions target residents and family members who complain about not getting adequate assistance.

We see this regularly: An assisted living will say your mom isnt looking well, were sending her to the hospital to be re-evaluated, and then, before she can return, theyll say weve determined her care level exceeds what we can provide and were terminating her agreement.

Amy Delaney, a Chicago elder law attorney, tells of a client in her late 80s with dementia admitted to an upscale assisted living community. When her two daughters noted deficiencies in their mothers care, managers required them to hire a full-time private caregiver for $10,000 a month, on top of the facilitys fee of $8,000 a month.

We Can Manage Our Moodsthey Cannot Manage Theirs

When we are not experiencing dementia and find ourselves upset by an experience or situation, we can evaluate, compare, and consider. We can choose to avoid being in a bad mood and we can choose to not inflict it on our companions. For example, if Im late for an appointment and the car ahead of me is driving slower than the speed limit, I might feel irritated and frustrated but I have the skills necessary to change that feeling before it affects my mood. I can tell myself that Im late due to my own lack of planning, that other people cant be expected to hurry to accommodate me, and that its too nice a day to be in a bad mood. I can do that with my memory skills and my rational thinking skills and change the negativity Im beginning to feel back into a positive mood. But when were experiencing dementia, we cant do any of that.

So, with dementia in the picture, people cant help taking everything personally, and they lack the skills to change the moods that result when they feel hurt or betrayed or taken advantage of.But theres more to think about. It gets both worseand better. Theres a third truth which is the key to avoiding combative and aggressive behaviors with dementia. When we are experiencing dementia, we cannot choose our own moods.

S To Calm Agitation And Aggression In Older Adults With Alzheimer’s

The most important issue caregivers need to understand is seniors with dementia are experiencing their own realities. In order to appease a seniors agitation and aggression, caregivers need to tap into this reality and embrace it.

How to Handle Difficult Behaviors When a Senior Has Alzheimers

Here are 10 tips for coping when an older adult with dementia exhibits difficult behaviors.

  • Music

    Music therapy helps seniors calm down and reflect on happier times. According to research from the Alzheimers Association, listening to music releases dopamine in the brain and triggers happy feelings throughout the body.

    Music also improves memory function and encourages social engagement.

  • Aromatherapy

    According to a study in BJPsych Advances, using scents like lavender can reduce difficult behaviors in older adults with dementia.

    Benefits include improved sleep, decreased agitation, higher concentration and reduced hallucinations.

  • Touch

    A gentle human touch can create a bond between the caregiver and the senior, resulting in a calming effect. It also helps increase trust. A soft back rub or gentle hand pat may be a way to reduce agitation in a senior loved one.

  • Pet Therapy

    According to Every Day Health, pet therapy has many benefits for seniors with dementia. They include decreased agitation, increased physical activity, increased appetite and joy.

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    A doctor will perform a physical exam to evaluate your mental processes. He or she will also ask you about any medications youre currently taking and any stressful situations youre facing. Your memory loss provider may also ask you about your symptoms and ask you to take notes on how youre feeling. The doctor may recommend that you get an appointment with a neuropsychologist. A neuropsychologist can help you figure out the best way to treat your memory loss.

    A doctor will conduct a physical exam to determine the exact cause of your memory loss. He or she will also ask you about your medical history and whether youve experienced other forms of memory loss. After your medical history, your provider will discuss your options for treatment. If youre experiencing severe symptoms of memory loss, you should seek out a professional. It will help you get the right kind of care for your specific situation. So, take action today.

    A healthcare provider will perform a physical exam to assess the condition of your memory. He or she will ask you about your family and friends and any medications youre taking. Once he or she has established the root cause, a proper treatment will be given. If you have a mild form of memory loss, you can still function independently and perform everyday tasks. If your symptoms are more severe, you may need to see a medical professional.

    Aggressive Behaviour In Dementia

    Dementia &  Aggression

    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.

    Also Check: Aphasia In Alzheimer’s

    Triggers To Violence & Issues Of Homecare And Healthcare Services

    There are a number of things which have been correlated in the literature as triggers for violence, including: pain, reduced vision and/or hearing, changes in the environment, excessive noise or activity, locked doors, limited privacy or space, and quality of relationship with caregivers . Depression and premorbid aggressive personality traits may also be related to aggressive or violent behavior . found a significant correlation between depression and physical aggression against the caregiver , and some evidence suggests that testosterone levels may be related to aggression in dementia patients, although not agitation .

    To complicate matters, although physical or chemical restraints are frequently used to try to manage behaviors, there is little evidence that restraint of any kind is either an effective or safe method, although some medications have been found to have more impact than others . Questions have been raised about the ethical implications of medication and restraint use, noting that such methods are the antithesis of person-centered care , and some additional cautions in the literature note that some classes of medications may actually increase behavioral disruptions . note that âMany patients … are often inappropriately prescribed psychotropic medications, which are then inadequately monitored and reviewed, with the potential for serious detrimental consequencesâ .

    Aggressive Behaviour From People With Dementia

    Being on the receiving end of aggression is often frightening and distressing. When this has come from a person we are trying to help, we may also feel hurt and rejected. But if the person has dementia, we need to be aware that such behaviour is unlikely to be a deliberate act of aggression in fact, it is much more likely to suggest fear or desperation.

    When we realise that aggression is usually a reaction, theres good news we can do something about it.

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    You Are In Charge Of Mood

    So, if you are spending time with someone whos experiencing dementia, this is the most important principle to understand: You are in charge of mood. You can bring it and you can change it for both of you. This is the only relationship youll ever have in which you actually are in control of mood for both of you.

    These principles about mood management are among the first that I teach to families and caregivers in my classes, because if we can inadvertently cause someone whos experiencing dementia to feel angry and hurt, we can also consciously cause them to feel happy and safeonce we understand how what they can and cannot do affects their moods. I created the DAWN Method® to do exactly this: to teach caregivers and families how to bring a sense of peace and safety to the people who need it the mostthose who are losing skills to dementia.

    Planning For When Your Loved One Does Wander

    How to Deal with Aggressive Dementia Patients

    In case your loved one does wander, its a good idea to have a plan in place.

    • Notify neighbors and local police about your loved ones tendency to wander, and circulate your phone number.
    • Have your loved one wear an ID bracelet or labels in clothing. Digital devices using GPS technology can track your loved ones location.
    • In case a police search becomes necessary, have a recent photo of your loved one and some unwashed clothing to help search-and-rescue dogs.
    • In the U.S., sign up for the Alzheimers Associations Medic Alert and Safe Return Program, an identification system to help rescue lost Alzheimers patients.

    How to find a missing Alzheimers patient

    A person with dementia may not call out for help or answer your calls, even when trapped somewhere, leaving them at risk for dehydration and hypothermia.

    Check dangerous areas near the home, such as bodies of water, dense foliage, tunnels, bus stops, and high balconies.

    Look within a one-mile radius of where the patient was before wandering.

    Look within one hundred feet of a road, as most wanderers start out on roads and remain close by. Especially look carefully into bushes and ditches, as your loved one may have fallen or become trapped.

    Search in the direction of the wanderers dominant hand. People usually travel first in their dominant direction.

    Investigate familiar places, such as former residences or favorite spots. Often, wandering has a particular destination.

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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.

    Do Not Ignore Physical Abuse

    As much as one needs to be tolerant, kind, forgiving, and patient with older adults who have dementia, it does not mean that they have to excuse the patients when they become physically aggressive and allow the abuse to continue. It is not to be accepted, and if it happens, it is best to alert your doctor who will work on the solution to make sure it stops. It will keep both the patient and caregiver in safety.

    From physical manifestations to angry outbursts, taking care of an individual with dementia may not be easy. However, working with the tips above can help caregivers and loved ones to get through it. Remember that there are plenty of treatments, interventions and special care providers who can help therefore, you should never be shy about getting help when you need it.

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    Care Options For Aggression In Dementia

    Caregiving to dementia patients requires a lot of effort, time, and patience. Depending on the stage of dementia, these patients exhibit different symptoms which are managed accordingly. In the mid-to-late course of the disease when the patient starts showing aggression, caregiving becomes challenging. At this point, both the patient and family can suffer a lot. At Hometouch, we believe in empathy and compassion. The different care options for aggression in dementia are:

    Live in Care for Dementia Aggression:

    In this, a professional caregiver resides with a dementia patient in their own home. This option is more feasible for the aggression experienced by dementia sufferers. One of the causes of aggravation of dementia symptoms is unfamiliar surroundings and people. The inability to recognise the location and unfamiliar faces increases confusion in patients and ultimately worsens symptoms. When a live in carer resides with the dementia patient, matters can often settled down.

    At Hometouch, our professional caregivers for dementia are experts in providing round the clock care. They help the patient with their daily tasks, provide companionship, takes them to social gatherings and doctor’s appointments. They are also trained to manage anger, agitation, and aggression in dementia.

    Care homes for aggressive dementia patients:

    Dementia Behavior: Sleep Problems

    What to Do When Someone With Dementia Lashes Out ...

    While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect as many as a third of seniors with dementia.

    Common sleep issues may include:

    • Difficulty getting and staying asleep
    • Agitation and restlessness when trying to sleep
    • Thinking its daytime when its night, going as far as getting up, getting dressed and wanting to start the day, Hashmi says

    Sleep disturbances are hard on patients and caregivers alike, Hashmi says. Its physically and mentally exhausting to be up night after night.

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    Your Superpowerpositive Eye Contact

    Eye contact. This is a critical nonverbal communication tool with dementia. Eye contact is your superpower if you spend time with people whore experiencing dementia. You can use it to send instant messages of love, acceptance, gladness, and gratitudeeven when your hands are full and youre at a loss as to what to do next. You can use it to prevent your loved one from sinking into the anger, hurt feelings, and misunderstandings that result in combative or aggressive behaviors.

    And the opposite is true, too. If you dont understand that eye contact is more necessary than usual with dementia, you are inadvertently communicating disinterest and lack of caring. People whore experiencing dementia are living in the three-second nowa place that lacks any previous messages of love, acceptance, and appreciation.

    So, when you find yourself wondering how your loved one became so mean, angry, and unhappy, remember these tools that you have at your disposal and they do not. Remember that wetheir companionsare able to manage their moods while they are not. And that we can change what we are inadvertently communicating into messages of love and acceptance.

    Stage : Moderately Severe Dementia

    When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:

    • Delusional behavior

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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.

    The Rules In Relationships Change With Dementia

    New approach to care for Alzheimerâs dementia and aggression

    If youre spending time with someone whos experiencing dementia, you can avoid the dementia anger stage , but only if you become more aware of whats causing it. When dementia comes into a relationship, the rules change. A relationship including dementia is different from any youve experienced before. You will need to understand the cognitive skills we all normally useand then which ones we continue using when were experiencing dementia.

    In my first article in this series , I described our two thinking systems and explained the most frustrating rational thinking losses caused by dementia. I also described our intuitive thinking skillsthose that we continue using. It will be helpful to read that article first if you havent yet.

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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.


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