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What To Do With A Violent Dementia Patient

Do Not Try And Alter Undesirable Behavior

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

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.

What Causes Alzheimers To Turn Violent

  • Physical discomfort
  • Physical pain from infections or the urinary tract can contribute to a change in behavior. This is common for Alzheimers patients. Patients are also unable to articulate or identify the cause of discomfort or pain so they may express it through violence. Other sources of physical discomfort include lack of enough sleep, hunger, and thirst or medication.
  • Environmental factors
  • Loud noises and physical clutter can over-stimulate a person with Alzheimers. If the person is surrounded by unfamiliar people or they feel lost,
  • Alzheimers can turn violent.
  • Poor communication
  • When patients are unable to understand and process the information given to them.

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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Coping With Agitation And Aggression In Alzheimers 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.

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Planning For When Your Loved One Does Wander

How To Talk To Someone With Dementia That Is Angry

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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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.

Tips To Ease Alzheimers Aggression

Once you understand the triggers for Alzheimerâs aggression, you can take steps to prevent it. A few things to try:

  • Think ahead of time if a situation might make your loved one uncomfortable, overstimulated, or confused.
  • Donât ask too many questions at once, give instructions that are too complex, or criticize. That way, youâre less likely to confuse and upset the person you are caring for.
  • Limit the amount of loud noises, activity, and clutter around them.
  • Donât argue. People with Alzheimerâs disease see a different reality than you do. Rather than challenge them about it, sit and listen. Ask questions about it.
  • Focus on the past. Alzheimerâs affects short-term memory, so itâs often easier and less stressful for someone to recall and talk about distant memories than what they watched on TV the night before.
  • Use memory cues. As the disease gets worse, remembering when and how to do everyday tasks like brushing teeth or getting dressed gets harder. Reminder notes around the house can help prevent frustration.
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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.

    No Easy Solutions But Improvement Is Usually Possible

    How to Deal with Aggressive Dementia Patients (4 Strategies)

    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.

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    Aggression And Agitation In Dementia

    Behavioral and psychological symptoms are very common in dementia, and affect up to 90% of people living with dementia. In addition to memory changes, people with dementia may experience agitation, psychosis, anxiety, depression, and apathy. These behavioral symptoms often lead to greater distress than memory changes.

    When people with dementia become agitated or aggressive, doctors often prescribe medications to control their behaviors in spite of the known risks of serious side effects. The most frequently prescribed medication classes for agitation in dementia carry serious risks of falls, heart problems, stroke, and even death.

    Caregivers, who often experience burnout in managing aggressive behaviors, welcome medications that can temporarily decrease agitation. Unfortunately, aggressive and agitated behavior often contributes to the decision to transition a loved one to an alternative living situation.

    Stage : Moderate Dementia

    Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.

    While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.

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

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    Dont Be Afraid To Ask For Alzheimer’s Support

    How To Handle Personality Changes And Aggression

    “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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    Rummaging And Hiding Things

    Caring for a patient who rummages around or hides things in the home can be a challenge, but not an insurmountable one.

    Rummaging/hiding things behavior management
    Protecting property
    Lock certain rooms or cabinets to protect their contents, and lock up all valuables.
    Have mail delivered out of reach of your loved oneperhaps to a post office box.
    If items do disappear, learn the persons preferred hiding places.
    Restrict access to trashcans, and check all wastebaskets before disposing of their contents in case objects have been hidden there.
    Protecting your loved one from harm
    Prevent access to unsafe substances, such as cleaning products, alcohol, firearms, power tools, sharp knives, and medications.
    Block unused electrical outlets with childproofing devices. Hide stove knobs so the person cant turn on the burners.
    Lower the temperature on water heaters.
    Designate a special drawer of items that the person can safely play with when keen to rummage.

    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 residents 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.
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    Dealing With Dementia Behavior: Wandering

    Two characteristic precursors to wandering are restlessness and disorientation. An Alzheimers patient may exhibit signs of restlessness when hungry, thirsty, constipated, or in pain. They may also become disoriented, pace, or wander when bored, anxious or stressed due to an uncomfortable environment or lack of exercise. As well as adding physical activity to your loved ones daily routine, you can:

    • Immediately redirect pacing or restless behavior into productive activity or exercise.
    • Reassure the person if they appear disoriented.
    • Distract the person with another activity at the time of day when wandering most often occurs.
    • Reduce noise levels and confusion. Turn off the TV or radio, close the curtains, or move the patient to quieter surroundings.
    • Consult the doctor as disorientation can also be a result of medication side effects, drug interactions, or over-medicating.

    What You Can Do About Medications And Difficult Dementia Behaviors

    The best ways to handle violent Alzheimerâs patients.

    If your relative with dementia is not yet taking medications for behaviors, consider these tips:

    • Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.
    • Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.
    • Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.
    • For all medications for dementia behaviors:
    • Monitor carefully for evidence of improvement and for signs of side-effects.
    • Doses should be increased a little bit at a time.
    • Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.

    If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.

    The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.

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    Stage : Age Associated Memory Impairment

    This stage features occasional lapses of memory most frequently seen in:

    • Forgetting where one has placed an object
    • Forgetting names that were once very familiar

    Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.

    How To Respond To These Causes

    • Identify the immediate cause that may have triggered the Alzheimers to turn violent
    • Rule out any pain that may cause the violence
    • Dont focus on the facts and specific detail rather focus on the patients feelings
    • Dont get upset or raise your voice. Stay positive and reassuring. Use a soft tone.
    • Limit the distractions in the patients surroundings.
    • Try and engage the patient in relaxing activities like music, massage, or exercise. You should soothe the patient.
    • Change the focus from the immediate situation or activity that may have caused the Alzheimers to turn violent to another activity
    • Take a break from the patient when you have established their safety
    • Establish the safety of both you and the patient especially when the patient is unable to calm down
    • Talk with other people who have had similar experiences and learn what strategies have worked for them

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    Existing Interventions & Previous Related Work

    found that only 38.3% of caregivers had received suggestions from healthcare personnel, although 70% of caregivers with a severely aggressive care-recipient had found strategies to avoid conflict. Some of these included: distraction, ignoring, positive nurturing, and maintaining routines. reported on several strategies for reducing conflict that showed promise in the literature, including person-centered care planning, personalized and respectful bathing and toileting routines, personalization of patient’s bedrooms, respect for privacy and dignity, and person-centered interactions outside of ADL management. Effects of these types of interventions were reported to reduce aggression by as much as 60% . Indeed, found strong evidence relating bathing and aggressive behavior in nursing home settings, implying that this is one of the most challenging aspects of care, and that attention to adaptation this task could substantially reduce behavioral disruption.

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