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When Alzheimer’s Patients Get Violent

Manage Stress In An Alzheimers Or Dementia Patient

How to Deal with Aggressive Dementia Patients (4 Strategies)

Different stress-reducing techniques work better for some Alzheimers patients than others, so you may need to experiment to find the ones that best help your loved one.

Exercise is one of the best stress-relievers for both the Alzheimers patient and you, the caregiver. Regular walking, dancing, or seated exercises can have a positive effect on many problem behaviors, such as aggression, wandering, and difficulty sleeping. Indoor shopping malls are vast walking opportunities protected from the weather.

Simple activities can be a way for your loved one to reconnect with their earlier life. Someone who used to enjoy cooking, for example, may still gain pleasure from the simple task of washing vegetables for dinner. Try to involve your loved one in as many daily activities as possible. Folding laundry, watering plants, or going for a drive in the country can all help to manage stress.

Remembering the past may also help calm and soothe your loved one. Even if they cant remember what happened a few minutes ago, they may still clearly recall things from decades ago. Try asking general questions about their distant past.

Use calming music or play your loved ones favorite type of music as a way to relax them when agitated. Music therapy can also help soothe someone with Alzheimers disease during mealtimes and bath times, making the processes easier for both of you.

Take time to really connect with the person youre caring for

What You Can Do For Your Loved One

As an individual with dementia declines, you can help them by providing a loving and supportive presence. Sit with them. Hold their hand. Play music they enjoy.

One of the greatest gifts you can give your loved one is helping to get their affairs in order. Ensure that financial and healthcare powers of attorney are put in place, so you can make decisions when your loved one is no longer able. Look into funeral arrangements before you need them, so you dont need to make important decisions in a time of crisis.

Talk to your loved ones physician about the possibility of palliative care support in the home and hospice care when your loved one is ready.

Paranoia Delusion And Hallucinations

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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Understanding The Causes And Finding Ways To Cope

While some people living with Alzheimer’s disease or other types of dementia remain pleasant and easy-going throughout their lives, others develop intense feelings of anger and aggression.

When someone with dementia lashes out at you for seemingly no reason, it’s normal to feel surprised, discouraged, hurt, irritated, and even angry at them. Learning what causes anger in dementia, and how best to respond, can help you cope.

When Alzheimer’s Turns Violent

Dementia Caregiving

CNN iReportMadison ParkSTORY HIGHLIGHTS

  • Families struggle to balance their desire to care for patient versus their safety
  • 5% to 10% of Alzheimer’s patients become violent
  • iReporters share tips: staying calm and patient, and finding support groups

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— One minute, Sam Cohen, 80, points to photos of his kids and talks about how his son wanted to become an actor.

The next minute, he unravels.

Cohen, a former New Jersey taxi driver and ironworker, is convinced his family will steal his money. He talks about escaping to Israel. He ignores his grown children’s pleas to take his medication — he tells them they’ve been brainwashed. And he threatens his wife, Haya.

“He is starting to make Charlie Sheen look rational,” said his son, Michael Cohen, about his dad’s Alzheimer’s disease.

Earlier this month, he went from paranoid to physically violent. An attack on Haya put Cohen in a hospital psych ward.

Sometimes, verbal rants, as in Cohen’s case, escalate, leaving families in a bind. What can you do when your loved one with Alzheimer’s becomes physically aggressive?

To share patient experiences, CNN Health asked the iReport community how they have dealt with the challenges of Alzheimer’s. Some described being cursed, kicked, slapped and bitten by their loved ones, who cannot understand their actions because of their disease.

“We’re at a loss,” his son said. His father had never before behaved in such a way.

Now, she could barely navigate her house.

1. Back down.

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Repeating The Same Question Or Activity

Repeating the same question or activity may be a result of memory loss where the person cannot remember what they’ve said or done.

It can be frustrating for the carer, but it’s important to remember that the person is not being deliberately difficult.

Try to:

  • be tactful and patient
  • help the person find the answer themselves, for example, if they keep asking the time, buy an easy-to-read clock and keep it in a visible place
  • look for any underlying theme, such as the person believing they’re lost, and offer reassurance
  • offer general reassurance, for example, that they do not need to worry about that appointment as all the arrangements are in hand
  • encourage someone to talk about something they like talking about, for example, a period of time or an event they enjoyed

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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Following A Partner Or Carer Around

Dementia makes people feel insecure and anxious. They may “shadow” their partner or carer as they need constant reassurance they’re not alone and they’re safe.

They may also ask for people who died many years ago, or ask to go home without realising they’re in their own home.

Try to:

  • have the person with you if you’re doing chores such as ironing or cooking
  • reassure them that they’re safe and secure if they’re asking to go home
  • avoid telling them someone died years ago and talk to them about that period in their life instead

Alzheimers Care Challenges: Handling Dementia & Anger

Wife of Alzheimer’s patient recalls violent behavior in latter stage

Handling anger is one of the biggest challenges when caring for a person whos suffering from Alzheimers or another form of dementia. While almost everybody shows some form of aggression every now and again, Alzheimers and dementia can make anger issues much worse or develop anger issues in people who previously had none. Studies show that anger issues generally worsen the more severe an Alzheimers or dementia sufferers condition becomes.

Managing anger in dementia sufferers can be difficult. It may often mean reacting against your first instincts, but proper anger and dementia strategies can make care much easier for loved ones and caregivers alike.

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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.

Tips For Managing Alzheimers Aggression

Getting to the root cause of outbursts can help caregivers manage dementia-related behaviors more effectively and may lessen the frequency of agitation and aggression.

The advantage family members have when they become caregivers for their aging parents is knowing their likes and dislikes. Things that annoyed or frustrated them in the past will most likely continue to do so. These known triggers are then complicated by new challenges caused by the progression of the disease.

Learning to redirect their attention and having open and honest conversations with other family members and health care providers can be of great assistance. Support groups can offer an outlet for frustrations as well as new information on this condition and creative ideas on how to deal with common behaviors and situations.

Most importantly, patience is key for everyone involved. Providing care for someone with dementia is hard work. When frustration mounts, look to the advice of experienced caregivers to help you cope: Dementia Caregiving Tips from Teepa Snow.

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Consequences Of Aggressive Behaviour In The Home Care Setting

Consequences of aggressive behaviour by persons with dementia are far-reaching. Carter and Galinsky et al. described shortened visits of professional home caregivers as a result of aggressive incidents or threatening situations. This may result in neglecting persons with dementia . Due to the dependence between the professional caregiver, the care recipient and the family caregivers, persons with dementia living at home are particularly vulnerable. Leaving the home of the person with dementia after an aggressive incident is risky. In contrast to the inpatient setting, colleagues cannot stand in immediately for the caregiver who left. Therefore, the person with dementia is abandoned for several hours until another caregiver or relative arrives. Often the support of the home care service enables the person with dementia to remain at home. However, it is the person with dementia who decides whether she or he will open the door to the caregiver. This renders the relationship more fragile than in the inpatient setting. Furthermore, there are specific issues hindering the improvement of the situation.

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Residents With Combative Behavior In Long Term Care

Tips for Dealing With Aggressive Behavior in Parents With ...

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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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Violent Behaviors In The Elderly

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  • Its impossible to anticipate how a senior may interact with other residents and staff in settings like assisted living facilities and nursing homes, but staff should be prepared to handle difficult interpersonal issues and defuse tensions.

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  • Seniors with urinary tract infections may not exhibit classic physical symptoms. Instead, confusion and mental and behavior changes can be the tell-tale signs of a UTI.

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  • One of the biggest challenges for dementia caregivers is dealing with anger and aggression. Understanding how and why these behaviors occur can help you defuse them.

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Do Not Engage In Arguments

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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What Causes Alzheimer’s Disease

The exact cause of Alzheimers is not known. However, several factors increase the risk of the disease.

The risk factors of Alzheimers include:

  • Age: Risk increases with age, affecting 15% of people older than 65 years and 50% of people older than 85 years.
  • Family history: Family member with the disease increases the risk. Inherited gene mutations also increase the probability of developing the disease.
  • Gender: Women have a higher risk than men.

Preventing And Handling Anger In Alzheimers Care

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

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.

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Biological Clocks And Circadian Rhythm

Biological clocks are specific groups of proteins that communicate with cells in nearly every organ and most tissue in the body.

They respond to changes in light and dark in the environment and give rise to circadian rhythms that is physical, behavioral, and mental changes that follow a daily cycle.

Most living things, from microbes to plants and animals, have circadian rhythms. For example, being awake during the day and asleep at night is a circadian rhythm that arises from biological clocks responding to changes in light levels in the organisms environment.

Scientists have discovered that the genes that make and control the various components of biological clocks are largely similar in humans, mice, fruit flies, fungi, and many other organisms.

While biological clocks are found nearly everywhere in the body, they are all synchronized by a master clock in the brain.

In humans, mice, and other vertebrates, the master clock is located in the suprachiasmatic nucleus, which is a cluster of neurons inside the hypothalamus region of the brain. The cluster contains around 20,000 cells and receives signals directly from the eyes.

There Are Many Possible Reasons For The Aggressive Behavior

Every communication from someone with Alzheimers gives us an opportunity to understand what is going on. Aggressive behaviors can tell us whether any of the following might be occurring with the individual:

  • Pain, stress, or fatigue
  • Confusion due to a sudden change in environment a change in routine or the change of a person
  • Reaction to medications, or to the interaction of medications
  • Noisy or confusing surroundings
  • Feeling pushed to do something uncomfortable such as taking a bath
  • Feeling uncertain when asked to do something that seems too hard

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Stage : Mild Cognitive Impairment

Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:

  • Getting lost easily
  • Noticeably poor performance at work
  • Forgetting the names of family members and close friends
  • Difficulty retaining information read in a book or passage
  • Losing or misplacing important objects
  • Difficulty concentrating

Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.

Circadian Pattern Of Aggression

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For their study, Prof. Saper and his colleagues measured the frequency and intensity of interactions between male mice as resident mice defended their territory against intruder mice that were introduced into their cages at different times of the day.

They reported, for the first time in a published study, that the attacks on the intruder mice showed a circadian pattern of aggression that is, their intensity and frequency depended on the time of day.

The mice, explains Prof. Saper, were more likely to be aggressive in the early evening around lights out, and least aggressive in the early morning, around lights on.

It looks like aggressiveness, he continues, builds up in mice during the lights on period, and reaches a peak around the end of the light period.

In another set of experiments, the researchers manipulated the mices master biological clock by tweaking genes in the neurons that regulate it.

They found that when they stopped the master clock neurons from being able to make a specific chemical messenger, or neurotransmitter, the mice lost their circadian pattern of aggression. Aggressiveness remained high all the time, showing no highs and lows.

The researchers then used a tool called optogenetics to map the brain circuits involved. The tool uses laser light to stimulate and deactivate targeted brain cells.

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