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When Dementia Patients Get Violent

Our Most Frustrating Rational Thinking Losses

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

If Im experiencing dementia and you ask me to do something I cant do, Ill feel embarrassed, angry, hurt, or all three at once. Its essential that you understand what someone experiencing dementia is no longer able to comprehend for you to avoid getting combative, aggressive, and mean;reactions.

Rational Thinking Loss #1Becoming unable to understand why.

Rational thinking skills are for understanding how, why, when, who and whatthe ability to perceive relationships between facts. Dementia takes that away. So if you try to explain to your loved one why they need to do something, or what went wrong, or how to do something, they will not be able to follow you and will end up embarrassed or concluding that youre making fun of them. Anger or hurt feelings will result. Whenever you catch yourself explaining why, stop. Youre asking them to do something they can no longer do. Youll have pleasanter interactions once you build new conversational habits and turn your focus away from why to talking about things that are;pleasant.

Rational Thinking Loss #2Becoming unable to see cause and effect.

Rational Thinking Loss #3Becoming unable to follow sequences.

Rational Thinking Loss #4Becoming unable to prioritize.

Common Changes In Behaviour

In the middle to later stages of most types of dementia, a person may start to behave differently. This can be distressing for both the person with dementia and those who care for them.

Some common changes in behaviour include:

  • repeating the same question or activity over and over again
  • restlessness, like pacing up and down, wandering and fidgeting
  • night-time waking and sleep disturbance
  • following a partner or spouse around everywhere
  • loss of self-confidence, which may show as apathy or disinterest in their usual activities

If you’re caring for someone who’s showing these behaviours, it’s important to try to understand why they’re behaving like this, which is not always easy.

You may find it reassuring to remember that these behaviours may be how someone is communicating their feelings. It may help to look at different ways of communicating with someone with dementia.

Sometimes these behaviours are not a dementia symptom. They can be a result of frustration with not being understood or with their environment, which they no longer find familiar but confusing.

What Can You Do When A Dementia Patient Gets Agitated

Although agitated behavior is not common in persons with dementia, it can present during a phase of the disease. Often it occurs in the middle of the disease when the person is still physically strong, but judgement has begun to fail. When a dementia patient experiences frustration, it may turn to anger. We hope that some of the techniques and protocol listed below will help the family and caregiver cope when a person with dementia becomes agitated.

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Five Ways To Help Identify The Causes Of Problem Behavior

  • Look at your loved ones body language and imagine what they might be feeling or trying to express.
  • Ask yourself, what happened just before the problem behavior started? Did something trigger the behavior?
  • Are the patients needs being met? Is your loved one hungry, thirsty, or in pain?
  • Does changing the environment by introducing favorite music, for example, help to comfort the person?
  • How did you react to the problem behavior? Did your reaction help to soothe the patient or did it make the behavior worse?
  • Common Causes of Problem Behavior

    Consequences Of Aggressive Behaviour In The Home Care Setting

    Elderly Dementia Patients Benefit From Visits With Loved ...

    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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    Violent Behaviors In The Elderly

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    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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    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.
  • What Can Families Do When Dementia Patients Are Kicked Out Of Care Facilities

    How to Deal with Aggressive Dementia Patients (4 Strategies)

    The phone call came as a shock. Your aunt cant transfer into memory care; we have to discharge her from this facility, a nurse told Jeff Regan. You have 30 days to move her out.

    The next day, a legal notice was delivered. Marilou Jones, 94, who has dementia, was being evicted from Atria at Foster Square, an assisted living facility in Foster City, Calif. The reason: You are non-weight bearing and require the assistance of two staff members for all transfers, the notice said.

    Across the country, assisted living facilities are evicting residents who have grown older and frail, essentially saying that we cant take care of you any longer.

    Regan was taken aback: After consulting with Atria staff about his aunts deteriorating health, he and Jones husband, William, 88, had arranged for her to be transferred to a dementia care unit at the facility. A room had been chosen, and furniture bought. But now, Atria was claiming it couldnt meet her needs after all.

    This action isnt unusual. Across the country, assisted living facilities are evicting residents who have grown older and frail, essentially saying that we cant take care of you any longer.

    Evictions top the list of grievances about assisted living received by long-term care ombudsmen across the U.S. In 2016, the most recent year for which data are available, 2,867 complaints of this kind were recordeda number that experts believe is almost surely an undercount.

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    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.

    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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    Planning For When Your Loved One Does Wander

    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.

    Rummaging And Hiding Things

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

    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.

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    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 .

    New Research Shows That Nondrug Therapies Are More Effective

    According to a new study looking at more than 160 articles, nondrug interventions appeared to be more effective than medications in reducing agitation and aggression in people with dementia. Researchers found that three nonpharmacologic interventions were more effective than usual care: multidisciplinary care, massage and touch therapy, and music combined with massage and touch therapy.

    For physical aggression, outdoor activities were more efficacious than antipsychotic medications . For verbal aggression, massage and touch therapy were more effective than care as usual. As a result of this study, the authors recommend prioritization of nonpharmacologic interventions over medications, a treatment strategy also recommended by the practice guidelines of the American Psychiatric Association.

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    What Causes These Behaviours

    There are many reasons why behaviours change. Every person with dementia is an individual who will react to circumstances in their own way. Sometimes the behaviour may be related to changes taking place in the brain. In other instances, there may be events or factors in the environment triggering the behaviour. In some instances a task may be too complex. Or the person may not be feeling well.;

    Implications For Health Policy

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

    Recognising the growing challenges in the home care setting and appreciating home care as necessary part of the health system will be critical. The policy of shortening hospital stays and discharging patients quicker and sicker results in increasingly complex home care situations. Therefore, action is necessary regarding the growing number of persons with dementia. To ensure person-centred home care for persons with dementia, political support for further education is required as well as the adaption of insurance schedules.

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    Look For The Underlying Factor

    Once you have established your safety and that of the patient, you should then look at what could have triggered such violent behavior.

    It is important that you try and understand what may have led the patient to suddenly become violent. Violent outbursts may be caused by:

    • Physical discomfort
    • Frustration
    • Environmental factors like loud noise

    When you are able to identify the triggers, try and reduce them. Understanding the stressors will also help you avoid any future incidences of violent outbursts.

    Hindrances To Solving The Problem Of Aggressive Behaviour In The Home Care Setting

    One hindrance to solving the problem of aggressive behaviour towards professional caregivers was the difficulty of identifying aggressive behaviour. Fear of sanctions after reporting aggressive incidents or lack of reaction to such reporting intensified the difficulty of reporting aggressive behaviour in the home care setting . In the inpatient setting, shame or fear of not being considered resilient enough was one of the reasons for not reporting aggressive incidents . Whether these aspects influence professional caregivers in the home care setting is not known. Furthermore, home care is characterised by working alone without an opportunity to discuss and to classify the incident. Therefore, there is a lack of reporting structure as well as a lack of social control. Additionally, home caregivers shy away from leaving the care recipient alone, particularly if she/he is affected by dementia. However, abandoning the person with dementia and interrupting care activities, particularly interventions associated with personal hygiene, can also help to calm down the situation. In this case, leaving the home of the person with dementia might also prevent further aggressive behaviour .

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    Dying From Dementia With Late

    The death of your loved one can be a hard concept to wrap your head around and accept. But knowing what to expect can help you when your loved one has late-stage dementia. It might help to know what will happen in the future so that you can be prepared emotionally and logistically.

    This article discusses how dementia progresses and what to expect during late-stage dementia.

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