Monday, June 27, 2022
HomeHealthWhy Do Alzheimer's Patients Become Aggressive

Why Do Alzheimer’s Patients Become Aggressive

Can I Realistically Offer Home Care

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

There are a number of factors that affect whether or not you can realistically offer home care:

  • How much support does the patient need?

The patients physician may be the best person to advise how much support they need, and you can also seek advice from the Alzheimers Association. The amount of support needed will depend on the stage of Alzheimers, but also the patients specific symptoms and difficulties. There are useful guidelines of what you can expect as a caregiver at every stage here.

  • Is family support available?

Caring for an Alzheimers patient is an exhausting and potentially overwhelming task, and if possible should not fall on only one persons shoulders. If there are multiple, committed family members to help out, during the day and also overnight when needed, then a nursing home may not be necessary – but otherwise, it should be considered.

  • Can I afford paid home help?

Paid home help is also a possibility, but the Alzheimers Association found that it costs around $20 an hour – which quickly becomes prohibitive if you need 24-hour care. However, if you are able to combine family support with brief home visits, this may be a good choice for minimal disruption to the patient. Other options include respite care and adult day centers, which can give you and your family a break. Alternatively, if you feel your loved one could use more support but is not ready for a nursing home, you could consider retirement housing or assisted living.

Practical Tips On Medications To Manage Difficult Behaviors In Dementia

You may be now wondering just how doctors are supposed to manage medications for difficult dementia behaviors.

Here are the key points that I usually share with families:

  • Before resorting to medication: its essential to try to identify what is triggering/worsening the behavior, and its important to try non-drug approaches, including exercise.
  • Be sure to consider treating possible pain or constipation, as these are easily overlooked in people with dementia. Geriatricians often try scheduling acetaminophen 2-3 times daily, since people with dementia may not be able to articulate their pain. We also titrate laxatives to aim for a soft bowel movement every 1-2 days.
  • No type of medication has been clinically shown to improve behavior for most people with dementia. If you try medication for this purpose, you should be prepared to do some trial-and-error, and its essential to carefully monitor how well the medication is working and what side-effects may be happening.
  • Antipsychotics and benzodiazepines work fairly quickly, but most of the time they are working through sedation and chemical restraint. They tend to cloud thinking further. It is important to use the lowest possible dose of these medications.
  • Antidepressants take a while to work, but are generally well-tolerated. Geriatricians often try escitalopram or citalopram in people with dementia.

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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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.

Pathophysiology Of The Hida Domain

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

Though the specific molecular mechanisms that lead to HIDA domain symptoms are generally unknown, pathology and human imaging studies have provided some insight into this domains pathophysiology. At first, the HIDA domain may seem like a disparate set of aberrant motor dysfunctions and behavioral states, but these symptoms all represent a common deficit in the appropriate inhibition of ones actions. Mirroring this common deficit, very similar neurocircuitry is implicated for all of these symptoms, namely, loss of corticostriatal control and reduction in neurotransmission of far-reaching monoaminergic inputs that modulate this corticostriatal circuitry . While specific investigation into the symptoms of the HIDA domain in AD has been limited, similar brain regions are usually implicated .

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Is My Loved One Safe At Home

There are several factors that you should consider when you evaluate the Alzheimers patients safety in their own home:

  • Alzheimers disease can cause sufferers to put themselves at risk. They may, for instance, leave pans on the stovetop, leave the gas on, ingest poisonous chemicals, or slip and fall. They may wander out into the street and get lost, or stumble into traffic. There are steps that can be taken to make the home safer, but at some point, you may feel that your loved one would be more secure in a nursing home.
  • If you are not physically strong enough to help them, then as they become more physically dependent on you, you may not be able to protect them from falls or safely lift them up.
  • Some Alzheimers sufferers develop aggressive behaviors that could put others around them at risk. Or, if they are sharing the home with family members, their forgetful behavior could cause harm to their co-habitants.

Alzheimers facilities provide round-the-clock supervision, as well as full security if your family member has a tendency to wander.

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.

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Ways To Reduce And Manage Mean Dementia Behavior

1. Calm the situation downThe first thing to do is reduce the tension in the room.

Start by limiting the distractions in the room, like turning off the TV or asking others to leave.

And if you stay calm, theyre also more likely to calm down.

It might help you to count to 10 or even leave the room for a short time to cool down. Repeat to yourself its the disease as a reminder that theyre not intentionally doing this.

If the current activity seemed to cause the agitation, try shifting to a more pleasant, calming activity. Or, try soft music or a gentle massage.

2. Comfort and reassure while checking for causes of discomfort or fearTake a deep breath, dont argue, and use a calm, soothing voice to reassure and comfort your older adult.

It also helps to speak slowly and use short, direct sentences.

Then, check for possible causes of agitation or fear, like:

  • Feeling disturbed by strange surroundings
  • Being overwhelmed by complicated tasks
  • Frustration because of the inability to communicate

It also helps to focus on their emotions rather than their specific words or actions. Look for the feelings behind what theyre doing as a way to identify the cause.

3. Keep track of and avoid possible triggersWhenever difficult behavior comes up, write down what happened, the time, and the date in a dedicated notebook.

Also think about what was going on just before the behavior started and write that down as a possible trigger.

Taking some time away can help both of you.

Late Stages Of Alzheimers Disease Symptoms

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

The needs of the person with Alzheimers become much more demanding as the disease progresses. In the late stages of Alzheimers, the person with the disease loses the ability to respond appropriately and is unable to converse with others. They will also develop an inability to control movements like sitting, standing and walking.

Here are some other common symptoms of the disease that can occur:

  • Catches colds and infections easily
  • Day/night reversal of sleep pattern
  • Difficulty communicating
  • Difficulty using the toilet independently
  • Eventually requires help with activities of daily living, 24 hours per day
  • Eventually unable to walk
  • Hoarding, rummaging
  • Inability to sit and eventually to swallow
  • Incontinence
  • Loss of awareness of surroundings
  • Needs help walking
  • Needs progressively more help with personal care
  • Personality changes such as aggression, anxiety, hostility, irritability or uncooperativeness
  • Repetitive questioning
  • Sundowners
  • Verbally aggressive or demanding behavior
  • Wandering

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What To Do About It

Family members or caregivers in these situations are the best ones to observe the patient and try to take steps to keep him or her from injuring themselves or others. At the same time, they also are closest target which puts them at a higher risk for physical or verbal harm.

Consider taking some of these steps to minimize possible disruptive aggressive behavior:

Understanding Alzheimers Or Dementia Behavior Problems

One of the major challenges of caring for a loved one with Alzheimers or another dementia is coping with the troubling behavior and personality changes that often occur. Aggressiveness, hallucinations, wandering, or eating or sleeping difficulties can be upsetting and make your role as caregiver even more difficult. Whatever problems youre dealing with, its important to remember that the person with dementia is not being deliberately difficult. Often, your loved ones behavioral issues are made worse by their environment, their inability to deal with stress, or their frustrated attempts to communicate.

As you try to identify the causes, its important to remember that a patient with dementia responds to your facial expression, tone of voice, and body language far more than the words that you choose. So, use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. And rather than take problem behaviors personally, do your best to maintain your sense of humor.

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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:

Create A Calm And Soothing Environment

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The environment and atmosphere you create while caregiving can play a large part in helping an Alzheimers or dementia patient feel calm and safe.

Modify the environment to reduce potential stressors that can create agitation and disorientation. These include loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish colors, and patterned wallpaper.

Maintain calm within yourself. Getting anxious or upset in response to problem behavior can increase the patients stress. Respond to the emotion being communicated by the behavior, not the behavior itself. Try to remain flexible, patient, and relaxed. If you find yourself becoming anxious or losing control, take time out to cool down.

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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.

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.

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The Thoughtful Pause Between Stimulus And Response May Deteriorate In Dementia

In the last post, we discussed how and why frustration, depression, anxiety, and not participating in activities are common in dementia. In this article well tackle the thorny issues of apathy, irritability, agitation, aggression, combativeness, inappropriate behavior, willfulness, and sundowning.

Apathy is common in dementia. When dementia damages the front of the brain or some of its connections, apathy can result. The normal drive to plan for the future is lost. Sometimes this loss can manifest by letting house repairs go, neglecting to pay bills, or not going to the grocery store until every scrap of food in the house is gone. When more severe, the desire to do anything at all may be gone, and the individual with dementia can sit passively for hours staring at a blank wall or a television that is not turned on.

Disinhibited behavior can lead to safety issues. When your loved one has behavior problems it can be distressing, physically exhausting, and heart-breaking. Behavior problems can also lead to safety issues. Dementia may lead individuals to act precipitously without thinking of the consequences. If they are feeling angry, they could strike out with their fists or any available item, including knives, guns, and baseball bats. If they feel like getting out of the car they may do sodespite the fact that the car is moving! In later posts, well discuss ways of managing these safety issues.

Key Questions

What Are The Signs Of End

Becoming Violent, When Will An Alzheimer’s Patient Do This?

Experts suggest that signs of the final stage of Alzheimers disease include some of the following:Being unable to move around on ones own.Being unable to speak or make oneself understood.Needing help with most, if not all, daily activities, such as eating and self-care.Eating problems such as difficulty swallowing.May 6, 2021

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Types Of Medication For Difficult Behaviors In Dementia

Most medications used to treat difficult behaviors fall into one of the following categories:

1.Antipsychotics. These are medications originally developed to treat schizophrenia and other illnesses featuring psychosis symptoms.

Commonly used drugs: Antipsychotics often used in older adults include:

  • Risperidone
  • Haloperidol
  • For a longer list of antipsychotics drugs, see this NIH page.

Usual effects: Most antipsychotics are sedating, and will calm agitation or aggression through these sedating effects. Antipsychotics may also reduce true psychosis symptoms, such as delusions, hallucinations, or paranoid beliefs, but its rare for them to completely correct these in people with dementia.

Risks of use: The risks of antipsychotics are related to how high the dose is, and include:

  • Increased risk of falls
  • Increased risk of stroke and of death this has been estimated as an increased absolute risk of 1-4%
  • A risk of side-effects known as extrapyramidal symptoms, which include stiffness and tremor similar to Parkinsons disease, as well as a variety of other muscle coordination problems
  • People with Lewy-body dementia or a history of Parkinsonism may be especially sensitive to antipsychotic side-effects in such people, quetiapine is considered the safest choice

2. Benzodiazepines. This is a category of medication that relaxes people fairly quickly. So these drugs are used for anxiety, for panic attacks, for sedation, and to treat insomnia. They can easily become habit-forming.

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