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.
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.
Preventing And Handling Anger In Alzheimers Care
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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Give Parents And Senior Loved Ones Their Space
This tip can be important for both you and a parent or senior loved one with dementia. First things first, it may be necessary for your own safety.
Giving the parent or senior loved one their space if they begin to show signs of aggression or frustration can also help prevent fits of rage or violence. Taking a minute to regroup and return to the situation gives you space to decompress the nerves before re-addressing the issue, says GinaMarie Guarino, mental health counselor.
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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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.
How Dementia Changes Our Thinking Skills
Everyone agrees that people experiencing dementia are often unreasonable. But whether Im teaching families or professional caregivers, I rarely find anyone in the audience who understands that because dementia takes away our rational thinking skills, expecting people to use them and be reasonable or rational is no different than expecting someone who is blind to see or deaf to hear. Please think about this for a moment: if Ive lost my ability to use reasoning, why would it be helpful to explain to me why I should do something?
It is also rare that I find someone who understands that we all have two separate and complete thinkingsystemsand that only the secondary one is lost to dementia.
Yes, the rational thinking skills we lose to dementia comprise our secondary thinking system, not our primary thinking system. Our primary thinking system is our intuitive thinking skills. Its misleading to think of this complex and essential set of skills as intuition. These thinking skills provide us with the broad and unfiltered data that our rational thinking skills sort to help us make sense of the world around us. Without our intuitive thinking skills, our rational thinking skills would have nothing to work with and we could not function.
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How To Respond To A Patient Hits
Find Out Where Such Behavior Is Coming From
In order to effectively manage the behavior of Alzheimers patients, it is important to find out what triggered the behavior. Besides that, it is also important to know what hitting means. Are they scared, hungry or thirsty? Are they reacting to something uncomfortable in the environment? When a patient strikes a person, it is often because of their distress even from remembering their past memories. Hitting could be a result of frustration since simple memories are fading away.
It may be difficult to know exactly what caused them to lash out. But it is necessary if you want to avoid any future instances of hitting. With time, you will be able to see patterns know what the triggers are, and eventually be able to avoid the common triggers that cause them to be angry. Most Alzheimers patients are not aware they have the disease or that anything is even wrong with them.
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.
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The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Alzheimers Care Challenges: Handling Dementia & Anger
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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Ignore The Angry Behavior
It is definitely not easy to get hit and ignore because there will be some pain and hurt. But an Alzheimers patient will hit you one minute and forget what they did in the next minute. So when they hit you, ignore. Secondly, make sure they are unlikely to harm themselves. Finally, stay clear of them until they calm down. Dont allow the situation to get out of control or even more violent.
When Alzheimer’s Turns Violent
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
RELATED TOPICS
— 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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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.
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:
- uncontrolled pain
- infection, such as a urinary tract infection
- side effects of medicines
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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Dont Be Afraid To Ask For Alzheimer’s Support
“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.
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
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Make Sure Physical Needs Are Taken Care Of
Sometimes what seems to be the issue is really a symptom of another, underlying problem. If your loved one is experiencing physical discomfort but isnt sure how to tell you , their agitation could turn into aggression. Dr. Beatrice Tauber Prior of Harborside Wellbeing explains, There are many illnesses that can lead to an increase in aggressive behaviors.
If you notice that the usual things that work to calm your loved one are not working, make an appointment to see their medical professional to rule out a physical reason/illness that may be causing the aggressive behaviors, she recommends.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Disorientation
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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Check The Environment For Irritants
In some cases, unseen physical discomfort can be the cause of the problem, but in others, it could be more obvious irritants in the atmosphere, like too much stimulus from noise or the number of people in a room.
If you can find anything in the atmosphere that may be causing a loved one to feel agitated, remove the irritant from the space to see if that helps.
How To Cope With Common Changes In Behaviour
Although changes in behaviour can be difficult to deal with, it can help to work out if there are any triggers.
For example:
- Do some behaviours happen at a certain time of day?
- Is the person finding the home too noisy or cluttered?
- Do these changes happen when a person is being asked to do something they may not want to do?
Keeping a diary for 1 to 2 weeks can help identify these triggers.
If the change in behaviour comes on suddenly, the cause may be a health problem. The person may be in pain or discomfort from constipation or an infection.
Ask a GP for an assessment to rule out or treat any underlying cause.
Keeping an active social life, regular exercise, and continuing activities the person enjoys, or finding new ones, can help to reduce behaviours that are out of character.
Read more about activities for dementia.
Other things that can help include:
- providing reassurance
- activities that give pleasure and confidence, like listening to music or dancing
- therapies, such as animal-assisted therapy, music therapy, and massage
Remember also that it’s not easy being the person supporting or caring for a person with behaviour changes. If you’re finding things difficult, ask for support from a GP.
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