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.
Activities That Can Be Done To Reduce Bursts Of Crying And Shouting:
You have checked that all the basic needs of the person with dementia have been answered, but they still continue to cry and cry: be calm. Breathe. Try performing the relaxing techniques below:
- Play them their favorite music: Check with the patient about what music they like and play it. It will help to distract them.
- Interaction with young children: Young children make a lot of joy for adults anddementia in particular.
- Animal therapy: Havinga pet can cause a feeling of empathy and love towards it from the dementiapatient and thus has a calming effect on them during their crying fits.
- Fresh air:Change the environment of the patient can always improve their day.
- Snacking or drinking: Sometimes a delicious snack or drink can distractthe person with dementia and provide temporary comfort.
- Gentle and soothing touch: Try to hold the persons hand, stroke their shoulder or comb their hair. These gestures, which express love and concern as well as helping them in everyday activities can greatly improve their quality of life and soothe them.
Why Do Dementia Patients Cry
A person with dementia may unexpectedly become tearful, start crying, or have sudden screaming episodes. This can be very upsetting to experience, for everyone: a person with dementia, caregivers, and people around them.
Possible reasons why your loved one with dementia cries often include:
- Sundown syndrome or sundowning a condition of the increased anxiety and agitation typical for dementia where these emotions and behaviors escalate toward the evening. Common sundowning behaviors involve crying, calling out, fearfulness, mood swings, pacing, falls, paranoia, and hallucinations.
- Physical and external causes such as pain, exhaustion, hunger, toilet needs, routine change, an environment that is too loud, or too busy.
- Emotional and mental factors such as loneliness, confusion, anxiety, boredom, depression, and delusions.
Also, a condition known as pseudobulbar affect can trigger sudden, excessive crying as well as inappropriate laughter. In people with dementia, the brain cells lose the ability to communicate with each other before they eventually die.
Because of this loss of communication, pseudobulbar affect in people with dementia affects the way their brain controls emotions, leading to episodes of uncontrollable and inappropriate crying or laughing.
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Do’s And Don’ts For Communicating With Someone Who Has Dementia
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Caring for someone with dementia isnt something that any of us expects to do when we are young. Yet, for the adult sons and daughters of more than five million American seniors*, that is their reality. And whether youre caring for your loved one every day or just occasionally, knowing how to talk to a parent with dementia will help keep the connection you share as strong as possible for as long as possible.
Navigating successful conversations with dementia patients takes trial and error, respect, and practice. It also helps to understand the dos and donts of asking and answering questions. Oh, and did I say patience? Youll need a lot of that.
Dealing With Agitated Behaviours
- Stay calm. Speak in a calm, reassuring voice
- A simple activity such as having a cup of tea or looking at a magazine together may help. Distraction and avoidance are often the most useful approaches
- Use what works for you. Answering repetitive questions works for some. For others, ignoring the question helps. It can be useful to look behind the questions to see whether the person needs some reassurance about something they are unable to express verbally.
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What You Can Do About Medications And Difficult Dementia Behaviors
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.
- Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors
- 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.
How Can Dementia Patients With Spontaneous Crying Outbursts And Screaming Be Helped
Thereare times when there seems to be no reason why the dementia patient will cry,at least there is no reason we can determine. Sometimes, patients with dementiaare stuck in certain behavior for no real reason.
However, before you try to determine the reasons behind the crying and screaming in patients with dementia, you need to understand that it is behavior without a specific cause.
There are, however, several ways to help. Instead of saying, Thats how it is in people with dementia, adopt the following interventions to make sure that you are doing everything for them to help.
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What Is Agitated Behaviour
Changes in the behaviour of people with dementia are very common. Sometimes they can become upset and display behaviours such as pacing and fiddling.
Constant vocalisations such as talking constantly, repeating words and phrases, crying or cursing and screaming are also types of agitated behaviours.
Repetitive questioning, such as being asked continually what day it is, or when dinner will be ready, is another type.
All of these behaviours can be distressing and a constant annoyance for families and carers. Remember they can also be a sign of some distress for the person with dementia, so it is important to be able to understand why these behaviours occur and ways to manage them.
How To Help With Poor Judgment
The deterioration of brain cells caused by Alzheimers disease can lead to poor judgment and errors in thinking. Some of these symptoms are obvious and apparent, such as hoarding household items, accusing a family member of stealing, or forgetting how to do routine tasks.
Some signs are more subtle, making it difficult for your aging loved one to realize theyre struggling. If youre curious and dont want to ask, take a look at a heating bill, suggests Mariotto. Sometimes payments are delinquent, or bills arent being paid at all.
Its important to minimize frustration and embarrassment for dementia patients, so know what works for your loved one and incorporate it into your caregiving strategy.
- Listen and offer subtle help.
- Work together to fix the problem.
- Simplify a task or routine by breaking it down into smaller steps.
This is what Napoletan did for her mother: As I sifted through records to complete her tax return, I gently mentioned noticing a couple of overdraft fees and asked if the bank had perhaps made a mistake. As we talked through it, she volunteered that she was having more and more difficulty keeping things straight, and knew she had made some errors. She asked if I would mind helping with the checkbook going forward. I remember her being so relieved after we talked about it. From there, over time, Napoletan was gradually able to gain more control over her mothers finances.
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No Easy Solutions But Improvement Is Usually Possible
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.
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:
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Dealing With Dementia Behaviors: Expert Tips For Understanding And Coping
Anger, confusion, and sadness are a few symptoms a person with dementia may experience regularly. The result of these feelings is a range of unpredictable behaviors including using poor judgment, aggression, mood swings, and repeated questioning or manipulation.
Even though you know your loved ones dementia behaviors are symptoms of a disease and not intentional, dealing with them is often emotionally and physically challenging. Learn more about typical dementia behaviors in the elderly and expert tips for managing them.
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Like others with LBD, muscle weakness may affect his swallowing ability. This can lead to aspirating food or liquid, resulting in pneumonia, a common cause of death in advanced dementia. Even without problems with aspiration, he’d probably succumb to pneumonia or heart failure after months of being bedridden.
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What To Do When A Senior With Dementia Screams And Cries
Family caregivers to elderly adults with dementia know how challenging the condition can be. One difficult behavior you may have to deal with is the senior screaming, crying, or calling out for help. Understanding the behavior and what you can do may allow you to better handle it and reduce it.
Why Does the Behavior Happen?
Crying and screaming are more common in certain kinds of dementia, including:
- Vascular dementia.
- Frontotemporal dementia.
- Lewy body dementia.
Sometimes the behavior is worse in the evening hours because of sundowning. Sundowning is common in seniors with dementia and causes challenging behaviors to worsen in the evening. Another thing that can cause crying and screaming is pseudobulbar affect, which causes inappropriate emotional responses that the person cannot explain.
The behavior can also occur because of actual distress. Some things that could trigger it are:
Physical Discomfort:Hunger, pain, restlessness, or having to use the bathroom.
Environmental Causes:Too much noise, a change in routine, or a room that is too busy.
Psychological Causes:Boredom, anxiety, loneliness, depression, and delusions.
Tips for Handling the Behavior
Its not easy to manage screaming and crying, but the following tips may be useful:
Keep Calm:Getting frustrated or upset can escalate the situation. Take a deep, slow breath and try to calm yourself before you try to deal with it. Speak in a soothing voice and use a gentle touch to help calm 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
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Why Do Dementia Patients Scream Out
Screaming is common among residents of nursing homes who have dementia, tends to occur along with the development of other related agitated behaviors, and has been attributed to a variety of causes, including vulnerability, suffering, sense of loss, loneliness, physical pain , clinical depression, and …
Sundowning Is Real And It’s Common But There Are Steps You Can Take To Help
In many dementia patients, the transition from day into night can become quite difficult. Known as sundowning, the syndrome is marked by a regular change of behavior characterized by confusion, agitation and anxiety. However, due to lack of research, doctors still are not clear on the cause.
Sundowning is difficult and poorly understood behavior, says Dr. Erinn E. Beagin, MD, Chief of Division of Geriatrics at Saint Peters University Hospital in New Brunswick, New Jersey. “We dont really understand why it happens.”
In addition to being aware of the syndrome, the best thing a caregiver can do is to anticipate the change in behavior and have a plan to address it.
Why sundowning happens Though causes are difficult to pinpoint, one main theory is that dementia may affect the circadian rhythm of the brain, meaning those living with the disease may have trouble telling the difference between night and day. This problem can be exacerbated during changes in the clocks, when daylight is either suddenly extended or lost.
Another potential cause could be that the needs of a person with dementia are not being met. They may be bored, hungry, dehydrated or overtired, but unable to understand and express it. All of those things that we have trouble adjusting to sometimes are exacerbated when someone has dementia, says Beagin. “And then, unfortunately, that older person cant express their needs or thoughts to us, so it comes out as a behavior.”
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How To Handle Aggressive Or Combative Behavior
A lot of times, aggression is coming from pure fear, says Tresa Mariotto, a social services supervisor in Bellingham, Washington, and certified trainer in dementia and mental health. People with dementia are more likely to hit, kick, or bite in response to feeling helpless or afraid. Managing aggression can be stressful for both you and your loved one.
- Try to identify the behaviors cause.
- Keep your tone light and supportive.
- Redirect your loved one by involving them in another activity or conversation.
- Remove your loved one from surroundings or environments that may be overstimulating during an outburst.
This is where truly knowing your loved one is so important, says Ann Napoletan, writer at the blog The Long and Winding Road: An Alzheimers Journey and Beyond. In my moms case, she didnt like to be fussed over. If she was upset, oftentimes, trying to talk to her and calm her down only served to agitate her more. Likewise, touching her even to try and hold her hand or gently rub her arm or leg might result in her taking a swing. The best course of action, in that case, was to walk away and let her have the space she needed.
Natural reactions to dementia behaviors can be ineffective or make the situation worse.
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