November 11, 2010
Dementia patients can get violent, especially if the disease process has affected the main part of the brain that houses judgment (frontal lobe). People who have been kind, caring human beings all their lives can turn combative and abusive. One of the main reasons we started Dementia Dymamics was because my father-in-law, a gentle, easy-going man all his life, became violent as Alzheimer’s disease took more and more of his cognitive abilities. Because he retained great strength and physical ability into the late stages of the disease, there was a point at which we were very afraid he would accidentally kill one of his caregivers in the facility in which he lived.
What we noticed was that some people could deal with him without incident and some people couldn’t. What was the difference? Here is what we have learned through our own experience and through the experiences and research of others.
- Most importantly, if something you are doing that is agitating or upsetting the patient, stop it immediately (unless it’s an emergency situation). If you stop, the patient usually will calm down to the point where you can deal with him. If he doesn’t and / or you are in physical danger, remove yourself from the situation and call the police. Most dementia patients never get to this point, but a small percentage do.
- Know your loved one’s physical signs of agitation: increased breathing, franticness, pacing, wringing of hands, etc. When you see your loved one exhibiting these signs, stop whatever your are doing or think of another approach.
- Don’t argue with the patient. No matter what she says, find something to agree with or at least manage an “Oh really?” This is true with all dementia patients, but especially with those with a tendency toward anger and violence. Arguing will only agitate her. Go along with what she says if you can. Redirect her. Smile at her. LOVE her. Gently pat her hand or hug her if this would not be dangerous.
- Talk with the patient’s physician about her tendency toward physical aggression or violence. Sometimes, medication is necessary. The doctor may order testing to determine whether the patient has another underlying medical condition aggravating the anger management issues.
- Feed the patient more frequent, small meals (or healthy snacks between meals) to help his blood sugar stay at a consistent level, giving more protein and less carbohydrates / sweets. Protein stays in bloodstream longer, keeping blood sugar at more consistent levels. Blood sugar greatly affects mood and behavior in the elderly. This is doubly true if your loved one has diabetes or hypoglycemia (low blood sugar).
- If you must do something that you know will upset the patient (bathing, doctor’s appt, etc.), choose the best time of day for the patient. Play the patient’s favorite music, talk to the patient about things you know they enjoyed in years past (“Remember the time when we were first married and we went….”)
- Be very careful about the patient’s alcohol consumption. Not only can this interfere with coordination and some medications, but alcohol is a depressant and can greatly affect mood.
- In the worst case, a patient may have such a tendency toward violence that she has to be committed through the court system. This is last resort, but can be the best solution in a horrific situation. We had to follow this path with my father-in-law, committing him to a geriatric dementia psychiatric facility. While it was very difficult to stand up and testify that this wonderful man was a danger to himself and others, he was finally in a place where they could regulate his behavior and medication. Talk to an elder law attorney if you feel your loved one may have anger management issues to this degree.
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