Sunday evening was pleasant. I was enjoying a glass of wine with my brother when my mobile rang. It was Mom’s residence. I answered fearing something was wrong - after all, she’d not really been much of herself. It was the med-aide. She informed me that Mom had punched her. What?! Mom hadn’t had any incidents for a while - usually it had something to do with being agitated and cornered by another resident - but that was very infrequent.
Apparently, the aide had come to give Mom her meds, left the door open and another resident poked her head in (and Mom is not fond of this resident - not at all!). The med-aide turned, asked that another aide come and take the peeping resident away, and when she turned Mom swung and connected. Wow!
Gratefully, the staff member was unharmed, but needed to alert me. This had me thinking - I’d known of other residents having troubles restraining themselves - one night I returned Mom from dinner to find a staff member fleeing a resident who was pinching, scratching, and biting her. Knowing the resident and watching the staff, I stifled my laughter, but knew it was probably a veritable issue.
And right I was! I received yet another call explaining to me that she had punched one of the administrators, and then on yet another day had punched the lovely busy-body lady she was beginning to loathe. The staff who phoned with the second bunch of assaults and I spoke at length about the problem. It seems, though, Mom isn't the only one who is acting out at this time, and the residents I named as being likely suspects were <da-ding!> the ones who were also without blame. All of these residents seem to be about the same stage as ma mere. Hmmmmmm.
And right I was! I received yet another call explaining to me that she had punched one of the administrators, and then on yet another day had punched the lovely busy-body lady she was beginning to loathe. The staff who phoned with the second bunch of assaults and I spoke at length about the problem. It seems, though, Mom isn't the only one who is acting out at this time, and the residents I named as being likely suspects were <da-ding!> the ones who were also without blame. All of these residents seem to be about the same stage as ma mere. Hmmmmmm.
So the question is: “What causes dementia patients to lash out if they’re typically mild-mannered?”
According to WebMd.com, and DementiaToday.com, there are three typical factors in causing aggressive behaviors in dementia patients:
- Discomfort from lack of sleep, medication side-effects, or indescribable pain;
- Environmental - loud noises, clutter, or too much activity occuring in or around the space;
- Confusion from not understanding questions, directions, or frustration from not being able to comprehend the situation. (Alzheimer's Violence, Aggression, Anger: Causes …)
- Feeling frightened or humiliated;
- Feelings of frustration at not being able to be understood or not understanding;
- Physical effects of dementia which have eroded their judgment and self-control;
- Loss of inhibitions and decreased awareness of appropriate actions learned in childhood. ( Dementia and Aggressive Behavior)
Many times, it is difficult to understand the root of the aggression, and it may simply be that the patient cannot recall what they believe they should know, and they know they knew but too much has vanished. (Alzheimer's Aggression: Causes & Management)
It is important for everyone to feel independent and able to fend for themselves, but when the realization slowly creeps in that this is possible less and less, this could also complicate the psyche of the patient.
Therefore, it is imperative we understand that the aggression isn’t necessarily directed at us, but there seems no where else to point that frustration and anger; also as the physical capabilities break down it becomes tougher and tougher to work out those aggressions in physical activities.
Speaking in calm tones, creating a safe and normal environment in which routine provides stability, and giving patients the assurances (through deed and word) that all is well, seem to be the greatest gifts in helping prevent the outbursts.
Also, Don’t argue with the patient. This is a battle that need not be fought. Who cares they think you’re Uncle Lemuel or Aunt Emertina. You are for them, and that’s all that matters - you won’t be able to snap them out of it, and even if you did it would last moments and you’d be right back to square one! So, be reasonable and rationale.
Forms of Aggression tend to be:
- Verbal or Threatening Abuse;
- Kicking or Punching/Slapping, Pinching, Biting, Stomping on Feet;
- Lashing out at People and Property;
- Overreacting or Becoming Quite Agitated Over a Minor Situation.
It is said that when a patient begins exhibiting these signs more frequently they tend to be in the later stages of their disease. However, as the disease progresses, there may be instances for the aforementioned reasons due to the loss of memory and abilities.
For Mom, it would seem that this was an isolated case as she becomes aggressive out of frustration and feelings of being cornered - or not understanding. Perhaps there was more activity aurally, visually, and orally, than she could handle in her room, and she felt threatened and violated because of this. I’m not sure I really know, but at least this has allowed me to process and learn a bit more.
Articles for Further Reading and Discussion:
Hagen, Brad F, and Dorie Sayers. "When caring leaves bruises: the effects of staff education on resident aggression." Journal of gerontological nursing 21.11 (1995): 7-16.
Jeanblanc, William, and Yvonne Battey Davis. "Risperidone for treating dementia-associated aggression." The American journal of psychiatry 152.8 (1995): 1239.
Chrzescijanski, Deirdre, Wendy Moyle, and Debra Creedy. "Reducing dementia-related aggression through a staff education intervention." Dementia 6.2 (2007): 271-286.
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