Caregiver safety in face of anger and aggression

This post may be of interest to caregivers dealing with loved ones who are angry and aggressive.

Many people in the local Lewy Body Dementia support group will remember long-time Brain Support Network volunteer Denise Dagan. In the past, she has shared helpful resources she’s found.  She’s doing that again today….

Here’s something she shared on the topic of caregiver safety.  This is Denise’s description of a 30-minute podcast about anger and aggression aimed at the caregiver.

Robin

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Notes from Denise Dagan, BSN volunteer

Talking FTD with Geri: Caregiver Safety
Guest – Geri R. Hall, PhD
Podcast – August 25, 2016

On August 25, 2016, caregiving.com presented “Talking FTD with Geri: Caregiver Safety,” as part of their weekly “Your Caregiving Journey” podcast series.  Geri R. Hall, PhD, ARNP, GCNS-BC, FAAN, addressed the topic of anger, aggression and caregiver safety in a 30 minute Q&A format.  You can listen to the podcast here:

www.caregiving.com/2016/08/thursday-at-2-p-m-et-talking-ftd-with-geri/

Although the discussion is entirely in the context of caring for someone with frontotemporal dementia, some points are worth remembering for anyone potentially dealing with aggression as a symptom of cognitive impairment or dementia.

There are medications that can help control aggression, and should be sought from your neurologist at the first sign of regularly occurring verbal aggression (3 times weekly).  These medications should be adjusted or increased at the first sign of physical aggression.

People with cognitive impairment or dementia will often indicate when they are becoming overwhelmed by their current activity by asking to leave or commenting on noise, etc. before they become agitated or aggressive.  Try to tune into those comments to avoid getting to the point of agitation or aggression.  If they do get to that point, help them leave immediately.

If a person does become agitated or aggressive, best practice is to apologize for whatever they are upset about, agree with their point of view and promise to resolve things to their liking as soon as possible so they don’t see you as opposition, but as being on their side, so aggression is not directed at you.

If aggression does not subside, or escalates, put a barrier between you and them, and call 911 for assistance.   Dr. Hall says arriving uniforms are usually comforting.  EMTs will take the person to the ER where urinary tract infection, etc. will be ruled out before admitting for medication adjustment to control aggressive outbursts.

Agitation or aggression can occur without current stimulation.  Dr. Hall recommends looking at changes in the usual routine over the past 24 hours, including visitors, a noisy or chaotic environment, even TV shows like news broadcasts, aggressive talk shows, and CSI or Law & Order genre programming.  Essentially overstimulation leading to fatigue can cause behavior changes.

If you are living with someone who is physically aggressive, you should sleep apart from them in a room with a locked door and alternate egress (e.g. a window).

Don’t blame yourself if a loved one with dementia becomes verbally abusive or physically aggressive.  It is a symptom of their disease process.  Often the behavior change is the result of a delusion, which is a fixed, false belief about which they cannot be dissuaded.

“10 Actions that Helped our Family after Mom’s Alzheimer’s Diagnosis”

Occasionally I check out online Alzheimer’s support groups.  Yesterday, I came across this helpful post titled “10 Actions that Helped our Family after Mom’s Alzheimer’s Diagnosis.”  Though this was written by a daughter whose mother had Alzheimer’s, I think this advice applies to anyone coping with a neurological diagnosis.

The ten actions described are:
1.   Gather the troops, build a support network
2.   Divvy up the tasks
3.   Educate yourself about Alzheimer’s disease and local resources
4.   Review legal documents
5.   Find the right doctor(s) and care team
6.   Look at alternative situations, just in case
7.   Expect cognitive decline and prepare for change
8.   Be patient
9.   Enjoy and celebrate the good days
10. Take care of yourself and stay connected with others

For details on the ten actions, see the post:

www.alzconnected.org/discussion.aspx?g=posts&t=2147528575

Robin

Tips for reducing dementia-related behavior (anger, etc)

This post may be of interest to those dealing with dementia-related behavior.

Friend of BSN’s, social worker Ann Blick Hamer, forwarded me this useful article today.  The topic is dementia-related behaviors, which includes anger, swearing, or aggressive outbursts.  The author suggests:

“As hard as it may be, remind yourself that the cursing or anger that might appear to be directed at you is really a symptom of the disease. Not only may it help you feel a little better when a challenging behavior occurs, but it can help safeguard the relationship between you and the person in your care.”

The author offers three tips to reducing dementia-related behaviors:

1. Get out your detective’s hat and looking glass

You don’t need to become a private investigator, but it helps to know that a great number of challenging behaviors are caused by an unmet physical or emotional need.

2. Approach & Connect – the Right Way

[Did] you know that with dementia, a person’s visual field shrinks to the size of binoculars by mid-stage? In late stage dementia it even reduces to monocular vision.

[Always] approach from the front so they can see you first.

3. Use the Environment to Your Advantage

Paying attention to settings, sounds, sights, lighting, or even smells can greatly impact your care outcomes.

Here’s a link to the article:

www.pineseducation.org/3-essential-tips-to-reducing-challenging-behaviors-in-dementia-care

3 Essential Tips to Reducing Challenging Behaviors in Dementia Care
Pines of Sarasota Education & Training Institute
02 August 2016

Note that the online version has a link to a list of the top ten “unmet needs” of those with dementia.  These “unmet needs” include physical needs (such as hunger, thirst, tired, temperature, pain) and emotional needs (such as anger, sadness, loneliness, and being scared).

Robin

 

Conditions with symptoms similar to dementia

This post may be of interest to those dealing with dementia-like symptoms and wondering if there are other causes besides neurological disorders.

An article, in Next Avenue, is about non-neurodegenerative conditions that cause dementia-like symptoms.  See:

www.nextavenue.org/dementia-symptoms/

Is It Dementia? Maybe or Maybe Not
Other conditions come with similar symptoms, experts say
Next Avenue
By Emily Gurnon, Health & Caregiving Editor
August 3, 2016

Lots of conditions present with dementia-like symptoms — depression, medication side effects, nutritional deficiencies, or metabolic problems, for example.  The key to knowing if it’s dementia or something else is testing.  Sometimes that’s neuropsychological testing, blood tests, depression testing, or neuro-imaging.  Or changing medications.

My father had progressive supranuclear palsy (confirmed through brain donation).  When we saw the first neurologist, I was very surprised when the neurologist ordered a syphilis test.  He said he wanted to be as sure as he could be that it was PSP and not something else.  Sure enough, syphilis is listed below as a condition causing dementia-like symptoms.

Robin

 

Managing difficult behaviors, hallucinations, and delusions with validation and redirection

This post will be of interest to those caregivers coping with dementia.

The title of an article on ElderCare Online suggests it’s about managing difficult behaviors. Actually, the article offers practical tips for managing difficult behaviors, hallucinations, and delusions.

Tips are given for dealing with the situation where a family member with dementia sees a rabbit on the sofa, asserts that you are not the spouse, insists that it’s time for breakfast (even though it’s “really” time for dinner), wants to re-arrange the cupboards, or gets “underfoot” all day long.

Some of these tips are based on Naomi Feil’s validation therapy. The author explains: “First, the idea behind validation therapy is to ‘validate’ or accept the values, beliefs and ‘Reality’ of the dementia person – even if it has no basis in your reality.”

And, the author says: “The key is to ‘agree’ with what they want but by conversation and ‘steering’ get them to do something else without them realizing they are actually being redirected. This is both validation and redirection therapy. Does this always work? NO! But it has a pretty high success rate because it is so non-confrontational.”

Three examples are given about how a conversation might go when the person with dementia wants to find his car keys, starts leaving the house, or wants to use the phone.

Based on the copyright, it looks like this article was written in 2000. Someone referred to it recently on an online Alzheimer’s support group. It’s posted to ElderCare Online (ec-online.net). See:

www.ec-online.net/community/activists/difficultbehaviors.htm

Using Validation Therapy to Manage Difficult Behaviors
by Jan Allen, CSW, MSE
ElderCare Online (ec-online.net)

Robin