Coping with such behavior can be very difficult and is often a matter of trial and error. Remember that the behavior is not deliberate: it is out of the person's control and they are probably quite frightened by it. They need your reassurance and love, even though it may often not appear that way. Trying to make sense of the environment becomes a difficult task confronting the person with dementia. Simple tasks such as bathing, dressing and eating are all major hurdles to overcome. People with dementia are frequently confronted by failure, so maintaining their dignity is most important.
Three common worries:
Is the person for whom I am caring brooding about past tensions and misunderstandings which have occurred between us?
Does he hate me now?
Have I done something unintentionally to upset him?
These are all normal reactions - it is important to realize that most of the anger and aggression is directed against the carer because you are the closest person, however, it is not a calculated personal attack.
Causes of Catastrophic Behaviors
1) Stress caused by the excessive demands of a situation
2) Frustration caused by misinterpreted messages
3) Another underlying illness.
Aggressive behaviors may come on without warning and make you feel very apprehensive. However, if you can figure out what situations are triggers (perhaps by keeping a diary), you may be able to work out ways of avoiding them. If not, you may still be able to find methods of dealing with the behavior quickly and effectively when it occurs. Remember, each person with dementia is an individual and will react to circumstances in their own particular manner.
Try to Minimize Stress
A calm, unstressed environment in which the person with dementia follows a familiar routine can help to avoid such reactions.
1) Approach the person slowly and calmly: try to avoid conveying your own stress, fear or alarm
2) Be aware that the person may not recognize you: try to give some information which may help, such as your name and your relationship to them
3) Try to make eye contact and address them by name. Touch may be helpful and reassuring, but be aware that some people may not like it
4) Speak clearly and use simple sentences, allowing time for response
5) Try to ask questions that require only a 'yes' or 'no' response
6) Try to talk in a place that is free from distractions
7) Try to focus on familiar skills which are within their capabilities
8) Give limited choices only, to avoid confusion
9) Break a task down into simple steps which are not overwhelming
10) Modify these steps as the person becomes less able
11) Demonstrate visually what you are trying to say.
12) If it has become difficult to understand what the person is saying, try to focus on a word or phrase that makes sense, or respond to the feeling they are trying to express
It may be necessary to remove yourself from the situation until the person calms down.
Modifying The Environment
People with dementia often become extremely upset if they find themselves in a strange situation or among a group of unfamiliar people where they feel confused and unable to cope. The situation may seem to be very simple, but the frustration caused by being unable to meet other people's expectations may be enough to trigger an outburst.
* Be aware of what situations lead to difficult behavior such as aggression and try to avoid them.
* Try to do difficult and frustrating tasks when the person is at their best and not tired.
* Use a diary to help you monitor when good and bad times are likely to occur.
* Pictures or labels on objects may help identify or locate them
* Try to avoid frustration by adapting the environment to cope with the problem behavior: e.g. allow the person to go for a walk if they want to wander.
* Close off certain areas of the house where problems are occurring.
* Simplifying the environment: e.g. place only essential cutlery on the dining table
* Try to use the person's other senses such as smell and touch
* Try to remember that problem behavior may intensify when there is a major change in lifestyle such as moving into residential care.
Distraction
If there are a few moments before an outburst when the person becomes increasingly agitated, you may be able to prevent the over-reaction by calming the person down early.
First try to respond to the feelings of anger by soothing, comforting and reassuring the person gently. Then try to defuse the situation by distracting them and, finally, praise success. Alternatively, you could try calmly ignoring the outburst and busying yourself with something else.
Try to distract a person who is sobbing excessively or laughing uncontrollably because this is not a sign of true emotion and may be very exhausting.
Things To Avoid
~Do not argue with the person when they become upset because they no longer have the ability to be rational or logical and there is no point in trying to reason. Save your energy and concentrate on trying to remain calm.
~Do not get upset or excited as well or the situation will simply escalate further.
~Never reprimand or punish, even if the behavior appears like an unreasonable tantrum. They are not responsible for it, cannot learn from it, and may forget the whole incident quite quickly.
~Try not to focus on what the person cannot do: focus on the positive.
~Try not to be condescending or sarcastic.
~Try not to ask questions which rely on memory.
~Try not to talk about the person in their presence.
~Try not to take things personally.
~Try not to hurry the person.
~Never try to restrain a person because this just increases their anxiety and distress.
Never put your own safety at risk! If the behavior escalates out of control, remove yourself from the situation and call your doctor or the police.
Violence And Aggression
Sometimes the person with dementia may become very violent for a short time. They may become verbally abusive, cause damage to property or become physically violent. (Physical violence almost always occurs when someone else initiates physical contact.) Try to stay calm and not show fear or alarm. Try to understand that even if the aggression is directed at you, it is not a personal attack.
Violence could be caused by:
Defensive behavior - people with dementia may feel humiliated and frustrated when they are placed in a situation where they have to accept assistance, especially with intimate tasks such as bathing and toileting.
When their independence and privacy are disrupted, they may react angrily.
Failure of competence - the person is not able to cope with certain tasks and may feel a failure.
Misunderstanding and bewilderment about what is going on. As the illness progresses, the person may be bewildered by events. Accusations of stealing may be an attempt to make sense of their inability to locate something and an unwillingness to accept that they have forgotten where they put it.
Fear. If the person is unable to recognize people or places, this may be very frightening. The person may be convinced they should be somewhere else (e.g. childhood home) or may believe the person with them is a stranger. Sudden noise or people approaching from behind may cause a hostile reaction.
Changes in routine such as the presence of a lot of people, a special event, distracting noise or activity may cause the person to feel unable to cope.
Attention-seeking
Boredom, distress, restlessness, illness or pain may be expressed in terms of anger, aggression or agitation, especially if the person is unable to communicate such difficulties verbally.
Attempts to control other behaviors such as wandering.
Looking After Yourself
Sudden over-reactions may leave you upset and a little shaky. It is essential that you seek support for yourself from a supportive family member, a friend, an understanding professional or a support group, and that you get a break from the constancy of the task. Identify the areas of support that you need and learn about the services in your area (respite care, in-home care, day care etc.) which are available to help you.
Allow yourself to get help with other tasks such as cleaning so that you can conserve your energy.
Remember that your own feeling of distress, frustration, guilt, exhaustion and exasperation are quire normal. However, sometimes situations are beyond your control, so seek help.
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