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How to Deal with Combativeness

By Gilbert Guide
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It's not uncommon for care recipients to display abusive behavior. Following are a few suggestions for caregivers dealing with combativeness. Gilbert Guide also offers tips on caring for patients with Alzheimer's or dementia.

When Does It Happen?

Although combative behaviors can seemingly come from nowhere, do not assume it is a simply personality trait. Are the combative outbursts tied to particular activities? Do they occur at specific times, such as late afternoons or evenings? Finding a common denominator may help you understand what the underlying problem is. For example, outbursts that occur late in the day could signal that the care recipient is prone to being combative when he or she is tired. In dementia patients, it could be a sign of Sundowner's Syndrome. If there doesn't seem to be a common denominator, do what you can to make the care recipient more comfortable and improve his or her quality of life; generalized unhappiness could be the culprit.

For an inspiring story, read Kay Paggi's memoir on her client Hank, who originally was deemed combative, and how she worked to enhance his quality of life.

Try Kindness and Humor

Combativeness could be the result of general unhappiness or even depression. Try to find a way to communicate with the care recipient, and work to maintain that person's sense of dignity and volition. One person's positive attitude is sometimes enough to overcome someone else's negative one. Humor can loosen up a tense situation and often makes people more receptive to what you have to say.

Take Your Time

Sometimes caregivers, especially in institutional settings, treat care tasks as simply another item to check off the list. Whether you're caring for a stranger or loved one, the urge to "take care of business" and "get things done" can be very strong. Try taking the time to gently guide the patient, maybe opening with chitchat or explaining what the next activity will be. Small gestures such as these will help the patient relax. This is especially important when interacting with individuals who have trouble focusing their attention, such as people who have dementia, or impaired hearing or vision.

Be Patient

If the patient is always combative during a certain activity, take steps to make the environment as comfortable and attractive as possible. Playing soothing music in the background may be helpful. If bathing provokes combativeness, for example, try gently reminding the patient how clean and comfortable he or she will be afterward. The simple idea that the individual needs help may not be enough to convince that person to allow you to help. It can feel very violating to have another person bathe you. Remember: most elderly people have spent decades being self-sufficient; giving up one's sense of privacy can be extremely difficult. Be patient and understanding.

Could It Be Depression?

We often think of depression as being something that manifests itself in sadness or tears; however, depression can also reveal itself in anger and abuse. According to the National Alliance on Mental Illness, senior depression affects more than 6.5 million of the 35 million Americans 65 or older, and it is closely related to dependency and disability

If you suspect that a patient is depressed, administer the Yesavage Geriatric Depression Scale to try and determine the level of depression that is occurring. You may also want to seek mental health services for the individual. Depression is a serious condition that can exacerbate existing health issues and cognitive decline.