How can we calm an abusive dementia patient?
Are there any protocols or calming techniques for a belligerent agitated dementia patients?
My dad has dementia and is being cared for by a team of caretakers 24/7. Recently he wakes he thinks his overnight caretakers (weekend and weekday) are his enemies. He gets belligerent and says hurtful things to them. They realize that he is delusional but it still has an impact on them. He is not this way all the time. We are trying to keep him in his home as long as possible.
There are really many techniques for calming an abusive dementia patient. To calm an agitated person with dementia, most techniques revolve around the caregivers being trained on a) the disease itself, b)how to approach the person prior to speaking or interacting, and c) how to react when there is some belligerence. Other items to try are soft music (whatever he liked when he was younger, but played to sooth him), soft lighting, but enough for him to see when he awakens so he knows where he is. Some communication basics are to always be calm and quiet. Never question the "reality" of the patient, rather just go with it. If there is agitation, leave the room (make certain he is safe) and return in 5 minutes with a good, calm, reassuring greeting and announcement that clearly states who the person is, and starts fresh. When your father awakens he may be disoriented and scared. He does not know who these people are as his memory does not allow that retention. That makes him belligerent. So, understanding that, the caregivers just need to learn techniques to deal with him that are specific to the Alzheimer's patient, and work with him. Here are some resources that you might find helpful to make certain that all are trained in how best to work with your father. Resources: The classic book on how to work with, speak to, and interact with a person with Alzheimer's is Mace and Rabins book the 36 Hour Day which can be bought really cheaply online as a used paperback. Dr. Verna Carson writes some excellent training manuals on what she calls becoming an Alzheimer's Whisperer. You can access information on those here: http://www.cvseniorcare.com/program_manuals.html.
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I agree with Merrily on the soft music.
I am a cancer (colon) survivor. While I was in the hospital I played a Yanni CD (softly) constantly throughout the day and night. I truly believe this had a huge impact on my survival.
There are many great cd's with soft healing music.
I also feel that if you or whomever the person is caring for him stays calm while he is angry it has a calming effect.
If you begin to become agitated he will become more agitated.
my hubby was like this found out it was his seizure med causing it. his meds changed he's his old sweet self again. good luck & god bless
I ordered the book you suggested. I'm sure it will give me more help in my role as caretaking. Thank you.
Research Retrogenesis and Body Memory Recall - Find out as much as you can about the loved one from their birth to present (likes dislikes etc.). As the disease progresses, the reality regresses - find where the loved one is in their reality and live it with them.
My mother had not become hostile to the point where she needs care takers, but she has hit me and pulled out my hair. I agree that leaving them alone in a safe place helps. I like to think of this as stepping away so that I won't get agitated, which will in turn make my mom angrier. Another t. hing that helps sometimes is that I ask my mom if she wants something to drink or a sweater or something she enjoys. This makes her feel a little more comforted.
I tried to step away and actually leave Monday; and she started in screaming don't you leave right now; sit down and calm down. She was the one going bananas. She was yelling, she was sarcastic, she was mean and hostile. My minister told me not to take abuse but when it got bad; walk out and go home. tough love. She said you have been abused by your husband and that was because you probably had some abuse at home before you were married so that you accepted his. Know you have bounced back into a beautiful patient person who helps so many and know the Queen of Quilt trips has dementia besides is pulling your strings. Once you have tried your best to calm her down and she won't then You have to leave or you will be sick. My therapist just old me the same thing today. If she won't calm down and be quiet; leave. I have been in contact with the author of Elder Rage, I have read 36 hour days etc. My Mother was spoiled by my father would bent backwards to please her. She has several things going on.
I also wanted to add - quit referring to the dementia patient as abusive. There are behavioral expressions and they are caused by some catalyst - KNOW THE PERSON from as far back as you can in their life and you will be able to reduce the number of expressions that are not desirable. And, YES they know who you are. It may take patience and knowledge of the person,but with promting you will see they know you and can communicate (not just verbal).
A dementia patient can be abusive. Just because they have a disease doesn't mean that the pain they are trying to inflict doesn't hurt. If the caretakers are crying there is abuse going on. Knowing WHY the patient is being abusive doesn't change the fact that everyone around them is frightened of them.
My Dad was kicked out the first nursing home he was in for his behavior and actually kicked a CNA in the head and sent her to the hospital in the second, if you can imagine (he was lying down at the time and she was bending down to adjust the bed). I have tried every trick I've read here about, some I've learned from the CNAs, and others I've come up with on my own. Early on he had the delusion that he was in the war and had to shoot everyone. I worked with the doctors to discover the best psychotropic medication to help control his paranoia, hallucinations, and delusions only because I could see how his quality of life had slipped into a life of terror and upset for him. I knew my Dad well enough (always a very gentle man) to know that these outbursts of anger were this terror turned upside down. It took some time, but the medication has made a huge difference. There are always trade-offs, though, and some of the side effects are difficult as well. It was a decision between the lesser of two evils.
I am a psychotherapist. I believe one major issue concerning the dementia diagnosis in general is that way too many adult children do NOT want to face it is happening to their parent(s) or other relative(s) until they must. That speaks to the under-responsibility issue within each of us, as potential caregivers or self-appointed case managers, in effectively working with our loved ones to keep them safe. Does someone really have to walk outside their house nude at 3:00PM or smash up their car and kill or seriously injure someone before the adult kids finally say: "Hey, something is wrong with mom!" I have seen this dynamic played out so many times, I could write a book about it. I just wanted to mention this because some will read these posts not yet knowing "if" their elderly relative has dementia or not "yet". Believe me, if you suspect it---they most likely DO have it! One thing I have seen both personally and professionally that isn't addressed much in the literature is when an elderly relative suddenly has a "new friend" or someone coming around that wasn't in their picture before. That's when adult children need to start reviewing bank statements and checkbook transactions to see how much $$ is being thrown out the door at the casino and/or in someone else's pocket. I just heard of two cases involving $400,000 over a period of about 10 years (to a man 40 years her junior!)...and another involving $200,000 (to her dead husband's obscure relations from another country). "It" can start out like that and continue on indefinitely unless you take time to pay attention to what is going on "now".
Secondly, reading about the abuse here that can go on; there is no amount of resources to be saved or inherited that is worth being abused over. Abuse is NEVER o.k., even when it is your father or mother or sister or grandpa who is being actively abusive towards you. At this point, a competent geriatric psychiatrist is a MUST to get your relative evaluated along with the RIGHT psychotropic medication(s) and dosage(s) to manage them more effectively. As 1whocares mentioned, "the medication has made a huge difference...always trade-offs...a decision between the lesser of two evils." That's absolutely true. Weight gain or dry mouth or whatever other side effects occur once medicated need to be evaluated against the psychotic delusions, hallucinations, violence, and verbal outbursts. The right med choices are as much art as science; it can take time to find the right "mix" that works best for your elderly relative; be patient with the process...but at least GO through the process if your relative is actively abusive, paranoid, etc.
Lastly, take GOOD care of yourself each and every day if you are involved in your relative's care in whatever capacity. The last thing you need is to stroke out or get sick yourself because the stress of "all of this" got to you. Nobody should be functioning as the all-giving martyr to anybody in this life; that is highly codependent and unhealthy for both you and your loved one. There are so many elderly support organizations in every community across this country that offer volunteer or low-cost help in whatever capacity you require. You do NOT have to "do it all" unless you choose to do it all. And since we teach people how to treat us...we really need to think what we are agreeing to do and "why". Authentic love does not involve or include being battered emotionally or physically on a regular basis; if you think it does---you have a bigger problem than your elderly relative's dementia issue!
Thank You so much for making it clear that a dementia patient outburst are no acceptable just because they have dementia. I have to find a doctor for my husband for his outburst I am the sole caregiver and need help to detach myself (oversee) from this and to let others come in it's been 4 yrs. and children will not come.
Maybe some of your parents are like my dad who has Alzheimers and in the later stages, he gets very agitated and mean when he has something going on in his body like the chronic UTI's he gets or pneumonia which he has gotten twice since September 2014. After he is treated for the illness he is back to his calm self again. Not back to his normal self 20 yrs ago but calmer and not at all agitated. When he gets agitated he name calls (which he never ever did in his life, always this wonderful minister kind of man) and even has hit a nurse or 2. I try telling them to stop forcing him to calm down it doesn't work, walk out of the room for a bit or take him for a little walk to get his mind off of how he feels. He cannot express what is going on in his body, I am assuming that is part of this dementia. I am not saying your parent has a health issue but maybe he/she does.
I'm dealing with my mother who is in her mid 90s. Since I can remember, she has had bipolar and narcissistic tendencies. And shes been on an unusually high dose of Lexapro for a long time. Well the dementia just exacerbates it. She is in rehab right now for a mild stroke. When people are nearby having a conversation, she thinks they are talking to her. Every day she goes on and on about how other patients are slighting her. Then she starts in on me. She tells me I'm stupid and to shut up, and calls me a bitch; and, the ever present guilt trips. Since my father died 30 years ago, my now-ex-husband and I helped her with so many things. It was mainly me though, and because of that, I'm in my 50s with no savings or decent career. I am her POA, and she often threatens to remove me and kick me and my son out of the house. If this happens, I will literally have nothing. All those years I helped her and took care of her needs and she just gives me the bird for it. And to top things off, I have a chronic illness that could very well keep me from working. We have no other family so I get no help. The rehab place says she must not be left alone. We can't afford help, but even if I get her qualified for Medicaid, there will be gaps in supervision. I have an attorney, and we (and her fried) are going to try to talk to her about doing what needs to be done for Medicaid, but its a crap shoot on whether she would agree. Knowing how she is, shell say "ill think about it", and 5 minutes later she will have forgotten about the entire meeting. Life can be so cruel. I hate seeing my mom suffer with this, and she seems to know she has a big problem with dementia. But its hard on me too, and something better give soon if my son is going to have a mother.
This summer my Dad had a couple of minor falls in the home which had me taking him in to the Dr. Of course it is mid summer, very hot, Dad refuses to use air conditioning, keeps windows shut and does not drink adequately. The result was dehydration and weakness. He was sent to rehab for two months (the second I appealed for to get him more therapy). I worked aggressively to keep him from having to stay in 24 hr care and to keep him med free since the meds they put him on without my approval sent him through the roof. He eventually improved enough to come home, which was his desire and I helped aquire it for him. The first week went well...I am his care-taker. By the second week he began to become abusive to me.....I have driven to work every day this week crying after dealing with him during breakfast. I have been bending over backwards trying to make things comfortable and pleasant for him. I try to vary his meals and will present special items that I know he enjoys. It is very disheartening to do these things to please someone only to be abused by them. I have contacted Elder Services and will be getting help in before I have a stroke or a heart attack. The other morning he was up at 1:30 am attempting to make breakfast....he dropped the bowl, broke the glass on the table, there was cereal everywhere and broken pieces of bowl. I was on my hands and knees cleaning up the mess at 1:30 am and then had to get up 3.5 hrs later to get ready for work and to help him in the morning. There has become a total lack of appreciation for anything I do for him, and he has become quite abusive calling the food I give him "slop" as well as calling me names. I think things will settle down once someone else comes in to do these things as opposed to myself. It is hard for me to disengage since I am running around like an idiot for him and get very upset by his commentary. It makes me very angry and then I feel guilty for being angry....a complete vicious circle. Hopefully things will improve when I get help in since I have clearly recognized very early on that this level of stress is impacting me tremendously and is not helpful for him. At least I will be able to step back and have some breathing room....
Dementia is a progressive, chronic disease, parts of the brain controlling emotion and self-expression are effected. The abuse should not be taken personally, it is the patients way of expressing what they can no longer verbally express.
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