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What's the best way to deal with combative behavior?

9 answers | Last updated: Oct 27, 2014
yojerry asked...

What is the best way to get my mother, who has Alzheimer's, to cooperate when she is being combative?


Caring.com User - Helene Bergman
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Helene Bergman, LMSW, is a certified geriatric care manager (C-ASWCM) and owner of Elder Care Alternatives, a professional geriatric care management business in New...
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Helene Bergman answered...

Alzheimer patients are often confused and become oppositional when a loved one, or a professional caregiver, attempts to provide direct care. The caregiver is 'well-meaning' but the patient does not See also:
Alzheimer's Behavior Problems
understand this and thus, may behave in a 'defensive' manner that ranges from saying 'no' to expressing anger. Sometimes, this behavior is perceived to be 'combative' when it really is a way the patient can communicate that he or she is not ready for this care. It might be when medication is being administered or a bath is given....or even a meal is served. The best strategy at that time is to 'retreat' and try to perform the task again in a little while. You may need to do this a few times before the patient will 'cooperate'. By understanding the patient's 'preferred time schedule' you also may foster cooperation rather than opposition; if a bath at night works better than in the morning, do it then. The key is understanding that you cannot usually cajole or negotiate with an Alzheimer's patient. Instead, you need to modify your methods of providing direct care. The key is understanding that you cannot usually cajole or negotiate with an Alzheimer's patient. Instead, you need to modify your methods of providing direct care.


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Charlotte ALIG answered...

Totally correct, but oh so hard to get used to....the change in a partner is hard to see when so many other things have not yet changed.. it is also hard to be the one to "retreat" and let something that is maybe important, just wait on the backburner...but yes, the advice is totally true.


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nanci2 answered...

My husband is still considered in the early stage of this horrible disease, but I do wonder if he has moved to a moderate stage. I have noticed more lately that when around children he is fixated on them and loves to interact with them. He actually acts like a child. I'm so afraid he might become inappropriate , and have to watch him constantly when he's around them. Any input would be welcome.


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frena answered...

when a person with dementia becomes "combative", it is a sure sign that we caregivers need to look at ourselves and how we interact with our person. i'm not talking about the wild and crazy all night long rampaging person( who, by the way, is much more likely to be schizophrenic, psychotic or have PTSD) people with dementia don't want to be bossed around (unlike the rest of us?), argued with, made to feel inadequate and childish. when they get mad at us, we've usually done some or all of those things. to manage the situation better, we caregivers need: a) to slow down; b) to be respectful; c) to make suggestions, not give orders; d) to keep things simple and do them in step-by-step order and e) be kind, be kind, be kind. when they react badly, we need to ask ourselves, uh oh what did i do here? if they hit out, we have frightened them, hassled them, moved into their space instead of stepping back out of it, and probably tried to hurry them too much. if it's not your approach that scares them, maybe it's what you're trying to do. most people with dementia are scared by the shower and there are many better ways to deal with that than trying to insist on it. see "Alzheimer's 911" by Frena Gray-Davidson (me) which concentrates not on disease but how we learn to communicate well with a perosnd ealing with dementia. remember, you may tell yourself it's worse to be a caregiver than to have dementia, but that is NEVER true.


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sanity answered...

my mom lives with me and has her bad days where she is uncontrolable and combative. i have had a lot of bruises and contussions from her. it doesn't hurt, i no she cant comprehend what she is doing. she has mod-severe alzheimers. its getting worse. we had a beautiful bright bedroom made for her with all her rememberences, nice furniture and pictures everywhere. well, after a few months, all the pics got knocked down or smashed. the furniture destroyed. 3 pr of window blinds, holes in wall, etc. when she has her bad episodes at night she destroys and yells and pounds on walls. i try to be very kind and settle her down but they have extremely super strengh!! but through it all, she will always be with me, in my home, and in my heart. patience is what we all must have. thank you for letting me vent.


frena answered...

well,melvinchun, if up all night involves pottering about, fidgeting with things, wandering through the house, then yes, it's probably a normal dementia activity. the first person i ever looked after would potter around in this way, moving things around her room (not furniture, but clothes or photographs, generally and quietly adjusting her environment and eventually going to sleep. you'd be sure to make the house secure from falls and your person heading off out of the door while you sleep. up-all-night-and-wild on a regular basis, i'd be getting my person to see a psychiatrist on the grounds that something else was going on within (ptsd, mental illness). a sudden wild all-nighter from a usually peaceable soul, i might want to get them checked out for possible urinary tract infection which can make usually peacefull people very wild temporarily or maybe even a medication reaction (especially if it was a new med they'd just started). follow your instincts about your person and always be willing to get expert advice from a doc. they don't know your person like you do (so you're the on-the-spot expert) but they know their own expertise. some people regularly use sleeping pills which may work well without side effects, or may not. again, you're the expert on your person. hope this helps and sweet dreams!


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APHA answered...

I am a professional caregiver and I loe working with Dementia/ Alzheimer's patient. My strategy is backing off and add affection and love, listed and respond to what ever he or she is trying to say. That usually work for me Tke care, my heart is with you Andria Harros