There are many challenges involved in caring for a patient with dementia. At times these patients may become combative. This is a regular aspect of the disease and may happen even in patients who were not aggressive earlier in their lives.
How do you deal with combative dementia patients?
I work as a pharmacist in a geriatric psychiatric unit. We care for these patients when caregivers are unable to. Our goal is to stabilize them and return them into the community.
This post will give you pointers on what to do when faced with aggression from a dementia patient.
Be Prepared and Keep Calm
It is essential to be prepared for unusual behaviors from dementia patients. Due to damage occurring in the brain, these patients often display unexpected behaviors.
Be calm when they become aggressive and speak to them in a soft, comforting tone. Always remember that this is part of the disease process and not a personal attack against you.
Although your instincts may lead you to retaliate when dealing with an aggressive dementia patient, this can make the situation worse. Try to learn from each situation and keep yourself and the patient safe.
Try to Identify Possible Causes of the Aggression
There are some basic things to rule out when patients begin to act out. Be sure basic needs are met. These include:
Pain – uncontrolled pain can cause individuals to lash out. They often are not able to communicate. It is vital to look for non-verbal signs of distress, including:
- Facial grimacing.
- Guarding certain areas or withdrawing from touch.
- Writhing or constant movement.
- Increase in blood pressure or respiratory rate.
Constipation-this can make anyone uncomfortable, including dementia patients. Be sure they follow a toileting schedule and pay attention to the frequency of bowel movements.
Urinary tract infections – These can be a cause of pain and discomfort and are more common in elderly patients. Monitor the patient for smelly, cloudy, or discolored urine. If these signs appear and the patient is acting differently, they should be seen by a medical professional for an evaluation.
Try to keep the patient comfortable. Maintain a reasonable room temperature and create a good place for the patient to relax.
Sleep – We all can become grumpy if we don’t get enough sleep. Follow the basic sleep hygiene guidelines listed below.
- Follow a sleep schedule. Try to get the patient to sleep at the same time each night.
- Avoid letting the patient take long naps during the day.
- Do not give the patient large amounts of fluid close to bedtime. This can increase nighttime awakening.
- Be sure the room where the patient sleeps is dark, quiet, cool, and comfortable.
It is important to note that sleeping pills other than melatonin are not appropriate for dementia patients. Drugs such as diphenhydramine (BenadrylTM) and other sedating antihistamines make dementia worse. Read my blog post on anticholinergics and dementia for more information.
Calm the Environment
Excessive noise and activity can agitate patients.
The nurses on our unit are quick to ask staff to quiet down when it becomes noisy or hectic.
Keep music soft, and try to have people speak quietly.
If too many people are around the patient, ask some of them to relocate temporarily. If the patient is starting to act out, try moving them to a different room.
Keep track of what works and doesn’t.
Every patient is different.
Many times you can calm a dementia patient by merely redirecting them. Read them a story, show them pictures or watch a TV show with them. Avoid activities that demand too much thought or concentration. Most dementia patients will become frustrated if they are asked to participate in activities that are too difficult for them to perform. Find activities that the person enjoys. Redirection is one of the best tools available to you.
Smile and be Kind
Sometimes a simple smile can do wonders—all of us like people to smile at us.
A gentle touch can also help.
Avoid startling the patient. Approach them from the front so they can easily see you coming.
Show them you care.
Give Them Time Alone
If nothing seems to be working, consider giving the patient some time alone.
Be sure the patient is safe and keep an eye on them.
They may just need to cool down.
Some alone time in a quiet place may be what is necessary.
Take Care of Yourself First
If you are taking care of a dementia patient, you will likely be under a lot of stress.
The most important thing for you to do is keep healthy, both physically and mentally.
You will not be an effective caregiver if you get burned out or become sick yourself.
If you need a break, find help!
Taking care of these patients often causes one to be up in the middle of the night. Try to find a family member or friend to help when needed.
We all need a break at times.
Know Your Limits
In some cases, you may be unable to care for the patient yourself.
If the situation becomes unsafe for either you or them, it is time to consider placement into a memory care facility.
This is not a sign of failure on your part. We all have our limits. Memory care facilities are staffed with individuals who know how to care for your loved one. They take care of these patients every day.
Caregivers in these facilities are trained to recognize behaviors that require medication.
Remember, your health and well-being are important too.
I have spent the last four years working on a unit that cares for geriatric patients with psychiatric issues. Many of these patients have dementia. There are several forms of this disease, but all of these patients become dependent on others for their care eventually.
Working with these patients has been one of the most rewarding aspects of my pharmacy career. Being involved in the final chapter of a patient’s life has a special meaning to me.
I hope this post has helped if you are caring for a loved one with dementia. I want you always to remember that there is help out there for you if you are struggling.
Safety is always the most important goal.
I have listed some resources below if you need help.
You can always contact me with questions at [email protected].
If I don’t know the answer to your question, I will find it for you.
Have a great week, and stay safe. Be sure to read our other blog posts to help you live a happy, healthy life, and please sign up for our newsletter below.
Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
Feel free to send Michael a message using this link.
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