Caregiver Corner: Keep calm and carry on!

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We’ve all had times when we felt overwhelmed to the point of ‘losing it.’ For me this happened when I badly injured my knee in the Alps and was alone in a hospital where no one spoke English and I didn’t know where to turn. Thank goodness I had coping skills that aided me in that situation.

Persons with dementia often find themselves in confusing and upsetting situations but gradually lack the necessary coping skills to help them out. This can sometimes lead to verbally or physically aggressive behaviors. Many caregivers tell us one of the hardest things they cope with is helping people with Alzheimer’s in frustrating situations.

When you are in an aggressive situation, try to identify the immediate cause. What happened right before the reaction that may have triggered the behavior? Many factors can contribute to this type of behavior, including physical discomfort, environmental factors and poor communication.

Physical discomfort
• Is the person able to let you know that he/she is experiencing physical pain? It is not uncommon for persons with Alzheimer’s or other dementias to have urinary tract or other infections. Due to their loss of cognitive function, they are unable to articulate or identify the cause of physical discomfort and, therefore, may express it through physical aggression.

• Is the person tired because of inadequate rest or sleep?

• Are medications causing side effects? Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions.

Environmental factors
• Is the person over stimulated by loud noises, an overactive environment or physical clutter? Large crowds or being surrounded by unfamiliar people — even within one’s own home — can be over-stimulating for a person with dementia.

• Does the person feel lost?

• Most people function better during a certain time of day; typically mornings are best. Consider the time of day when making appointments or scheduling activities. Choose a time when you know the person is most alert and best able to process new information or surroundings.

Poor communication
• Are your instructions simple and easy to understand?

• Are you asking too many questions or making too many statements at once?

• Is the person picking up on your own stress or irritability?

Here are a few tips for how to respond in when someone is showing aggression:
• Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.

• Assess the level of danger — for yourself and the person with Alzheimer’s. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.

• Be positive and reassuring. Speak slowly in a soft tone.

• Limit distractions and rule out pain as the cause of the aggression.

• Try a relaxing activity. Use music, massage or exercise to help soothe the person.

• Shift the focus to another activity – the immediate situation or activity may have unintentionally caused the aggressive response. Try something different.