May 27, 2014

Are dementia patients dangerous?

People with dementia sometimes exhibit aggression and behaviors that are frustrating, embarrassing, and sometimes even dangerous to the Alzheimer's caregiver and others.

People with dementia sometimes exhibit aggression and behaviors that are frustrating, embarrassing, and sometimes even dangerous to the Alzheimer's caregiver and others.
By Bob DeMarco
Alzheimer's Reading Room

I wonder what percentage of the public thinks or believes that persons living with dementia are dangerous or violent?

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One of the first questions I was ever asked about my mother was - has she tried to stab you yet?

The question implied it was inevitable or likely to happen. The question was asked by a well educated person with an advanced degree.

Are persons living with dementia more prone to violence than the general population? I have never read a study to indicate this; and, my own personal experience tells me no.

It is likely that a small percentage of dementia patients are predisposed to violence by their nature. This means they might have been violent before dementia set in. Or, they might have had a mental illness that predisposes them to violence.

It is true that medications can sometimes make Alzheimer's patients violent. Sometimes medications can interact with each other in a negative way and cause confusion that sometimes leads to violence.

Difficult, not dangerous, behavior is more common in Alzheimer's and dementia patients.

In their book on Alzheimer’s caregiving -- The 36 Hour Day -- Peter Rabins, M.D. (author of the Johns Hopkins Memory White Paper), and Nancy Mace discuss the six R’s of managing difficult behavior in people with dementia. They are:

* Dementia Strategy 1 -- Restrict. First, calmly attempt to get the person to stop the behavior, especially if the behavior is potentially dangerous.

* Dementia Strategy 2 -- Reassess. Consider what might have provoked the behavior. Could a physical problem (toothache, urinary tract infection, osteoarthritis) be behind the agitation or anger? Is a particular person or the noise level in the room triggering the negative reaction? Could the time of day and fatigue be contributing to the problem?

* Dementia Strategy 3 -- Reconsider. Put yourself in the dementia patient’s shoes. Try to imagine what it must be like to not understand what is happening to you or to be unable to accomplish a simple task. Consider how frustrating or upsetting the current situation or environment might be for a person with dementia.

* Dementia Strategy 4 -- Rechannel. Try to redirect the behavior to a safer, less disruptive activity. For example, if the person constantly disassembles household items, try finding simple unused devices, such as an old telephone or a fishing reel, that can be taken apart and put back together repeatedly. For someone who hoards or hides things, put away valuables and replace them with an array of inexpensive items. Distraction often works well to curtail disruptive repetitive behaviors and restlessness. For example, try asking the person you’re caring for to “help” with simple tasks, such as holding spoons or potholders while you cook.

* Dementia Strategy 5 -- Reassure. The demented person’s brain injury and the resulting confusion and frustration can lead to anger, anxiety, and outright fear in certain situations. Calmly reassure the person that everything is okay and that you will continue to take care of him or her.

* Dementia Strategy 6 -- Review. After an unsettling experience with your loved one, take time to review how you managed the problem and what you might have done differently. Think about what may have triggered the problem, how it might have been avoided, and what you might try the next time a similar situation arises. It also helps to create a patient-friendly environment. This might include soothing music in the background; pictures, words, or arrows to help orient the person in the house; or a secure place to sit outside or walk in the backyard.

For many caregivers, these difficult behaviors are the most challenging and exhausting aspect of caring for a person with dementia.

Have you ever been confronted with dangerous behavior from a person living with dementia?

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Bob DeMarco is the Founder of the Alzheimer's Reading Room (ARR).

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