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Memory Care for Aggressive Patients: Community Coping Strategies

By Kara LewisMarch 14, 2022
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Aggression is a common symptom of Alzheimer’s disease and other forms of dementia. In fact, 35% of dementia patients display frequent aggression throughout their disease, according to a study of 281 seniors published in Geriatric Psychiatry. Aggression may complicate caregiving and often requires specialized attention.


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Just the prevalence of aggression among dementia patients should carry significant value for caregivers: It demonstrates they’re not alone.

But it takes skill and training to manage aggressive patients day in and day out. Memory care community staff receive expert training, both in anticipating and redirecting hostility. And, these caregivers often see positive results from offering a personalized and compassionate approach to treating dementia aggression, according to David Troxel, former president and CEO of the California Central Coast Alzheimer’s Association.

“In so many ways, if you’ve met one person with Alzheimer’s, you’ve met one person with Alzheimer’s. Everyone is different,” says Troxel. “The best facilities and programs develop an individualized care plan that focuses on remaining abilities and strengths. I believe 90% of the time, you can make things better.”

What causes aggression in people with dementia?

For individuals with dementia, many of whom have lost their ability to communicate in direct ways, aggression and other dementia behaviors can be a way of conveying health issues, pain, discomfort, medication reactions, or fear.

“Any of us would get aggressive if we were frightened, in pain, or frustrated,” says Troxel. “Sometimes, these behaviors are not all that mysterious.”

Accounting for these situational factors, which Troxel calls “triggers,” is a key first step that memory care staff may take. They might perform a root cause analysis — sometimes called a root cause assessment — to understand a resident’s background and personality. The results can give insight into how to effectively communicate with and assist the individual.

“Sometimes, being reflective can help you understand if the behavior was something inadvertently caused,” says Troxel. “A good rule of thumb to remember is that dementia is slowly progressive. So, if there’s a sudden change in aggression, it often means that a person is sick — not that their dementia has suddenly entered a new stage.”

What strategies do memory care communities employ in overseeing aggressive patients?

Though caregivers may be cautious about finding memory care for a loved one who displays aggression, staff members at these communities undergo training on how to respond to such behavior and how to prevent future altercations. Memory care employees prioritize calm communication, transparent body language, and soothing environmental cues to deescalate belligerent episodes.

Communication strategies in memory care for aggressive patients

Communication is a major component of memory care training. Generally, staff use the following techniques:

  • Tone adjustment. Keeping a light, supportive tone of voice can have a calming effect.
  • Asking questions. “Talk to the person about interesting elements of their life story,” says Troxel. Staff at memory care communities may ask a dementia patient about their past career, travels, or children to initiate a warm and positive conversation.
  • Divert attention. Staff members may invite a resident undergoing an aggressive episode to partake in an activity they enjoy. This can include asking the resident if they want to get coffee, complete a puzzle, or watch a favorite show.
  • Simple, concise phrasing. Memory care employees try to focus on the present when speaking and avoid drawn-out, complicated language.
  • Responding to and validating emotion. Sometimes, seniors with dementia might be seeking emotional validation in moments of aggression. For example, a memory care resident asking to see their late mother could be a sign of loneliness and indicate they want to spend time with a caregiver or attend a group activity. Effective memory care training encourages staff members to avoid ignoring or dismissing a senior’s feelings, but, rather, to validate these feelings by listening empathetically and letting the senior express their emotions in a safe, productive way.
  • Speaking with, and not at, the resident. Memory care employees strive to make communication a collaborative effort. Overexerting a sense of authority may lead to rebellion and further agitation.
  • Holding regular staff and family meetings. Establishing a care plan and regularly communicating with every member of a senior’s care team can help standardize treatment and keep aggression at bay. Additionally, when staff members come together, they’re more likely to recognize a dementia patient’s triggers and find strategies to address them.

Physical and body language strategies in memory care for aggressive patients

Communicating with dementia patients involves much more than just words. As their condition progresses, those living with dementia and Alzheimer’s become more dependent on physical cues, eye contact, and body language. Memory care staff respond to and reduce aggression by:

  • Pausing before taking any other action. When a person with dementia feels distressed, taking a moment to pause is a crucial step. The person is likely signaling that they’re uncomfortable with the situation or your response, but they are unable to communicate that distress directly. Respecting their boundary and taking a breath is a necessary de-escalation tactic.
  • Getting into a “supportive stance.” Consider turning your body away or stepping to the side to discourage your loved one from feeling cornered or trapped. A “supportive stance” model is a common tool used by memory care communities, and it can help a person with dementia regain control of the situation.
  • Approaching residents from the front, never from the side or from behind. Startling a resident is a primary cause of aggression. By approaching someone from the front, staff members aim to ensure that the resident can see them the whole time and try to avoid catching them off-guard.
  • Making eye contact. Eye contact can guide individuals with dementia during a conversation. It can also be a grounding technique.
  • Incorporating touch therapy or massage. Touch is one of the most relaxing senses for dementia patients. In fact, touch therapy can enhance feelings of trust between seniors with dementia and Alzheimer’s and their caregivers. Memory care employees may brush a senior’s hair, provide a hand massage, or simply place their hand on the resident’s arm. Engaging in a familiar activity, like folding laundry, can expose the senior to a comforting texture they recognize.
  • Separating residents when necessary. In the event of an altercation between residents, memory care staff are trained to safely and efficiently separate them to eliminate potential danger.
  • Going for a walk or getting outside with a resident. With dementia medications showing only moderate benefits, physical exercise can possibly help improve cognitive symptoms in those with dementia, as noted in the Mayo Clinic Proceedings, a peer-reviewed medical journal. Memory care staff members will ask residents to take a walk to help them get exercise, provide a change of scenery, and to tap into the benefits of nature.
  • Removing seniors from loud or overactive settings. When a senior is overstimulated, they may respond with aggression. Community caregivers can remove them from bustling settings, such as a cafeteria or chapel service, and relocate them to a quieter, more private space.

Design and environmental strategies in memory care for aggressive patients

Memory care communities are designed with de-escalation and relaxation in mind. Facilities promote a soothing environment by concentrating on these areas:

  • Music. Memory care staff members have long relied on the power of music therapy for dementia. Studies show that music can lower dementia patients’ stress levels and evoke positive memories. In particular, memory care communities often select classical music, church hymns, or cheerful sing-alongs to provide a sense of comfort.
  • Aromatherapy. Diffusing lavender twice a day can significantly reduce aggression among dementia patients, according to a recent study. Communities replicate this effect with essential oils.
  • Lighting. Harsh or fluorescent lighting can trigger aggression. Communities may use dimmers to alleviate this.
  • Clear signage. Individuals with dementia often experience difficulty navigating. Clearly marked restrooms, exits, and communal areas can prevent outbursts that result from residents being lost or confused.
  • Gardens and other outdoor spaces. Access to plants and naturecan boost seniors’ happiness, reduce feelings of being overwhelmed, and stave off the progression of dementia. For these reasons, many memory care communities feature what they call “healing gardens.”

When is medical intervention appropriate?

Some caregivers may turn to medication to manage an individual’s aggression. However, most dementia care experts caution against psychotropic medications.

“The problem with using medication for dementia is that you often trade one problem for another,” says Troxel. “It could knock down a patient’s aggression, but [their side effects could] cause them to fall and break their hip a week later. With good care planning and productive activities, about nine out of 10 times dementia patients don’t need to be medicated.”

Both caregivers and memory care staff members should consult a dementia patient’s doctor before implementing medication into their care plan.

Do memory care communities evict hostile residents?

Evictions in memory care are the notable exception — not the rule. And, memory care communities will typically highlight eviction guidelines and standards in resident contracts.

While causes for eviction vary depending on the community, most facilities will only evict a resident who is a persistent danger to other residents, to staff members, or to themselves. Troxel notes that residents who are “spontaneously aggressive” — versus those with consistent, predictable triggers — are more likely to be evicted.

In other words, if the community cannot easily understand what is causing a resident’s unpredictable and aggressive behavior, then they may feel they can no longer help them.

Evicting an aggressive resident from a memory care community is rare and is a last resort. Before taking this action, a senior’s care team will often work with the individual and their family to explore other options.

Find memory care near you for aggressive patients

While finding care for a loved one who exhibits aggressive tendencies can seem difficult, A Place for Mom’s Senior Living Advisors can direct you to find memory care that fits your loved one’s specific needs. These local senior living experts can help you consider your loved one’s unique situation, your expectations for care, and your financial resources to find the right care for your senior loved one.

Sources

Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., & Petersen, R. C. (2011, September). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic Proceedings.

Collier, S. (2020, February 14). What’s the best way to manage agitation related to dementia? Harvard Health Publishing.

Greater New York Hospital Association. (2009). Conducting root cause analysis: a resource guide for health care providers.

Liljegren, M., Landqvist Waldö, M., & Englund, E. (2017, August 31). Physical aggression among patients with dementia, neuropathologically confirmed post‐mortem. International Journal of Geriatric Psychiatry.

Moorman, Li R., Gilbert, B., Orman, A., Aldridge, P., Leger-Krall, S., Anderson, C., & Hincapie Castillo, J. (2017, January 23). Evaluating the effects of diffused lavender in an adult day care center for patients with dementia in an effort to decrease behavioral issues: a pilot study.Journal of Drug Assessment.

Watt, J., Zahra, G., Angeliki Veroniki, A., Nincic, V., Kahn, P.A., Ghassemi, M., Thompson, Y., Tricco, A. C., & Straus, S. (2019, November 5). Comparative efficacy of interventions for aggressive and agitated behaviors in dementia.Annals of Internal Medicine.

Author
Kara Lewis

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