Memory Care for Aggressive Patients: Community Coping Strategies

Kara Lewis
By Kara LewisMarch 16, 2021
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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 care.

The prevalence of this issue carries a valuable significance for caregivers: They’re not alone. Staff at most memory care communities receive expert training in both anticipating and redirecting hostility. According to David Troxel, the former president and CEO of the California Central Coast Alzheimer’s Association, caregivers can take comfort in this personalized and compassionate approach to treating dementia aggression.

“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.”

Read on to understand what leads to aggression in individuals with dementia, how to manage it, and how communities facilitate effective, person-centered memory care for aggressive patients.

What causes aggression in people with dementia?

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

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.

Accounting for these situational factors, which Troxel calls “triggers,” is a key first step that staff at memory care take. Staff will perform a root cause analysis — sometimes called a root cause assessment — to understand a resident’s background and personality. The results can offer insight into how to best communicate with and assist a senior.

“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.”

How do communities provide memory care for aggressive patients?

Though caregivers may be nervous about finding memory care for a loved one who displays aggression, staff members at these communities receive training in how to react, as well as in 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. 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 their children to spur a warm, positive conversation.
  • Redirection. Staff members may invite a resident undergoing an aggressive episode to partake in a favorite activity as a means of distraction. 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 to 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 could signal they want to spend time with a caregiver or to attend a group activity. Effective memory care staff members will never ignore or push past a senior’s feelings, but rather encourage the senior to express these 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

Communication 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. Teepa Snow, a dementia expert with more than 40 years of experience, considers this delay to be one of the most crucial steps to take. “In moments of distress, the message that a person with dementia is sending is that what a caregiver is trying is not working. Their message is, ‘I need you to stop,’” explains Snow. Respecting this boundary and taking a breath is a necessary de-escalation tactic.
  • Getting into a “supportive stance.” “I want to turn my body,” says Snow. “I want to make it so I’m not right in front of them, because when I’m right in front of them, I’m trapping them. When I’m right in front of them, I’m saying, ‘I’m the boss of you.’” Many communities follow this “supportive stance” model.
  • Approaching residents from the front, never from the side or from behind. Startling a resident is a primary cause for aggression. By approaching someone from the front, staff members ensure the resident can see them the whole time and 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. Likewise, engaging the resident in an activity like folding laundry can expose the senior to a comforting, familiar texture.
  • Separating residents when necessary. In the event of an altercation between residents, memory care staff are trained to safely and efficiently separate them and to eliminate potential danger.
  • Going for a walk or getting outside with a resident. Physical exercise can be more effective than medication in treating aggression stemming from dementia, according to research from Harvard Medical School. Memory care staff members will ask residents to take a walk to help them get exercise, to 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, like a cafeteria or chapel service, in favor of relocating 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 through:

  • 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.
  • 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 due to residents being lost or confused.
  • Gardens and other outdoor spaces. Access to plants and nature can 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.”
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When is medical intervention appropriate?

Some caregivers may turn to medication to manage aggressive residents, and often assume memory care communities do the same. 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 cause them to fall and break their hip a week later. With good care planning and productive activities, about 9 out of 10 times dementia patients don’t need to be medicated.”

While there are exceptions to this, a recent analysis of 148 dementia studies encompassing 21,686 patients found that holistic, multidisciplinary therapies—including touch therapy and music therapy—were more effective in reducing aggression than medication. 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. Memory care communities will typically highlight guidelines and standards for evictions 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 also notes that residents who are “spontaneously aggressive” are more likely to be evicted—that is, when a root cause assessment does not uncover any consistent, predictable triggers.

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

Find memory care for aggressive patients near you

A Place for Mom’s Senior Living Advisors can help connect you with memory care communities in your area. Our local senior living experts can help you consider your loved one’s needs, your expectations for care, and your financial resources to find the right care for your loved one.

Sources:

Collier, Stephanie. “What’s the best way to manage agitation related to dementia?” https://www.health.harvard.edu/blog/whats-the-best-way-to-manage-agitation-related-to-dementia-2020021418816

Liljegren, M, Landqvist Waldö, M, Englund, E. “Physical aggression among patients with dementia, neuropathologically confirmed post‐mortem.” https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4777

Moorman, Li R., Gilbert, B., Orman, A., et al. “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.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327916/

Watt, J., Zahra, G., Nincic, V., et al. “Comparative efficacy of interventions for aggressive and agitated behaviors in dementia.” https://www.acpjournals.org/doi/10.7326/M19-0993

Kara Lewis
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Kara Lewis

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