By Gillian Slade on November 28, 2017.
One of North America’s leading educators on dementia says there are better ways to handle aggressive patients than giving anti-psychotic drugs and using physical restraints.
If someone with dementia is aggressive and violent, the first question is what made them feel they needed to “fight for their life,” says Teepa Snow, a dementia education and skills training specialist with Positive Approach¨.
If the person is heavily medicated they may no longer even be able to communicate clearly with words.
“Anti-anxiety drugs can actually cause people to put chairs through windows, put their fist right through a window, have cuts all over their hands and they would keep going,” said Snow. “They have to get out of there … they’re going to die anyway so they may as well do whatever they have to.”
The trigger may be something as simple as trying to undress them. If they have had a previous life event where someone tried to take their clothes off against their will, those memories come flooding back.
No amount of telling them to calm down will help. Calling in other people to enforce the task and/or holding the person down will simply escalate the fear, she says.
Snow uses a special hand technique to support the person and to show you are on their side. She suggests removing them from the situation that has triggered the rage. They no longer feel trapped, somebody has understood their need and is helping to defend them.
“If you just lock doors or tie me down, what that shows is you’re committed to enforcing this ‘concentration camp’ and I fight the restraints as long and as hard as I can,” said Snow.
Someone in that state of mind will certainly not take any pills offered or perhaps not even eat the food because it is perceived as coming from someone who wants to kill them.
To get out of the cycle you have to determine the trigger. If they’re seeing bugs and they think the bugs are trying to get inside them, remove the person promising to clean the area and get rid of the bugs.
“It’s called you go with their flow because you can’t fix their delusion,” said Snow.
Instead of using physical restraints it would be more appropriate to position the chair and the person close to an area where you are working so you are aware when they have the urge to get up. Respond promptly, said Snow.
“You’re ready to get up? Are you thirsty or do you just want to walk a little bit?” said Snow.
Are they uncomfortable from sitting, need to go to the bathroom, or perhaps heard something they want to investigate?
Success on both sides takes skills and knowledge, said Snow.
“You can’t be so focused on getting tasks done that you forget that you’re doing those tasks to a human being,” said Snow.
For the person with dementia there is an inability to comprehend and understand. Wandering could be an indication they feel they need to flee, said Snow.
Anti-psychotic medication may seem like the solution but that only works in some situations and for a short period of time, said Snow.
“The problem is they’re used as blankets. You throw this heavy blanket over somebody … it limits attention, focus, motor ability and sensory awareness,” said Snow.
It can create other issues — incontinence, difficulty moving, more falls and injuries. It can also affect hydration and infection because the person is not moving about, said Snow. The drugs may make some people even more aggressive.
This is particularly true of people who have Lewy Body dementia and in those cases you can permanently effect the part of their brain that allows them to move freely.
Tying someone up “is called illegal” and “torture”, said Snow. “We aren’t allowed to do this with any other population but we feel free to do it with dementia. You can’t do it in prisons, you can’t arbitrarily restrain somebody over a long period of time.”
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