As Mom's mixed dementia progresses, I have had to continually adapt to changes in mood swings even when I cannot understand what is causing the change. For me, adaption looks like a detective working on solving a case. Only our case changes daily. Because FTD (Frontotemporal Dementia) is more related to behavioral challenges than memory, it is hard to pinpoint what might trigger a flare-up one day to the next. Knowing is one thing, but living through the decline is still shocking to witness.
When I first stepped in as caregiver for Mom, I had limited time to balance my responsibilities. My patience was also limited, so understanding her actions or having better reactions made daily care frustrating. Anticipating Mom's reactions on shower days created an emotional challenge, but eventually, the aggressiveness and language created situational depression. I knew not to take her verbal abuse personally, but not wanting to be there made me feel guilty afterward.
Keeping her safe in familiar surroundings was important to me, yet difficult to find a balance between what she wanted to do versus what I needed her to do. I did not want to use the idea of assisted living as a punishment, but the conversation had to be started. As the months passed, I could see a decline in Mom's abilities also created limitations of how much I could do for her in our home. The worry of how she would be treated in a memory care facility if she behaved the same way there, made me keep her at home longer than I should have.
Once Mom became settled in her memory care community, I was able to become her daughter again. I also had an emotional break that allowed space to step back and see her behaviors for what they indicated. If your loved one is beginning to hit, kick, bite, have verbal outbursts, or engage in socially inappropriate actions or behaviors, there is usually an underlying cause. They are not trying to be difficult or mean to hurt your feelings.
When I received the first call from Mom's memory care community notifying me about her aggressiveness my response was fear of her being kicked out. Since then, having learned more about underlying causes, I can respond in a concerned detective mindset. Working with the staff to share details about her past to connect with present changes helps us all to be on the same page in how we approach her to help.
Some of the causes of aggression are related to pain or illness. Pain could be joint body pain from inactiveness or dental pain from poor oral hygiene. Illness from urinary tract infections (UTIs) may also cause extreme fatigue or nausea, making your loved one want to withdraw or be aggressive in response to daily activity requests. Chronic conditions such as PTSD may be related to trigger points you are unaware of that need detective work. Your loved one may also be frustrated with their limitations and cannot communicate verbally or effectively to express sadness instead of aggression.
Other possible reasons for aggression may be boredom, misinterpretation of sight or sounds, loneliness, range in temperature being too hot/cold, or crowded areas with overstimulation from lights or sounds. Maybe their demands are not being met; however valid the reason, they may feel insignificant or ignored. The act of aggression is a call for investigation before they are dismissed as crazy or mean.
The CDC national survey of nursing homes found that over half of all CNAs experienced significant job injury from aggressive behaviors, creating a costly turnover. Learning how to deal with aggression will take more than compassion and can be provided through caregiver training. When caregivers know their loved ones' past and possible trigger points, they will do better with a cinematic response such as improvisation or acting.
Stepping into their world may look like accepting an acting role in Gone with the Wind, a Western movie, or a telenovela. It may feel silly or deceptive, but you create compassionate deceptions for your loved ones to cope with reality and diffuse an aggressive outburst.
Here are some possible Interventions for aggressive behaviors:
Create a behavior log to track the trigger that may have caused the outburst. Find out the who, what, where, when, and why's.
Watch for cues of anxiety, stress, & restlessness
Simplify their daily tasks as much as possible
Approach your loved one slowly
If short-term memory is an issue, then introduce yourself repeatedly (every morning)
Provide a set routine to create predictability and reduce potential triggers.
Play soothing music or favorite styles (unless it is tied to a trigger)
Eliminate intrusive sounds like call bells, paging systems, or television
Use soft lighting
Remove mirrors (if they no longer recognize themselves)
Provide them with comfort items like rocking chairs, doll therapy, or teddy bears
Use distraction, encouragement, or reassurance with plenty of flexibility if they are uncooperative
Leave psychotropic medication and restraints as a last resort.
When you recognize violent or aggressive behavior escalating:
Approach your loved one from the side instead of the front to avoid being hit.
Speak calmly while reintroducing yourself and remind them of who they are. Your loved one may be stuck in an old traumatic memory. "Hi Mom, it's Jessica, your daughter. Are you teaching two or three subjects today?"
Use non-threatening body language with a calm voice
Make eye contact and try to gently stroke their hand
Don't take their behavior personally
Remain calm so you can continue to treat them with respect
Thank you for joining in and listening with us today. I hope this gave you more food for thought and until next time, BE PROACTIVE. Take care, everybody.
Intro: Vacation Time by Khris Paradise
Outro: Misty by Khris Paradise