People with dementia may have occasions where to express their anger, frustration or distress they hit out at others either physically using their arms or legs or using implements, for example throwing cutlery. The person might also bite or pinch others. This behaviour is a way of expressing distress by the person with dementia. But it can be extremely distressing for those people supporting the person in a number of ways, both physically and emotionally.
Occasions where this happens can very often be associated with a particular time of day, or related to care tasks such as when a person is being supported with washing and dressing. At these times the emotions surrounding intimate tasks for both the person with dementia and those providing support and care can be heightened, and it is not unusual for difficulties to arise.
Consider reasons why?
- What might the person be feeling? There are many possible feelings associated with being supported with very intimate tasks: If the person is feeling:
- Angry
- Frightened
- Embarrassed
- Frustrated.
This might be an expression of those strong feelings.
- What is the person experiencing? If the person is in an environment where it is difficult to hear what is being said or to see clearly what is happening this might be a reaction to feeling disorientated. The person might also be in pain.
- What approaches are being used? If the person is being rushed for example this could create a feeling of panic.
- Are there any cultural differences for example diet, clothing or rituals?
Complete the learning record and the quick activity.
What might help?
For situations where a person may be hitting out there are specific strategies that can be learnt to know how to position your body and move in ways which prevent as much harm as possible to yourself and the other person. Learning these techniques and practising them can build confidence in knowing how to physically respond to a situation. (This workbook is not a substitute for learning these techniques and courses for learning these techniques for example ‘Positive Behaviour Management’ are available in different forms). NB: It is important to be aware of potential triggers to enable the use of de-escalation strategies which may avoid a person physically hitting out at others.
General points to consider when responding to the person who is demonstrating angry behaviour
Become aware of your own body language:
- Be aware of body distance, posture, personal space.
- Stay calm…your non-verbal behaviour will show how you feel so try and relax your muscles.
- Check the person’s non-verbal cues. Don’t approach unless safe to do so.
Think about how you are responding:
- Show you are listening.
- When there is an opportunity, speak in a calm manner and tone.
- Try not to take things said personally: Know that person is upset – not with you, but with their understanding of what is or is not happening.
- Do not argue.
- Do not criticise.
- Do not tell the person off.
Think about the environment:
- Be aware of noise levels.
- Be aware of space.
- Be aware of other people.
- Be aware of your escape routes should you need them.
- Be aware of potential weapons. For example a walking stick.
Looking after yourself – when the incident is over:
- If needed take a break.
- De-brief: Talk about the incident confidentially with a colleague or your manager.
- Remind yourself you are doing your best for the person.
Identifying any underlying cause / triggers:
- Are there any patterns/themes to the behaviour?
- What might be being triggered from strong emotional memories or previous experiences?
- Has the person got a physical problem that needs addressing?
- How is the person’s mood – low and upset?
- Has the person had a reaction to any medication?
- Has something someone said distressed the person?
- Is the person hot, cold, hungry, thirsty etc?
- Is the person in pain?
- Is the person’s cultural or ethnic needs being met?
When a person is angry and distressed there is no ‘correct’ way to respond and communicate with the person. It is useful to think of the following as a ‘toolkit’ of potential approaches which might help;
- Calm and clear messages about what you need the person to do.
- Use of validation to identify and connect with how the person is feeling eg ‘I can see you are upset’.
Use of distraction such as finding something for the person to focus on or walking or other forms of exercise.
He has a mixed diagnosis of Alzheimer’s Disease and Korsakoff’s Syndrome. He is taking Aricept medication. His nephew who lives 50 miles away is both his financial and welfare attorney and visits him every other month. He had concerns that Mr Bevan was not eating or managing his hygiene needs from observing he is losing weight and that there is little evidence when he visits of adequate personal care. Mr Bevan denies he is having any difficulties but his nephew has made the decision in his ‘Best Interests’ to organise for carers to visit to support him with these needs. Carers are visiting Mr Bevan each morning to provide a full English breakfast which he has always had as a main meal all his life, and as was his lifelong pattern, to encourage him to bath and change his clothes once a week. Mr Bevan is accepting of the breakfast call but is known to get angry when carers approach him to provide support with personal care tasks.
Task: 1. In your notebook write down any thoughts you might have about why Mr Bevan might be behaving in this way?
2. In your notebook write down any strategies which you think might be helpful?
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