Difficult behaviour is not only aggressive behaviour, but all behaviour that is challenging for the caregiver because it requires increased strength, self-control and patience.
This may be due, for example, to a significant slowdown in the movements performed, resulting in a very long time for the elderly to perform each activity, which may initially be difficult for an energetic caregiver to accept. The reason for difficult behaviour in the ward may also be the long-term isolation of the elderly due to illness, which translates into the mental sphere, as such a person feels lonely and alienated.
Difficult behaviour is not only aggressive behaviour, but all behaviour that is challenging for the caregiver because it requires increased strength, self-control and patience. This may be due, for example, to a significant slowdown in the movements performed, resulting in a very long time for the elderly to perform each activity, which may initially be difficult for an energetic caregiver to accept. The reason for difficult behaviour in the ward may also be the long-term isolation of the elderly due to illness, which translates into the mental sphere, as such a person feels lonely and alienated. People with advanced dementia are often no longer able to respond adequately to circumstances, even during ordinary, everyday situations. Therefore, contact with people affected by dementia is perceived as not easy, even by close relatives. Many people with the disease scream and moan a lot because they can no longer express their ailments or pain in any other way. In addition, patients with dementia often openly show their dissatisfaction by insulting their loved ones. They can’t create a healthy distance from the world around them. For many people in the immediate environment of a senior with dementia, even this verbal aggression is overstepping their boundaries.
Non-verbal aggression of a ward goes far, if we are dealing with any of the following cases:
throwing objects
punching or kicking
biting or spitting
deliberate throwing away of meals
In such cases, it is of course very difficult for caregivers to react appropriately without losing their balance. In order to be able to respond professionally when you feel attacked, you should learn appropriate behavioural patterns that will help you with difficult behaviour:
Stay calm! – Especially in the case of physical attacks it is difficult not to lose control. However, under no circumstances should you imitate the behavior of a ward, and also attack (not) verbally!
Try to systematically look for reasons to understand the behavior of the subject: Why does he complain so much, whether the physical pain is unbearable? Is it a mental problem that’s causing these behaviors? Maybe deep down, the senior feels his life is coming to an end and there’s nothing good left for him? Maybe it’s causing bitterness? Think how you’d feel if you switched places for a moment. This is very hard to imagine, but it may at least make it a little easier to understand his attitude.
In what situations does a senior exhibit aggressive behavior? Maybe we can find a pattern? Which situations cause aggression and why?
What could be the reason for this behavior? Maybe pain, depression, isolation, feeling rejected?
How does the ward react to your attempts to calm him down? What makes him even more aggressive, and what calms him down? It is worth knowing these schemes to make your work easier.
Think of a way to calm the senior. Some people in need of care seek contact with caregivers – also physical and consciously provoke reactions from other people. If possible, distract the ward from anger, divert attention, change the subject, suggest, for example, going for a walk or to another room on some matter – a change of environment, even a temporary one, can distract from anger.
Get out of the situation! – If you feel overwhelmed by the situation, take a break. A necessary condition for briefly leaving the room until the senior calms down is self-defense of the caregiver. Have you removed all items from your reach that could hurt your ward during an angry attack? Can the patient be left alone for a few minutes, or is there a risk of falling/sliding out of the chair and getting injured during this time?
Don’t respond to insults and accusations! – You know that these statements do not concern you personally, but they are the result of dementia. Talking to an aggressive senior on the one hand could only unnecessarily aggravate the situation – nerves are not a good advisor. On the other hand, in most cases, the attempt to talk and make logical arguments during an attack of anger of a sick person is pointless, as the person is unable to accept the information.
Try to show empathy and compassion to the person in need of care! How would you feel if you were more and more dependent on other people? – Think about alternative ways of doing things that would make it easier for a person with dementia to understand you.
The causes of difficult, often aggressive behaviours, especially in dementia, can be of various types:
Changes in the brain caused by certain clinical pictures (e.g. loss of emotional capacity, biological changes, impaired conduction) – possible loss of control over one’s emotions and inability to interpret them
Mental instability (e.g. fear or depression caused by the awareness of impending death, worsening general condition, self-pity or jealousy of healthy people)
Loss of independence and related dependence on caregivers, relatives, specialists, doctors
Influence or interactions of different drugs, e.g. lowering the inhibited threshold of their reactions in people affected by the disease
Not very warmly treated by the caregiver, feeling of being a burden
Lack of sleep e.g. due to pain at night
Social isolation and lack of contact with other people
What actions are worth taking?
Get support if you can. At home, you’ll often be alone with your ward. However, do not be afraid to ask for help in situations that threaten to get out of control (e.g. when the person in need of care cannot calm down for a long time). If you already know that the person in need of care is behaving very difficult before starting work, we recommend talking to family members to determine who to call for help if the situation gets worse. This also applies to circumstances when you notice that you can no longer act confidently and professionally in a given situation and you are concerned about your safety.
Ask third parties (such as neighbors, friends) to leave the room during a ward rage. On the one hand, it serves to protect these people, and on the other, you protect the ward from other people’s reactions.
Make sure all dangerous items (e.g. cutlery, heavy items, glasses) are out of reach of the patient. This is the only way to prevent throwing them, breaking them, or even hurting yourself or others.
Stay calm! Try to approach an aggressive subject in a balanced way, addressing the person directly by name, with a confident voice asking simple, specific questions, showing understanding. Nervous movements and signs of stress can worry the elderly and increase their propensity to aggression. The senior needs to see that his attempts to throw you off balance are pointless, because you are a professional and know how to behave in such situations.
Once the situation is under control, try not to return to it when dealing with the senior if we know that there is no way to achieve understanding in the given field. However, such incidents must be discussed with loved ones and the senior’s doctor to prevent or reduce further incidents of this type.
How to behave when the situation gets worse?
spot signs of escalation and take them seriously
treat the person in need of care with respect
react calmly with composure
don’t speak too loudly – raising your voice will only make things worse
don’t talk too fast and chaotic
pay attention to the choice of words
avoid threatening gestures
distract the senior, try to occupy his mind with something else
avoid getting into discussions and power struggles
How to talk to a senior so as not to inflame the situation?
Do not oppose a person with dementia.
In your behaviors, reflect the needs and feelings that the senior communicates through language, facial expressions and gestures so that he knows you are there to help him, not fight him.
Communicate calmly, firmly and loudly enough to be understood.
Address the senior face-to-face while making eye contact.
Don’t overcomplicate your statements – long sentences that contain a lot of information may not be assimilated.
Support language communication with non-verbal elements (open posture, gestures, expressive facial expressions, change of pitch, friendly smile)
Respect and accept the behavior of a senior – your acceptance will help him accept his reality.
Try not to comment and try not to correct the behavior and expressions of the subject.
Give the senior time to communicate freely and independently take action at his own pace.
If you notice that the subject has lost the course of the conversation or can’t remember what they were supposed to do, don’t treat them in advance, just try to help them, steer them carefully, or ask them a few questions that will help guide them back to the conversation or the activity they are doing.
How to adapt an apartment to a ward with dementia or Alzheimer’s?
– remove the mats or attach them with an anti-slip tape – to protect the senior from falling
– remove potentially dangerous items (detergents, sharp or breakable items)
– hide medicines
– place pictures or inscriptions to facilitate orientation at home
– secure the entrance and balcony doors, so that the pupil cannot leave without our knowledge
– prepare meals regularly, best cut into small pieces
– buy a suitable cup with a tube to facilitate the consumption of liquids
Remember that the disease may occur in one person without a trace, while another undergoes a complete personal transformation. In addition to the above-mentioned reasons, behaviour is also determined by a person’s personality, upbringing and life experiences, which shaped his behaviour even before the onset of the disease.
