Aggressive Behavior in People with Dementia | Linda Ercoli, PhD | UCLAMDChat

good morning my name is Linda Erica Lee and I'm a geriatric psychologist and a neuropsychologist at the UCLA Semel Institute and I'm here today to talk to you about managing aggressive behaviors in people with dementia and just to let you know that you can ask questions on twitter using hashtag pound sign UCLA md chat so tweeting your questions and we'll answer them on air for you so today I'm going to talk about a number of topics that have to do with aggression how to manage it and a little bit about some of the other consequences associated with this very difficult problem that caregivers of patients with dementia contend with quite a bit so let's talk a little bit about terminology the first is aggression and agitation now these two terms are used interchangeably but they're not quite the same agitation really is a generic term and it refers to both non aggressive verbal and physical behavioral problems such as when a patient is confused they may get worked up or pace but it also does include behavioral problems that and verbal problems that are aggressive okay so aggressive behavior means actual hostility either verbal or physical that is directed towards the self or other people so on the verbal end you have threatening and swearing yelling you also have things like sex talk or obscene language okay so inappropriate sex sexual talk is considered aggression but then you have more physical types of aggression like spitting hitting kicking throwing things pushing could be use of a weapon against another person or the self and of course self-harm is a form of aggression and then there is this area called catastrophic reactions where somebody with dementia may overreact as a result of maybe asking them a question or a minor setback or criticism I want to clarify though that just because somebody is is crying out for help or pacing and wandering that's not aggression now aggression is is pretty common in dementia the bottom line is about 96% it occurs at about the prevalence rate of 96% during the course of the dementia so this means that if you're a caregiver you're likely to contend with some form of aggression during the course of your taking care of someone now it occurs roughly 20 to 50 percent of people but it can be as high as 96 percent so the bottom line is if you're a caregiver you can expect that you're going to deal with some type of aggressive behavior as the dementia progresses now one study has shown though that within about the first year of diagnosis almost 16% of people who are being cared for with dementia might act violently towards the caregiver okay now aggression works both ways so sometimes about 5% or so of the caregivers in that first year we're aggressive towards the patient and then in about 4% of cases within that first year of diagnosis it was mutually aggressive so aggression happens both ways and sometimes when the patient is aggressive a loved one can return that behavior and react in an aggressive way and then it becomes mutual now people might want to know well does agitation or aggression when does it happen and does it matter what kind of dementia might my loved one have and really the answer is it varies um think about somebody with Alzheimer's disease it tends to occur in the more moderate stages okay as the severity of the dementia gets worse but in diseases like frontal temporal dementia which often present with a personality change or a behavior change early on that tends then to happen more earlier in that type of dementia in people with Lewy body dementia it can happen during sleep and this is a completely type form of aggression that's not intentional in any way not that aggression is but this type of aggression happens during REM sleep where people with Lewy body dementia often have what we call a REM sleep behavioral disorder where they act out their dreams and these dreams are often violent in nature or very vivid and so the person may be acting to defend themselves in the dream and this can result in physical behavior like fighting kicking and punching the person who's acting out those dreams has no awareness that this is going on they have no even not even a memory for the events and sometimes forms of aggression verbal aggression personality changes can happen before dementia onset is is actually identified and diagnosed so sometimes retrospectively people notice that their loved one is more irritable they might be more verbally aggressive or abusive and once a person is diagnosed looking back they'll say oh you know what I know this this person was different even before they were diagnosed with Alzheimer's disease now the consequences of aggression is one reason why we're having this talk first of all it's harmful obviously it can result in danger or harm to the patient or to the caregiver or other people that are interacting or around the patient but it's also obsessing to the patient patients who are aggressive aren't happy right and it's a major source of caregiver stress so it adds to the burden that caregivers have just already have when they care for someone with dementia aggressive behaviors can be difficult to control and they definitely result in premature nursing home placement according to studies and a lot of nursing homes or long-term care facilities either won't accept someone with dementia or they won't keep somebody there who has dementia and therefore this can result in very negative consequences including restraints either physical or what you call chemical meaning that somebody is medicated to calm them down now the causes of aggressive two-hit behavior are really multi-dimensional the first thing to know is it's the disease okay it's not something that's intentional it's not something that's meant personally but it is definitely the disease process and a few reasons why this happens first has to do with what parts of the brain are affected by dementia so a number of studies show the frontal lobes of the brain which are important for managing behavior like filtering your behavior inhibiting behavior that's not appropriate being able to have judgment being able to foresee consequences of your actions these parts of the brain are affected in dementia and so people lose those abilities to kind of hold back and judge their own behavior in a situation other parts of the brain too though are affected like other cortical regions like the anterior temporal lobes the parietal lobes and even areas underneath the cortex such as the caudate nucleus can be sites of what we call lesions or abnormalities in the brain there are also changes in neurotransmitters and in hormones that may affect whether somebody behaves or has a propensity to behave aggressively and again we talked about the cognitive deterioration especially these functions that are controlled by the frontal lobes like judgment now there are other causes when you think about that the dementia itself has a has sets up a vulnerability for these kinds of aggressive behaviors now we have on top of it a few categories of things for you to think about that add to this and might trigger or essentially release or set the stage for these disinhibited behaviors to occur so one includes difficulties with communication so when someone has dementia they have really language problems this includes difficulties understanding behavior difficulties communicating their feelings and their thoughts and they're not necessarily able to formulate a concept about what's going on around them so somebody with dementia can't tell you I'm upset I don't understand what you're trying to say to me so they may act out behaviorally with their frustrations and their confusion so usually if there's some kind of agitation going on it's helpful to think about it as somebody is having a communication problem they're trying to tell you something and you have to be a detective and figure out what it is then there are internal factors that means what's going on inside the patient and this could be anything from psychological factors like they're feeling fear or anxiety or it could be biological factors like they have an infection so you often see urinary tract infections causing a delirium which in turn in return is confusion and agitation and people can lash out aggressively sometimes medicines and definitely alcohol can unleash these kinds of behaviors and finally there's the environment so what's going on around the patient and it can be anything from who's in the room what your behaviors are as the caregiver what's going on on the television set what's the temperature like all these things that perhaps are bothering the patient and they cannot communicate you with with going on they don't understand what's going on they may act out and lash out so let's look a little bit more closely at at these types of problems so this is a good way to think about it it's usually some somewhere among these three or all three in combination with each other so usually what we call something that sparks or releases or causes a behavior to manifest is called a trigger and you can see from this chart that there is a lot of different things that can trigger a behavior so we talked about those three major categories but let's let's split a few hairs here and look more closely so if you have somebody who's acting out you might want to be well you should be thinking about any of these possibilities so one is somebody again has psychological factors depression fear anxiety they're not able to communicate they're frustrated so they can't do a task a task that they used to do or a task that you're asking them to do it's too complicated or they don't understand it they could be in a new surrounding a place where they've not been before or the place where they are doesn't seem familiar to them anymore could be loud noises in the environment like chaos people coming and going violent shows on TV because people with dementia have a difficult time separating what's real from what's not real and physical discomfort so pain hunger thirst and again we talked about biological factors like delirium and other illnesses infection so again if somebody has depression or mania if they have anger if they're frustrated these can be considered triggers more along the psychological spectrum of aggressive behavior paranoia and suspiciousness so delusions can trigger aggressive behavior so here are some examples and if your caregiver you may have heard these before like my daughter is trying to poison me my daughter is trying to put me away my husband is cheating on me and particularly these delusions about a cheating spouse can engender aggression in in a patient sometimes towards the spouse and sometimes towards the person they think is cheating on them with the spouse also prior personality and behavior so if you have a person who has loved one who has a tendency to have been aggressive or very reactive in the past this can be a behavior that is more easily manifested once dementia sets in again if you think about it it's the frontal lobe functions that a person doesn't disinhibitor so think about when you're driving on the road and you get road rage you might be very angry at someone but you're not necessarily going to run them down with your car at least we hope not somebody with dementia wouldn't be able to really inhibit that behavior so what they're thinking they may act out even though normally before dementia they would not do such a thing or maybe they had a tendency to do it but now it just comes out much more easily so what you do in these situations is you try to treat the underlying psychiatric problem if somebody has depression or mania you would want to treat it and again if if you are interacting with someone maybe you're giving them too complicated of instructions you're asking them to do things that they can no longer do you want to change your communication style and rethink how you're interacting and what you're asking that person to do environmental factors include again what's going on around the patient so anything things that you may not think about and simply go and turn down the thermostat a patient who can't do that might get testy or edgy if it's too hot or too cold important is the attitude of the caregiver so even though patients may not be able to communicate well they can pick up on emotions so if you're angry you're stressed if you're impatient if you're rushing someone this can help trigger aggressive types of responses and reactions in someone now in in long-term care facilities nursing homes roommates can trigger aggression in somebody because let's say somebody is yelling and screaming in the bed next door or somebody wanders into another person's room by accident this can trigger an aggressive response taking somebody on vacation sounds like fun but this can cause confusion in a loved one and sometimes it results in someone acting out and lashing out and finally changes in personnel like having a lot of turnover of caregivers can result in these types of lashing out behaviors they don't know who they are remember it takes a long time to learn and get to know someone and they cannot they cannot even sometimes recognize them from time to time so changes and caregivers can be a source of lashing out and aggression so in these cases if it's you and your attitude you try to change your behavior and try to ingest them adjust the environment now what about the medical or biological triggers so we talked about delirium pain is another factor it definitely can result in people being cranky irritable and acting aggressively believe it or not constipation has come up in the number of studies as a as a source of potential acting out of aggressive behaviors because it's painful because people are in comfortable and remember they can't tell you and they may not understand that this is what's going on with them so some medications and medication interactions for example drugs like benzodiazepines so drugs like a divan and Valium and drugs in that family of medications can dis inhibit patients some medications that increase dopamine can cause aggression in patients that take those medications like patients with Parkinson's disease definitely alcohol intoxication so if somebody is intoxicated and they have dementia they definitely can act aggressively and it also even if they're not you know floridly drunk alcohol can cause disinhibition and finally we talked about those REM sleep behavior disorders so what do you do in these cases is you treat the underlying medical condition and you definitely would if your if your loved one is showing these changes talk to your doctor perhaps they need a medication reconciliation they need a review and definitely eliminate alcohol from their diet their recreation and their relaxation now what about the caregiver as a trigger of aggression well sometimes it's what you do and sometimes it has nothing to do with what you do one of the things that happens in dementia is that patients tend to not recognize who they're relating to they may not recognize a caregiver they may not even recognize their own adult child so that person can be perceived as a stranger and so they may act defensively they might perceive just being cared for as a threat so giving medications especially if someone is delusional or they think they're being controlled that might be a way that the caregiver would trigger aggression definitely we talked about the caregivers attitude before but let's revisit that confrontational punishing impatient and critical attitudes from the caregiver to the patient is not a winner it's going to create this type of aggressive response so definitely you know you have to think about ok I'm angry I'm not happy but when you're with the patient try to remember that you're dealing with someone who can't control their behavior it's not personal and whatever you do don't confront and escalate a situation and sometimes the caregiver can just react and that reactiveness to an inappropriate to hate behavior sometimes is is what keeps a behavior going so this happens in patients who are sometimes sexually inappropriate so they may expose themselves to someone and actually the shocked reaction on someone's face can can actually reinforce that behavior there are a common excuse me a common reason for this aggression and animosity between the caregiver and and the patient can be just unresolved biases or issues between the caregiver and the patient from the past so perhaps you've had a contentious relationship with the person that you're taking care of and sometimes this plays out even in the caregiver care recipient relationship the sex of the caregiver is an issue especially in the cases of inappropriate sexual behavior sometimes you're better off with the same-sex caregiver especially if you have a male patient who is acting inappropriately towards a female caregiver it could also be sometimes people feel during bathing they become very private they feel like any of us would modesty is an issue and so having a caregiver of the same sex sometimes doesn't work especially for men but sometimes having a giver of the opposite sex again doesn't work for both men and women so that's a trial and error situation and sometimes it's just a specific person has nothing to do with the behavior of that person but that that individual may remind them of someone that they've had a contentious relationship with before so in this case again adjust your behavior or your attitude and you might have to consider a change in personnel so let's go over some specific do's and don'ts now you have your general your general framework for thinking about what can trigger aggressive behavior so we're talked about communication we talked about internal factors and external or environmental factors now let's go into some specific do's and don'ts so think about what keeps an aggressive behavior going that's called a reinforcer and this can happen this can be completely inadvertent on your part or even unexpected but a patient gets a desired outcome and that outcome keeps that behavior going it's like a reward so avoiding something that somebody doesn't want to do like taking a medication or getting a bath coming out of one's room by chasing someone away or acting aggressively they don't get the medication then the patient learns that that's that's a behavior that will bring about that desired outcome again people can want attention so let's say you're ignoring somebody or a caregiver you know again unintentionally is ignoring someone all right this isn't this isn't about blame or doing wrong but things happen you're busy doing something else the person feels ignored and they may yell or say something or act inappropriately it gets your attention so that's a desired outcome and we talked about caregivers reactions you usually being calm is definitely a good response or reaction even leaving the room if you need to but not looking too too perturbed not escalating a situation by confrontation so again the object here is try to figure out what's keeping that behavior going and try to eliminate it let's talk about communication so do communicate people who can't express themselves verbally or understand what's going on might lash out so let's take the scenario Jorge refuses to follow instructions so you might think oh well he's just being difficult and he might yell he might have a tantrum he might throw something first of all can the patient understand speech so is his level of dementia so severe that he cannot understand what you're saying or you're talking too fast and he can't catch it does he speak a different language does he have vision or hearing problems so definitely hearing problems people miss a lot of information and it causes frustration this is this is true even than someone who doesn't have dementia it's even worse than someone who has dementia and the memory problem so you want to enhance communication so always identify who you are and why you are there don't assume that that person knows that don't assume that somebody remembers you be calm and soothing when you approach someone and try to be out there I level they make eye contact with people and listen and be reassuring and that can include some reassuring touch all right a gentle touch on the shoulder provided again that if that person does not accept that then you wouldn't want to try that again pay attention to what your body language and your facial expressions are saying and ask about specific wants or needs so do not say what do you want lunch today what do you want for lunch today but do you want a sandwich do you want a chicken sandwich or a ham sandwich so would you like a glass of water so this avoids the frustration of somebody having to make a decision and feel overwhelmed by that and then again keep communication in general just short and simple one-step commands and tell people what you're going to do next here's a don't don't be insensitive again this may not be what you are trying to do but it it will come off that way to the patient so here's a scenario your mother yells at you I did not when you say to her I already told you where we are going today 10 minutes ago sound familiar so what could be going on there well be mindful of people's dignity people are feeling criticized that could bring out a lashing out type of behavior don't remind somebody that they have a memory problem and don't test their memory by virtue of somebody having a memory problem they can't remember that they already asked you a question so even though you know they've already asked you 5 times in 10 minutes every time to them is the first time don't say I already told you that and a good rule of thumb is try to use honey instead of vinegar so if if your mother asks you gee where are we going today at 10 o'clock it's a good idea to have a big calendar in in your main room or even a calendar that you give someone every day and you can refer them to the calendar and see so you look at the calendar there's your schedule for today and that's a that's a good way for you to to feel like okay I can you know I can cope with this I can deal with this frustration I'll just refer them to their calendar the wrong approach can lead to catastrophic reactions so here's here's another example so bill is seated at a table and the caregiver approaches that patient from behind and puts a puzzle in front of him and he Street screams like get out of my house and he throws the puzzle across the room again the caregiver intentionally do something wrong not at all but it's how the patient is approached that is important here so try to approach somebody from the front give a greeting make eye contact and tell the patient what you're going to do and what you have so saying hi Bill from the front and giving him a puzzle say let's play with a puzzle or let's do a puzzle together would tend to avoid that type of a catastrophic reaction and we've talked already about don't confront but essentially somebody with dementia they can't reflect on their unacceptable behavior and it's not something that they're doing on purpose and it's very difficult to control for them if they can control it at all so try not to confront somebody and whatever you do don't initiate physical contact during an outburst because that's going to escalate it and think about safety first so first and foremost remove guns and other weapons from the home and that includes making sure that you don't have bullets etc in the home always leave a situation if necessary do not get into a contest with someone lock up sharp objects and lock up medications too because people can take medications to harm themselves and they can take medic they can take sharp objects and use them against themselves or you or another person here's a great do distraction is your friend it's a great tool to use for most kinds of behavior problems and that includes aggressive behavior so give somebody something to do boredom is not a good thing so exercise and expend energy because people can get pent-up energy and then they can become agitated and they can become aggressive so adult day care is a good option for people where they they go for several hours during the day to a center they play they have activities they have lunch and when they come home they're tired it's a good thing okay and give someone a daily schedule something for them to look forward to because when an individual has a memory problem it's like being it's like putting a paper sack over someone's head and dropping them in an unfamiliar space they don't know where they are they don't know what's happening they don't know what's coming up and so having a structured type of schedule that people eventually can learn and look forward to like lunch at a certain time a walk at a certain time of the day bed usually at a certain time is is very helpful in avoiding these kinds of agitating aggressive types of behaviors and distraction involves things like just simply change the subject put on Pleasant soft music offer a snack talk about the past and things that people know so this might mean getting out of photo album and go for a walk is a great way to distract someone so chill out that's a that's something to think about here's the case mrs. Smith yells at you when you come to give her medication she does more than yell she throws it in your face what can you do in those situations give her a timeout give her give her a chance for you to chill out and for her to chill out and come back in a few minutes and try again but have a different approach another way is again you can try to ignore behavior so if somebody swears at you try to ignore it and see what happens immediately looking shocked could reinforce that swearing so see if ignoring it works and try to address with someone is feeling and reassure them so it's it's very natural for people to focus on the behavior but really the communication is with somebody who has dementia is on a feeling level so try to reassure them say I can see that you're scared don't worry I'm here to help you and again don't take it personally and this is a hard situation that a lot of people run into their mother screams at them and says you're the worst daughter in the world it does hurt but those behaviors are not personal try to keep your cool don't punish the patient and in these situations may be a good way to cope would be you know to really think about the emotional burden of dealing with this give yourself some slack and say you know what I know I can't this behavior I can't get rid of it but I have to tell tell yourself you know this is part of the disease this isn't a vendetta against you and again we're only human and we tend to go there sometimes but that's not what's going on here and then you can devise specific plans to really focus in on ok how do I know really what's what the triggers are because that can be tough to figure it out you know you know in general the universe of triggers but which one is operating in this situation so we you can develop a behavioral modification kind of strategy based on trying to identify these triggers like what's happening right before the behavior what's the situation in which it's occurring who are the players who's there when does it happen because that matters sometimes time of day and what happens right after that behavior the idea here though is not to expect that you're going to completely eliminate a behavior if it were only that easy but it's not the goal here would be to try to reduce a behavior or avoid the circumstances in which it occurs so once you can figure out these triggers then you can develop the plan to intervene and you can simply make up a nice behavior log like this for yourself where here's the behavior so in this case he would say dad threw through his glass of water at me well what happened right before that all right who's involved when does it happen these this and you fill in the blanks and over a few days or a week a pattern should occur or emerge and it's from doing this every time that behavior happens that you can learn what the triggers are and you can learn what might be a possible way to reduce that behavior or manage it so let's try this one your loved one says get the hell out of here when you intent to give a medication and they throw the glass of water at you so what could be happening well what happened right before you walked into the room and said time for your medication it's like why should that make anybody angry right but this is pretty this is true well what happened right after that person yelled at you well you got offended you look maybe angry and you yelled back come on dad you know you do this to me every time and again that might work in somebody who's not demented but this is a different situation and this can escalate the situation so try to develop a plan you might want to approach somebody a little more calmly and quietly and maybe have a letter even a letter that's a phony letter from the doctor saying hey dr. Williams your cardiologist want you to take this medication to keep your heart healthy so sometimes a little a little white lie like that can really help in getting somebody to go along with you if that person though becomes aggressive go away and try again right you might need to revise the plan you might need to just give medications and applesauce is it could be just swallowing the pill is what's hard for the person and and having it in applesauce might help so you have to be a little bit again of a detective to figure this out now I'm going to talk about two situations where aggression is really common and one is during personal care so especially centering around private matters like bathing and toileting always think about these are this is about dignity and modesty it can be about seeing less of a need for bathing uncomfortable with help and perceiving it as a threat a bathroom being a scary place full of echoes and let's face it it's not the most warm and fuzzy room in the house and somebody being afraid of slipping or falling so one of the things you can do is watch your language and I'm not talking about bad words I'm talking about the word take a bath that alone can set some people off so might want to use a word like let's get clean try to think about a reward like hey after after your spa treatment let's go get a snack let's take a walk make the bathroom a nicer place with scents and candles flameless candles but very importantly is modesty so cover the person up with the towel they may not want to be seen completely unclosed in front of you I mean if you put yourself in their place think about that right and have them help as much as possible because people like to be as autonomous as possible have them redirect the showerhead have them scrub if they can do it let them do it but definitely allow more time so you might take 10 or 15 minutes to take the shower it's probably going to take 40 minutes with your loved one and make sure there's proper a safety equipment and if the morning doesn't work try a shower in the afternoon and remember that you don't have to give someone a shower every day two or three times a week with sponge baths in between is sufficient inappropriate sexual behavior is another problem that people encounter that can be considered aggressive and it definitely can happen depending on the prevalence it's not well studied but up to 30% depending on the study and it's definitely higher in institutionalized settings it's more common in men than in women and it's definitely a higher rate of occurrence in younger men who are more medically healthy and these behaviors can be masturbation in public it can be sex talk or obscene language unwanted advances and of course inappropriate touching and it can be implied acts and that really is just reading something like pornography in public asking for unnecessary genital care so those can be forms inappropriate sexual behavior it makes people very uncomfortable and if you're a caregiver and you feel uncomfortable about this so we'll a paid caregiver especially to everybody interprets this differently especially if you yourself have to have a history of sexual abuse or trauma it's going to be hard for you to deal with it's hard for anybody to deal with again this is a part of the disease it's part of the brain dysfunction it's also can be related to loss like if people have lost a sexual partner they could be under stimulated in other words member boredom not a good thing and they might miss it misinterpret cues so if a caregiver are bending down in front of someone they might think well this is an invitation but it's not but they misinterpret that and you know they may have had a history of inappropriate sex or high sexual activity when they're younger and their their behavior now they're more disinhibited and definitely make sure that this is not about alcohol and have a medications checked it's not an easy behavior to manage but think about keeping people busy so a redirection again is your friend increasing socialization using same-sex caregivers and remember some is depressed you want to treat these underlying illnesses it's very difficult to say I think so-and-so should have a sex partner because this right raises ethical issues because both partners you know have to have the capacity to consent to sex right and STDs or sexually transmitted diseases is not just an issue for the young it's also an issue for the old so safety becomes an issue I briefly want to touch on suicide and homicide because it happens and this is not an easy thing for people to think about or talk about but we really need to go there so let's first talk about suicidal thoughts risks and attempts in the patient it's not well studied there aren't a lot of controlled studies or very good rigorously scientifically studied studies out there on this but the prevalence of suicide attempts depending on the study you read can go from five to about 12% certainly people with suicidal ideation can or suicidal ideation can be expected in people with a new diagnosis who are in the early stage of dementia nevertheless it should be taken seriously and if somebody is having these thoughts they should be encouraged to talk about it and and really talk to the person's doctor definitely if somebody has a plan and a time where they want to do it this means it's even more serious so those are to be taken seriously suicidal ideation might get might become more linked to changes in judgment and frontal lobe dysfunction as dementia progresses and it seems according to one study that people at highest risk for it would be men highly educated and professional who have depressive symptoms that come on after they've been given the diagnosis but they may be insightful nevertheless and they have suicidal thoughts but again it's not limited to this population but this is a profile of someone who tends to be at high risk and one thing that people who have suicidal attempts have in common is that they may be delusional so especially delusions associated with a spouse cheating and people will try to take their life in many different ways but self poisoning overdosing etc is common and followed by hanging and drowning homicide is when someone of course takes the life of another person very few studies on this homicide by patients is uncommon but generally the risk factors for violence in patients include frontal lobe lesions a pre-existing history of aggression catastrophic reactions and alcohol abuse caregivers on the other hand they also can be worried about if they are going to become violent and about 20% of caregivers do live in fear that they'll become violent according to the National Center for elder abuse now will they become homicidal well it does again it happens murder suicides are rare but in those cases usually the caregiver is the perpetrator and these are caregivers who are depressed they're isolated they may be feeling like they want to end the suffering for the patient and for themselves suicide family carers excuse me may be at high risk for suicide themselves and there was a survey of about 560 566 family caregivers and about 16 to 26 percent contemplated suicide in the previous year about 30 percent said they would try it in the future and about 50 percent only actually talked about it with somebody else and again you have depression poor cope ability few less confidence that you can reach out and get help these are risk factors for this so what do you do is you know definitely get help you can you can contact the the Alzheimer's Association has a hotline you can contact Adult Protective Services if you're if you fear for yourself or you fear of hurting someone else definitely go to a support group although I would not suggest you go there in an emergency if you're suicidal if it's an emergency you go to an ER room you call a hotline think about getting psychotherapy for yourself and if your patient love doing this aggressive talk to their doctor if there is a child in the house this is this this is a potential if violence has been acted out towards the child then this becomes a Child Protective Services issue if violence has been put against you and you're over 65 then you are the victim and it's an Adult Protective Services issue I'm not going to say much about medications except that they are the last resort for when for aggression and sexually inappropriate behavior it doesn't always work and it might make things worse in some cases but if somebody is not eating due to severe depression they're injurious it could be an emergency consider though the risks versus benefits you want to use the lowest dose that works and you start out really low on your dose and you go up very slowly there are side effects and the idea is if somebody goes on one of these meds it's to wean them off after a while and just about any many what drug classes are used to treat aggression so anxiety can be for agitation and resistance often antipsychotics are used for when people are delusional anti prescence for compulsive behaviors and for underlying depression but again these are not the first resort and it comes with a lot of ethical considerations to use drugs so talk to your doctor and again this is where you can get help when do you get how high more they want to do it this means it's even more serious so those are to be taken seriously suicidal ideation might get might become more linked to changes in judgment and frontal lobe dysfunction as dementia progresses and it seems according to one help and so these are the various resources on the right for talking to get help again suicide hotlines your doctor and at some point please go to a cari group of support group because there you will learn the skills for dealing with these kinds of behaviors and will reduce depression these are great resources in general if you have a loved one that you're caring for with dementia and the Alzheimer's Association even if even if your patient or your loved one doesn't have Alzheimer's caregiver support groups we have videos here at UCLA that we developed and you don't have to be a patient to aura or a patient at UCLA to watch them they're available online at dementia dot UCLA health.org so this webinar will be up there on demand we have other webinars that have to do with caring for patients there and there are great resources like the 36-hour day is sort of the the go-to book for dealing with people with dementia and for caregiver stress and another is learning to speak Alzheimer's but really if you go on the internet you go to Amazon or some other source you can find a lot of different books there this is a sample of what our behavior behavioral management videos look like and again you'll see about six or seven of them on on the Internet help you deal with specific problems and the UCLA Alzheimer's and dementia care program again visit us online you don't have to be a patient there's lots of great information there for everyone so you can ask Twitter questions on Twitter now and I'll take questions let me take that Thanks all righty how is aggressive behavior extrapolated over a culturally diverse population well that's an excellent question first of all I want to say there aren't a lot of studies on it because there aren't a lot of studies on aggression but I think you have to think about how is how is aggression expressed in a culture and that's that's one way to think about it the other is what about the individual so you're always looking at the individual what were the individuals tendencies before they before they had dementia what are the what are the health issues that they're dealing with so some of those basic those basic factors stay the same but what would change would be the individuals experience their prior behavior and of course communication because I think this is important when you're dealing with people communicating from different cultures this adds another parameter of of complexity to the situation is are they understanding each other and are they speaking the same language both linguistically and culturally other things to be thinking about is whether is the relationship between men and women in the culture what is what is the the perception of being touched in the culture how do people feel about close proximity in the culture right so these are things to think about some cultures are very you know are very close when they speak to each other other cultures stand farther apart cultures have different feelings about being cared for about the same sex versus the opposite sex the role and the proprioceptors in the room with someone so I think all of these things would be culture specific considerations next question is a common for dementia patients with english-as-a-second-language to digress back to their first language yes it is but remember that language in general deteriorates in dementia so usually the more recently acquired language deteriorates first but people can also deteriorate in their native language our mind-body approaches usually useful for people suffering from dementia we've had more up more research on this lately it's not well researched but the answer is it can be helpful deep breathing relaxation techniques even some evidence that aromatherapy can be helpful in the person with dementia now it doesn't mean that they understand that they are using a mind-body approach right but you helping them engage in one could be helpful whether they can actually meditate that's really debatable but they can take advantage of relaxing environments sometimes sensory stimulation rooms things like that can be very helpful okay so those are the ends of the question at the end of the questions and I want to thank everybody for tuning in thank you very much you

Channel: UCLA Health

Views: 364,923

Keywords: Linda Ercoli PhD, UCLA Alzheimer's and Dementia Care Program, patients with advancing dementia, advancing dementia, reducing and managing aggression., Dementia Care, Dementia, Alzheimer's Disease, Caregivers

Id: EdkhpGMD9nU

Length: 55min 22sec (3322 seconds)

Published: Wed Mar 02 2016