Working with Alzheimer's residents takes a great deal of patience, understanding and compassion. It is not always easy to care for these special residents as they get agitated easily and may become angry and aggressive (Winston, 2010). Their moods change quickly, and caregivers need to adapt to each new situation. Knowing your residents and being able to anticipate their needs is so important. When you can anticipate, you will be able to diffuse a tense situation before it actually begins.
Behavior management begins with good communication skills. Good communication skills are the key to effective and safe practice. When a resident becomes agitated and starts to "act out," direct caregivers must learn to control the situation, keeping the environment safe for everyone in the area. Communication is difficult, at best. People with dementia have trouble with communication, and react with frustration and anger. The best way to manage agitation and anger is to prevent it. Learn to anticipate the residents' needs before they start to act out. Aggressive behavior is usually born from frustration. Alzheimer's residents are not able to verbalize their needs, hence the frustration.
Tips for good communication:
- Always approach from the front
- Identify yourself
- Use calm voice and relaxed body language
- Use simple words
Because dementia affects every part of the brain, as the disease progresses, residents will need more intense assistance. No one progresses at the same rate, and the most likely scenario in long term care would be that there are 20 residents, all in a different degree of dementia. Each resident will do some things that others would never do (Alvare, Fuzy, & Rymer, 2009). Learn to be aware of the "triggers" that set off residents. If you know that one resident will act out in a noisy environment, try to place the resident in a quiet place. Identifying triggers and the emotions that follow is the basis of cognitive-behavioral therapy. It is a strategy that will give you a way to think through difficult scenarios and help to find solutions (Atkins, 2008).
Some triggers to look for:
- What is happening around him/her at time of agitation?
- Is it too noisy? Too much stimulation?
- Hot? Cold?
- Scared? Confused? Tired? Frustrated with an activity?
- Was resident shouting? Cursing? Threatening with hands/fists?
- Tired? In pain? Bored?
- Has the person recently moved to new surroundings?
Be sure to document everything you observe about the shouting, agitation and any other behaviors including the date, time and what is actually happening at the moment. Be sure to share the information with your co-workers at a staff meeting or at the change of shift. This is important because of continuity of care. You and your co-workers can then look for ways to remove the causes and solve the problem.
Validation therapy is letting the resident believe they live in the past or in imaginary circumstances (Alvare, Fuzy & Rhymer, 2009). Validating is giving value to what the resident is living at that time. Keep in mind that arguing with a dementia resident is like arguing with a small child. You will never win.
Safe approaches must be used when dealing with agitated or angry residents. Never approach a dementia resident from behind. If you try to touch a dementia resident, and they do not see you, they become startled and will try to hit you. Good eye contact, while standing right in front of the resident is important. Talk to the resident quietly and calmly. If you remain calm, so does the resident. Please remember that if the resident is angry, it most likely is not because of you. Do not take what they say personally because the resident is most likely unaware of his/her words on you.
A quiet environment is essential to help reduce agitation. This also helps the resident hear and understand what is being said. Turn off the television and radio during meals so the residents are better able to focus on the food. If the resident does become agitated, try to remove the resident to a quiet area.
Remember to watch your body language when dealing with Alzheimer's/dementia residents. If you appear to be angry or threatening to the residents, they will act in kind. Do not cross your arms, or put your hands on your hips. Sometimes dementia residents cannot understand spoken words and depend on body language to try to understand.
Some of the common behaviors are:
- Getting undressed anywhere
- Stealing (rummaging)
- Resisting care
- Was the resident scolded, ignored or sedated?
- Recent change in medication?
- Recent changes in eating, drinking or toileting?
There is a difference in verbal and non-verbal communication. When talking to a resident, keep your voice calm and soothing. Always smile when talking to the resident. Tell the resident what you are going to do before you do it then proceed slowly. Use short sentences, call them by name and establish eye contact. Make the person feel important. Never argue with a dementia patient because you will not ever win. Arguing with these residents is like arguing with a toddler.
If the resident is pacing, try to figure out why he/she is pacing. Is the resident agitated or angry? Is the resident clenching his/her fists or grinding teeth? These are sure signs of agitation. If the area is noisy, try to assist the resident to a quiet place. If the resident refuses to move away, try to assist everyone else in the area away.
Wandering is done for a reason, even though we may not understand why. We must make sure that the person is safe while wandering. There are a few signs that wandering will begin: restlessness and disorientation (new). If you see these signs, redirect the resident if at all possible. Offer finger foods or an activity you know the resident likes. Know your resident, anticipate behaviors before they begin. If you are working in a home setting, be sure all doors are locked at night. If in a long-term care setting, frequent rounds must be made at night. Get rid of clutter in their rooms and turn on soothing music.
Rummaging or stealing is taking things that belong to someone else. The dementia resident may think the item belongs to him. Try to redirect the resident away from the area. If this is not possible, watch the resident carefully. Do not tell the family that the resident is "stealing" as this causes added stress (Alvare, Fuzy & Rhymer, 2009). Talk to the family about the behavior so they are prepared when they visit.