Some diseases or conditions in the later stages of our lives, unfortunately, have no permanent cure. If any of your loved ones are inflicted with these conditions, you can, at best, look to subdue the major symptoms, so that she can lead as natural and peaceful a life as possible.
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The conditions that lead to dementia, impair the nervous system or brain functions, and sadly, in the sunset years of their lives, the inflicted patients start to act like toddlers.
They throw tantrums and become agitated at the slightest of pretexts and generally are difficult to manage. It affects their own mental being and the mental state of their loved ones.
Over a period of time, it also affects the patient’s social life and the situation is further aggravated as the inflicted person becomes socially stigmatized and isolated.
Therefore, while some medical aspects of these diseases are not in our control (we can only pray that the medicines will find a way to cure or reduce the seriousness of the condition), proper management of the psychological aspects may reduce the pain significantly for the patient as also her loved ones.
What is Dementia?
Dementia is an umbrella term to collectively describe the symptoms that are generated from the gradual loss of cognitive functions – functions like recognizing people, remembering stuff, disorientation, that is, in general impairment of higher brain functions. It is often caused by diseases of the nervous system and disorders of the brain.
In medical terminology, dementia progresses through four stages –
- Stage 1: Mild cognitive Impairment [MCI] – general short term memory loss; widely prevalent in old age
- Stage 2: Mild dementia – characterized by difficulty in problem-solving, trouble to organize or expressing thoughts , drifting off, loss of recent memory & cognitive functions
- Stage 3: Moderate dementia – Characterized by confusion, agitated or angry behavior and disturbance in sleep; Gradual withdrawal from social activities
- Stage 4: Severe dementia – Loss of ability to communicate, and some lower-level brain functions like bladder or bowel control; Mostly bedridden lifestyle and constant assistance required for all daily activities such as eating, dressing, etc
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Some Unfortunate Facts About Dementia
If you do not know anybody suffering from dementia, I would say you are fortunate, because:
- There are over 50 million sufferers of dementia worldwide
- That makes for almost 1 in every 100 people in the world
- This condition mostly affects older people, so the percentages are much higher when compared to the most vulnerable population (10% of people above the age of 65 and almost 30% of people above the age of 85)
Common Symptoms of Dementia
The symptoms of dementia vary a lot from person to person and depend on the patient’s age, the condition that has led to dementia, her lifestyle and the level of mental activity that she indulges in. As a caregiver, you need to keep an eye out for both cognitive impairments and psychological impairments.
Some of the common cognitive failures include:
- Short or long term memory loss like difficulty remembering what she ate for lunch, repeatedly misplacing items
- Difficulty in focusing and incidents of drifting off, not being able to concentrate in an activity, not being able to follow instructions or plan an activity; lack of any initiative
- Difficulty in reasoning or communicating and not being able to find the right words; not being able to continue a conversation strain coherently
Some of the common psychological symptoms include:
- In an agitated mood for no apparent reason or on the slightest of pretexts
- Being sad for no apparent reason or depression in severe cases
- Anxiety may get aggravated to the level of paranoia
- Hallucinations or always being suspicious of other people
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What are the Medical Causes of Dementia?
The most common cause for dementia is Alzheimer’s Disease. It is a disease of the nervous system (brain), whereby, gradually the patient’s nervous system deteriorates.
The nerve cells and nerve connections degenerate with time and the size of the functional brain reduces. This leads to impairment of mental functions.
Some other causes of dementia are (not an exhaustive list):
- Vascular Dementia: Impairment of the vascular system which leads to damage of the blood vessels that carry oxygen and nutrient-rich blood to the brain. Lack of sufficient blood to the brain results in gradual nerve cell damage and consequent loss of cognitive functions
- Lewy body dementia, in which there is an abnormal deposition of protein – in the brain leading to problems with thinking skills and higher brain functions
- Traumatic brain injuries (picked up in accidents, falls, sporting activities), Parkinson’s disease and Huntington’s disease are some of the other common reasons for the onset of dementia.
Finally, once you, as a family member or a care giver, have identified a symptom that can make your loved one a candidate for dementia, you must immediately consult a physician for suggestions and the way forward.
How Can Care Givers Deal with Aggressive Behavior in Patients with Dementia?
First Step: Understand the Root Cause of Hyper-Ventilation
In order to respond effectively to a bout of aggressive behavior by a patient inflicted with dementia, you need to understand the triggers behind that behavior. The reasons behind aggressive behavior can be classified under physical, emotional or psychological triggers.
- Physical – If the episode is triggered by pain, soreness or any kind of discomfort
- Emotional – if the episode is triggered by acute sadness or feeling of being lonely
- Psychological – Confusion, hallucination or being needlessly suspicious of people may also cause sudden angry outbursts
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Your Possible Actions when Dealing with an Angry Dementia Patient
While sudden episodes of angry outbursts can be stressful and challenging for the care giver or family members of the patient, it is important to know how to best encounter them, so that the episodes reduce over time, both in number and duration.
- Stay calm and hear out the person: You should always bear in mind that angry behavior should not be met with force or abuse or overcoming the patient by use of strength. Come whatever may, you should never mirror that person’s actions. Hold your composure and always remember to disassociate the person from the behavior. That will aggravate the situation by making her more insecure. Instead, you should be calm and hear the person out. When you are calm, she will feel more reassured and secure.
- Give emotions precedence over facts: You may very well know that what the patient is saying may not be true, but you should never spell that out; Concentrate on her feelings and acknowledge them; Mirror her emotions and say a soothing word or two to reassure her. Try to validate the feelings by saying that it is all right for somebody to feel like this once in a while. This will go a long way in pacifying her and reduce tensions.
- Stress on Communication: Your loved one may not be able to articulate why she is feeling unsafe or why she is agitated. You should try and ask leading questions which will have simple answers and she will be able to answer them. There is no better alternative than if you can make her communicate. Having a normal conversation will have a soothing effect on her
- Focus on the Environment: Often a bout of agitation is caused by environmental factors like too much light, too much loud noises or new surroundings. If it is caused by new surroundings, like when you have shifted to a new place, take good care to make her surroundings as aligned as possible to the place where she was used to living. Other calming factors include dimming the lights, using noise cancellation headphones or playing soothing music (proven research exists that music helps to reduce such episodes). If you are hosting a house party or you have a lot of guests coming over to your place, ensure that you keep her as insulated from the bustle and din of the party / crowd.
- Ask about any physical discomfort: Bouts of anger are often triggered by physical discomfort. Always make it a point to offer different solutions to reduce any pain or soreness, like repositioning them on the bed, making them comfortable on another seat or cushion. You should also periodically check for any bruises, sores or injuries if your loved one is not able to alert you regarding them due to a disability.
- Show love and compassion: During these episodes, you will do well to focus on the person and not the behavior. As a family member, it is important that you keep reminding your loved one how much love and compassion you and your family members have for her. It will make her feel a part of the family and give her a sense of belonging.
- Redirecting attention or distraction: Distracting from the cause of agitation or helping the patient to refocus on something else often proves to be a worthwhile attempt at reducing tensions. Try to get the patient to focus on a happy thought or a recent happy experience. This will inevitably reduce the intensity of the outbreak and give you the scope to communicate further.
Medicine
Medicine should be the fallback of last resort for you. Having said that, if your loved one is regularly experiencing bouts of violent anger, you need to have the necessary medication handy so that you can administer it as a preventive step or a reactive step to calm her down. You should always consult her physician for the commercially available medication and associated doses.
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Long Term Solution through Changes in Life Style
- Reducing alcohol use (abuse) and smoking: Smoking and alcohol use aggravates diseases of the vascular system and reducing these will help you control the symptoms of dementia
- Diabetes: Controlling your diabetes goes a long way in reducing the pace of degeneration of the nervous system
- Diet to Reduce Cholesterol Levels: High cholesterol levels also often inhibit your blood vascular system and having a healthy diet will improve your chances of staving off severe dementia
- Higher Brain Activity: Take care to engage your patient with as much brain activity as possible, which will help to improve and stabilize higher brain functions
Here we have a Youtube video that shows some caregiving tips for dementia patients.
Conclusion
Over a period of time you should learn the common triggers of combative behavior and build a routine that eliminates the patient’s stressful interactions with her environment.
Research supports the view that patients with dementia can remember feelings or emotions – a feeling of happiness recently felt, compassion and love recently shared.
They may not remember the incident, but the experience will leave an impression of that hue, on their brain. Therefore, as a family member or a care giver of the patient, you have your responsibility cut out.
Show enough love and compassion so that your loved one feels at ease, feels secure and happy. That is more than half the battle won.