Any tips on preventing self harming please?

[Ann Mac]

I just wondered if anyone has faced this, and can offer any tips for dealing with it, please.

Mil moved into an EMI Nursing home just over two weeks ago and (very early days, I know) can't really be said to have settled. Those of you who have perhaps read the So Bizarre thread, know that challenging behaviour has been a feature of Mils awful dementia journey, and that its got worse as time has gone on. Verbal aggressiveness has been there for a long time, and it was because that developed into her becomming physically aggressive that we had to finally give in and agree to residential care for her. She had been in an asessment unit in the local hospital since April, and in the last couple of months, there have been an increasing number of instances of her slapping, hitting, pushing and throwing things at other patients and staff there. She has occasionally managed to injure herself in the past, usually bruising and skin tears from banging at doors and windows - but the injuries have been accidental, she hasn't set out to hurt herself.

In the last week, however, she has started to dig her nails in and gouge at her arms, resulting in some really nasty bruises and some deep skin tears. I've spoken to the staff - they are very aware of this, are monitoring it and have told us that she is very deliberately doing this to herself 'in temper', usually whilst sundowning (which has worsened in terms of it lasting for longer periods snce she has been there) and wanting to go home. When she has been agitated when we have visited, the staff are really quick to intervene and try and distract her, to be fair, they are very on the ball - but she is very resisitant to any sort of distraction - she always has been. Dressings are removed by Mil pretty much as soon as they are put on, and long sleeves don't seem to have any effect - she is digging her nails in so hard that she is still managing to break the skin even through material. The last couple of times she has done it, she had (again, very deliberately) re-opened 2 really bad tears on her left arm, making them bigger and deeper each time. She has also made several comments about how she wants to die and how she would like to kill herself - and again, this is new behaviour since she has been in the home.

We are hoping that she will settle and that this behaviour will eventually stop - but in the meantime, there is a big worry about infection, particularly as she is diabetic. We visited yesterday and her left arm was just a mess - crusted blood and the wounds have obviously been deepened and enlarged since Wednesday, when I had seen her last.

Has anyone encountered this and can they please offer any suggestions or advice about how to best deal with it?. The staff tell us that if they try asking her stop, she is stubborn enough to just do it all the more - and as I said, long sleeves and dressings have not worked.

Thanks xxxx

 

[RedLou]

This may be a silly idea Ann but it might be worth trying -- I have tops for yoga which have a thumb hole. You actually can pull them up and over the thumb and roll them back but seeing as MiL is unlikely to have come across this arrangement before she might not figure out how to do it. (Possibly. I know how she defies expectations!) Might be worth getting one to start with?? If she had dressings and then the thumb-top over them, might be enough? Places like H&M and Mango do do them, rather than just rip-off speciality shops. *hug*

 

[onlyme1]

how about making sure her nails are kept short and clean. x

 

[BR_ANA]

It is weird that she doesn't stop by pain. Maybe it worth a chat with her GP.

 

[Bod]

Whats she like when you are not visiting?
As you say 2 weeks is not long, maybe you not visiting for a month, may give her time to start to settle.

Other than that, boxing gloves! I do believe adult anti-scratch mitts are available.


Bod

 

[Ann Mac]

Thanks everyone,

Red, I actually read your reply on my phone as we were on our way out shopping yesterday - I went into a couple of sports shops, and couldn't find any - but intend to try the local H&M as soon as I can - thanks

Her nails are short, Lemony - the staff at the home give her regular 'manicures' so they can keep them filed short and dispence with any possible jaggy edges, to try and minimise the chances of injury - she is still managing to do a lot of damage

The tears/gouges look really sore, Branna - I honestly don't know why the pain doesn't stop her

Bod, she hasn't actually done this in front of us - we have just seen the results when we have visited. Whether we are there, or whether we have visited or not, the staff tell us that for at least part of every day (usually towards afternoon, but it can start even in the morning when she wakes) she is extremely agitated, demanding home, demanding to be allowed to 'go to work or she will be sacked', wanting to go and see her Mum/Dad, who she is sure are very ill (they died over 50 years ago) or just basically demanding that the staff open the doors and let her leave. She bangs on doors and windows, and on tables, with the intention of either breaking the doors and windows to get out, or - as she has actually said to the staff - simply making so much noise that they will have 'no peace' until they give her what she wants. Thats pretty much how she was in the assessment unit at the hospital, and even when she lived with us - its just worsening as time is going on, and is now accompanied by not only her being physically aggressive towards others on a very regular basis, but also by this new (started in the last week) phase of deliberately hurting herself. You don't know how tempted I am by the boxing glove suggestion, TBH - its so worrying (and upsetting) to see the damage she is doing to herself. I will look up the anti-scratch mitts too - but suspect that Mil would have no problems with removing items like that, or even that if she couldn't get them off, it would infuriate and upset her even more.

She was on an horrendous cocktail of medication to try and deal with her agitation - successive consultants just piled on the meds, and the reason for her being admitted was mainly because they were not helping and OH and I actually suspected that they were making her worse. Diazapam and Lorazepam were tried as prn meds to calm her - and she was incredibly resistant to them, they had no impact at all. She is currently on just memantine, with respiredone being given as a prn - but true to form, even before she left the hospital, the resperidone wasn't having much of an impact , and the staff at the home have said the same - it doesn't seem to do anything to calm her, they may as well give her smarties.

Its just horrible to see the depths that this illness is driving her too - I just have to hope, I think, that this phase passes soon, before she ends up seriously ill as a result of infection or an ulcer developing

 

[LadyA]

It's horrific to think of. When I was a baby, I had impetigo very badly. I had to be stopped scratching it. So I had to have gloves on that I couldn't get off. No-one said anything about "restraint" - because it was obvious that the gloves were to stop me injuring myself. I know you would hate to see your MIL restrained - but do the home have any other suggestions?

 

[Ann Mac]

It's horrific to think of. When I was a baby, I had impetigo very badly. I had to be stopped scratching it. So I had to have gloves on that I couldn't get off. No-one said anything about "restraint" - because it was obvious that the gloves were to stop me injuring myself. I know you would hate to see your MIL restrained - but do the home have any other suggestions?

Other than they are monitoring her, are keping a close eye on the wounds to try and prevent infection and that they hope that once she settles a little she will stop, they haven't come up with anything else Lady A. It is horrific - they look so sore and though once she has calmed, she has no recollection of how they really happened, the thought of how distressed she must be to do that is really hard to deal with

 

[dottyd]

No ideas Ann but just wanted to say how very sad.
It was bad enough watching my mum try to scratch the arm of the nurse trying to put her cardigan on.

Apart from the thumb tops/ short nails/ scratch mitts.

I don't know what the answer is.

 

[Sophie9]

Sorry to hear you are now having to deal with this on top of your previous conundrums you have dealt with with Mil. Looking back over the last year Ann you and her and family have done amazingly, everyday a hard day but you are getting there.

I personally used to have a child with eczema who had to have anti scratch mutts on, so I used to secure them in his wrist by using microporous tape . Stopped a lot if damage. Maybe some cotton gloves on at sun downing time, although mittens better but harder to get I'd imagine, with the tape might help.

I have looked on self harm website called WRSPC who suggest lots if things, some are possible others not, like giving ice cube in her hand to distract, would she be able to snap pencils to get rid of frustration but not use them as weapons maybe?

Instead if boxing gloves a punch bag, or very firm pillow, with a pillow case that has a face drawn in it maybe?
How about getting a cardigan with very long sleeves stretch them if you have to and tying a knot in the end of the arm so she can't remove the arm of scratch. Is the skin maybe itchy anyway causing her to scratch it?

How about asking for a small dose of diazepam given an hour before she starts in her loop of self harm. Just to stop agitation starting.

I'm sure she will settle but it's so hard for you trying to solve each problem as they come up then are replaced by four more if you are anything like me.

Hope something helps, I'd also look at eczema sites as they will have anti scratch ideas.

 

[BR_ANA]

Can she has 1:1 care while she is setting/ healing, so one staff could prevent her from hurting herself.

Maybe she needs her meds reviewed, she must feel very bad on sundowning.

 

[Bod]

Has she been tested for infections?

Bod

 

[RedLou]

This is the sort of thing, Ann -- from the H&M website. She might notice them less than gloves/mitts? Something to take her frustration out on might be worth a try - sometimes slapping bread dough around with enormous vim used to work out some of my frustrations when I was a carer!

http://www2.hm.com/en_gb/productpage.0397072009.html

 

[doodle1]

Hi Ann really difficult situation but is there any chance someone could sit with mil and massage/ cream her arms with e45 or something soothing that smells nice . My mum adores being stroked.it doesn't take long to do. Have you suggested the home look at the Teepa snow video on challenging behaviour - it's not long but is very useful. My mum is also on Risperadone for very agitated behaviour .