MONITORING AGGRESSIVE BEHAVIOUR

[good gosh]

For those interested in monitoring their partner’s aggressive behaviour over weeks and months - to get a useful record and see the changes over time - I’ve come up with a practical statistical method that only needs a few minutes attention whenever an agitated bout kicks in.

First, write down anger level codes for common outbursts - my code is:.

0 = contented
1 = unsettled / moody and unapproachable
2 = bad tempered / provocative, insulting
3 = angry / shouting irrationally
4 = angry / Slamming doors and crockery
5 = hysterical / yelling, screaming in temper
6 = hysterical / threatening violence
7 = violent / punching, kicking, hitting with towel or bag.
8 = violent / hitting with hard blunt item
9 = violent / attack risking serious injury.

Next, in a day book or spread sheet, note each agitation event each day, recording:

time started / severity code / duration in hours / note the cause of concern / note action taken to calm things.

Multiply each severity code by hours sustained, to give an agitation level for each outburst.

Add daily agitation outburst levels together for each day, and for each week. Inspection of these numbers week by week will indicate if things are worsening or improving.

Ideally, the numbers can also be plotted on a graph for a clearer weekly or monthly total picture.

 

[marionq]

You must be joking! I don’t get a minute to think much less plot graphs of behaviour. I have just spent an infuriating 40 minutes of him going to the toilet but refusing to pee. Wanting to go to bed but refusing to take his trousers off. Struggling to get him into his pyjamas so he slid onto the floor. Manoeuvring him to the top of the stairs so he can stand up with the aid of the banisters. It was hell. I want to run away before I end up with a stroke or heart attack. I won’t say any more as I am fizzing mad at the whole sorry mess. He is sound asleep.

 

[Maryland]

You must be joking! I don’t get a minute to think much less plot graphs of behaviour. I have just spent an infuriating 40 minutes of him going to the toilet but refusing to pee. Wanting to go to bed but refusing to take his trousers off. Struggling to get him into his pyjamas so he slid onto the floor. Manoeuvring him to the top of the stairs so he can stand up with the aid of the banisters. It was hell. I want to run away before I end up with a stroke or heart attack. I won’t say any more as I am fizzing mad at the whole sorry mess. He is sound asleep.

Take care Marion’s. You sound as though you have had a day like me, I got up with vertigo but had t get up to sort out his meals, he was doing a jigsaw which I started with him but threw it in the box because he couldn’t find the picture which he never uses anyway, I just put him a football match on tv but he couldn’t find the TV. OMG roll on bedtime which can’t come soon enough but I have the wander8ngs first telling me it is my bedtime, oh well !! Tomorrow is another day - better I hope. Take care x

 

[karaokePete]

Hello @good gosh, welcome to TP. I hope you find the forum to be a friendly, informative and supportive place.

Your spreadsheet sounds like a more elaborate version of a system that is having some success in Care Homes in NI in solving the reasons for various behaviours. The system was mentioned in a BBC article that can be reached with the following link
https://www.bbc.com/news/uk-northern-ireland-39794639

 

[Lawson58]

I just go on to Notes on the iPad and jot down anything of significance - at the moment he is going through an episode of paranoia

Neither the geriatrician or GP are much interested in anything more than my jottings as they are as busy as I am. And they trust me to give accurate reports of any concerns I have as we have been going to them both for years and we know each other very well.

 

[marionq]

I just go on to Notes on the iPad and jot down anything of significance - at the moment he is going through an episode of paranoia

Neither the geriatrician or GP are much interested in anything more than my jottings as they are as busy as I am. And they trust me to give accurate reports of any concerns I have as we have been going to them both for years and we know each other very well.

Yes, I do a quick entry in the diary as to whether the bed is wet or dry, John difficult or compliant etc. Any falls. That is as much as I can manage. In the early years when he was active and a wanderer I could fill an A4 page with problems. Each phase requires a new approach. Aggression with us is more accidental or incidental rather than intended or regular.

Best wishes to anyone who can deal with a better approach.

 

[Lawson58]

Ye

Yes, I do a quick entry in the diary as to whether the bed is wet or dry, John difficult or compliant etc. Any falls. That is as much as I can manage. In the early years when he was active and a wanderer I could fill an A4 page with problems. Each phase requires a new approach. Aggression with us is more accidental or incidental rather than intended or regular.

Best wishes to anyone who can deal with a better approach.

yeah,but I 'm still a bit confused as to what it really is going to achieve. We don't need spreadsheets to tell us if our PWD is getting worse.

 

[Rosettastone57]

For those interested in monitoring their partner’s aggressive behaviour over weeks and months - to get a useful record and see the changes over time - I’ve come up with a practical statistical method that only needs a few minutes attention whenever an agitated bout kicks in.

First, write down anger level codes for common outbursts - my code is:.

0 = contented
1 = unsettled / moody and unapproachable
2 = bad tempered / provocative, insulting
3 = angry / shouting irrationally
4 = angry / Slamming doors and crockery
5 = hysterical / yelling, screaming in temper
6 = hysterical / threatening violence
7 = violent / punching, kicking, hitting with towel or bag.
8 = violent / hitting with hard blunt item
9 = violent / attack risking serious injury.

Next, in a day book or spread sheet, note each agitation event each day, recording:

time started / severity code / duration in hours / note the cause of concern / note action taken to calm things.

Multiply each severity code by hours sustained, to give an agitation level for each outburst.

Add daily agitation outburst levels together for each day, and for each week. Inspection of these numbers week by week will indicate if things are worsening or improving.

Ideally, the numbers can also be plotted on a graph for a clearer weekly or monthly total picture.

I just kept a written record in a note book of my mother-in-law's more noticeable events. I didn't need anything more to tell me she was getting worse . My notes more than satisfied professionals, who I'm sure would not have been interested in anything further. If you've got time, then fine.

 

[camilia]

Hi, I'm new to all this but my mother is getting an increasing number of paranoid episodes and is becoming aggressive and violent. How do you get professional input? I managed to talk to our GP (we have the same one) but only because I wasn't asking him anything about her just telling him. I got her to see him but he just did a memory test - which wasn't too bad. She is much too paranoid to go back to the GP.

 

[good gosh]

Hi, I'm new to all this but my mother is getting an increasing number of paranoid episodes and is becoming aggressive and violent. How do you get professional input? I managed to talk to our GP (we have the same one) but only because I wasn't asking him anything about her just telling him. I got her to see him but he just did a memory test - which wasn't too bad. She is much too paranoid to go back to the GP.

Ask your mother's GP to refer your mother to the local NHS mental health team. They will visit your mother to assess her state of mind and prescribe medication as needed. They will then send a visiting nurse every three or four weeks to monitor your mother's response to treatment over several months and be on call for any worries that she or you may have..

 

[good gosh]

Ye

yeah,but I 'm still a bit confused as to what it really is going to achieve. We don't need spreadsheets to tell us if our PWD is getting worse.

Not everyone wants to keep a spreadsheet going, but it only takes 10 minutes a day to update. But it will show if behaviour improves or not, when new medication is tried, and shows if the things are becoming worse - so that increased dosage or different medication can be discussed and tried

 

[camilia]

Ask your mother's GP to refer your mother to the local NHS mental health team. They will visit your mother to assess her state of mind and prescribe medication as needed. They will then send a visiting nurse every three or four weeks to monitor your mother's response to treatment over several months and be on call for any worries that she or you may have..

Thanks I'll try that.

 

[Lawson58]

Not everyone wants to keep a spreadsheet going, but it only takes 10 minutes a day to update. But it will show if behaviour improves or not, when new medication is tried, and shows if the things are becoming worse - so that increased dosage or different medication can be discussed and tried

I sort of understand that bit but for most of the people on TP medication tends to be long term (my husband has been taking Rivastigimine for four years) and changes are made when things suddenly get worse. I know the geriatrician wouldn't be remotely interested in poring over a spreadsheet. And there aren't a lot of different medications that are used for dementia patients. If you read some of the posts on TP, there are a few familiar ones that keep popping up all the time.

The other thing is that I have a pretty fair idea of what triggers OH's paranoia and it is nothing to do with his medication. I also know that it will pass eventually - without medication.

 

[PalSal]

You must be joking! I don’t get a minute to think much less plot graphs of behaviour. I have just spent an infuriating 40 minutes of him going to the toilet but refusing to pee. Wanting to go to bed but refusing to take his trousers off. Struggling to get him into his pyjamas so he slid onto the floor. Manoeuvring him to the top of the stairs so he can stand up with the aid of the banisters. It was hell. I want to run away before I end up with a stroke or heart attack. I won’t say any more as I am fizzing mad at the whole sorry mess. He is sound asleep.

@marionq So, with you on this ....but I think people are caring for different levels of the disease and so perhaps graphs are helpful. I personally know that we get good care and my husbands doctors rely on me to tell them his condition and path. I make notes from time to time...but as someone else said...there is nothing anyone can do to stop the progression and the meds he is on are on an as needed basis. I find I use them less and less as he declines.