Aggression During Personal Care - help please!

[Kay111]

Late night post in the hopes that some of you have some advice for me and mum.

Mum and Dad have now moved in nearby and I'm helping care for Dad so that mum no longer has to do everything herself. The past few days have been fine, no real dramas, have had some lovely chats with Dad looking through photo albums and listening to music etc. But tonight I saw what mum's been struggling with most first hand.

Dad is immobile and doubly incontinent. This evening we started giving him a "clean up" and a change of pull ups and all hell broke loose. He just would not let us do a thing, became verbally and physically aggressive (though "luckily" - not sure that's the right word - because he's no longer mobile and not very strong, I can deflect the aggression to me and it doesn't hurt when he squeezes my fingers/wrists and I can easily dodge any kind of lashing out no bother. Rather me than poor mum who is in her 70s and tiny).

He's never happy when it comes to his personal care. TBH it's always a flash point, but on previous days with the two of us we've been able to distract him enough and cajole him enough that he'll let us do what we need to do (even with a little bit of verbal aggression and a couple of heart hearted attempts at lashing out). But today he just would not and shouted the house down "NO NO NO NO NO!". We tried leavning the room for 15 minutes (though really, hovering in the corridor keeping an eye on him) and coming back but he still was just as wound up.

When it's just been mum looking after him previously, on the odd occasion it got this bad she would just wash him and pull up the pull ups even if he was screaming at her. But now they've moved here and are renting a flat she's terrified that the neighbours will hear and complain.

At all other times of day, Dad's really chilled and lovely. He is on meds for anxiety/aggression - maybe it has helped his overall day-today mood but the personal care issue has always carried on, meds or not.

Has anyone got any advice at all about how to do personal care in this situation? I'm wracking my brains as to why today might have been any different (though I do understand it might just be one of those things). Today he 1. watched a lot of telly (overstimulating maybe?) 2. was changed later than usual 3. he had a lot of sugar as . (No idea if that has any effect?!).

Anyways, any advice would be really gratefully received. Thank you!

 

[Cat27]

How upsetting for you all @Kay111

Have you read these fact sheets?

https://www.alzheimers.org.uk/get-support/daily-living/washing-and-bathing

https://www.alzheimers.org.uk/get-support/daily-living/dressing

Personally, I’d contact the GP & see if anything could be done?
Have you considered carers coming in to do the personal care as he may respond to someone who he isn’t related to?

 

[Splashing About]

This is really hard and I think if you are unable to get past it probably changes the situation in terms of living at home with support to being in care. I’d second the idea of getting carers in.

Worth contacting the incontinence team via your GP?

 

[Bunpoots]

I agree with The others @Kay111

A dementia trained carer may be able to help. My dad was much more co-operative with carers than he was with me when it came to personal care.

If you google Teepa Snow she has some techniques for approaching personal care with PWD. I don’t know if you’d find any of them useful.

 

[MaNaAk]

There is a fact sheet on dealing with aggression and I was wondering if anyone here would be able to pass on the Alzheimers Society's hot line so that they can send it to you.

Thinking of you both.

MaNaAk

 

[Louise7]

No need to phone, all of the fact sheets are available on-line. Here's the one on aggression which you may find helpful: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggression-and-dementia

 

[Cat27]

Do you mean this one @MaNaAk?
https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggression-and-dementia

 

[silver'lantern]

We dont have this issue (yet?!) so forgive me if I am speaking out of line. But I am joining the conversation to store knowledge for future needs. (preparing {futurising is the modern word I think :/ }. I read how others cope with lots of different situations so I can adapt to my own situation.
What I was wondering was - maybe its frustrations and embarrassments. On a totally different level I know my PWD get cross and frustrated when He can no longer do something. Or tries and can't process the next step, but he is at the stage after the initial stomp and frustrated temper, he takes himself off up the garden and paces round talking to himself until he calms down.
If, like your Dad, they can no longer do for themselves but also can no longer verbalise/process the fact they are uncomfortable letting wife/daughter do such personal care, maybe lashing out is the only way to express it? Now I am only making a guess here, and not at all suggesting what I am guessing is right. and also realise it is different for everyone. But, if it is this, maybe getting carers in to do personal care might lower the stress? Although I see a problem there right away....how do you have carer there at the moment needed! Talking things through helps to see it at all angles. But with this in mind, on a level that fits your situation, if this is the cause of the aggression maybe think of a way it could be worked around his embassisment and frustration.
How could it be eased for me. I alway look at things as ....how would I feel in that situation. During the day are there other things that destress a situation or help relax or he enjoys that could be adapted to the situation. Singing or playing favorite music helps calm some.
Sorry I don't have answers. I am just adding my thoughts as I havent got this issue. And by no means am I making light of it, or even suggesting I have the answer.Its all trial and error I think. I am just adding my thoughts. I appreciate and understand how stressful this must be for you and your mum. Like everything along this road the knowledge is built on questions.
Just a thought... on the worry over the neighbours, would it be out of order to knock and explain? Dad has dementia that causes stressful moments for him and hope they are understanding. If that added pressure is taken off mum she might be able to relax more, things may calm down?
best wishes

 

[Kay111]

Thank you @Cat27 @Splashing About @Bunpoots @MaNaAk @Louise7 for your replies - not going to lie it was really distressing to see dad like that. I genuinely don't know how mum's been coping by herself all this time.

Thanks for the links - unfortunately I've already read up (hello 3am panic googling) quite a bit about managing aggression. The frustrating thing is we've already tried as many of the preventative steps as we can - I was even doing the Teepa Snow comforting handhold etc. The problem is a lot of the advice is basically find out what's causing the aggression and remove that aggressor. But we can't not change/clean him Even if we do it with as much gentleness and dignity as we can, there's still a lot of indignity about having your bottom wiped etc.

I will definitely suggest carers to mum. I just don't know what to do until that's all arranged. Going over there now and I'm hoping he's in a calmer mood. Wish us luck!

 

[Alex54]

Think about it from his point of view. Recently moved house, now in a strange environment, and most likely embarrassed about having to have personal care.
I would suggest getting agency help in for a week or so. They are trained on how to approach the situation and it takes away the 'family' issue.

 

[Alex54]

terrified that the neighbours will hear and complain

I would suggest you go and talk to the neighbours and explain that it is a difficult unexpected situation but that you are working on it.
I have never come across yet anyone who has not been supportive as soon as they know what is going on.

 

[Kay111]

@silver'lantern thank you for your reply! Yes, I think you're absolutely spot on about the embarrassment/frustration. That's a very good idea about speaking to the neighbours. I will definitely do that!

@Alex54 - absolutely! Poor dad. Maybe with outside help we can get a better understanding of where we might be going wrong too. I've no doubt we could do better for him.

 

[Kay111]

@Alex54 - definitely will do. Don't know why I didn't even think of that. Too busy seeing the trees for the wood or whatever it is! (You know the situation of me urging mum to move, and so I feel really responsible now and am spending every spare moment analysing everything. Was my jumper too bright with too much of a dizzying pattern, is that why he suddenly took against me? Was the TV on for too long? Not on for long enough, so he was bored and frustrated? etc etc etc.)

 

[Helly68]

With my Mum - very resistant to personal care, in a CH, this has been partially helped by increasing mood stabilising drugs, and taking them at a certain point in the day, when things "kicked off" and having trained carers, especially those she gets on really well with, do her personal care. It is still an issue - biting, pinching, spitting etc but they are aware of the problem and have been very patient with her. I would echo what people are saying about getting trained carers in, sadly they are very used to this sort of thing.
Sometimes Mummy is better if she has something to do. The got a blood pressure reading by telling her to watch the display for the heart symbol - and this seemed to work. Sometimes singing calms her, though that isn't always easy - bursting into song in the middle of a care home can be a bit trying for others - especially when I am singing.....

 

[Alex54]

spending every spare moment analysing everything. Was my jumper too bright with too much of a dizzying pattern

Just be yourself, there are going be times when things don't go the way you expected. The trick is not to overreact and just carry on as normal. Chances are he will have forgotten all about it long before you do.
I have my own little coping device. Everything my wife does right is because of the care and attention I give her, everything else is down to the illness.

 

[silver'lantern]

a better understanding of where we might be going wrong too. I've no doubt we could do better for him.

please dont think you are 'going wrong' it is a steep learning curve.....you are not going wrong you are learning on the job! its hard work and as each follows their own route down the same road we adapt as we go. But you are not 'going wrong' you are supporting parents through a hard part of their life, there is nothing wrong with that at all!

 

[LynneMcV]

Hi @Kay111,

The tv might very well be part of the problem, it certainly was with my husband. I remember one time helping him with personal care while the tv was on in the background and he thought I was removing his trousers in a public place.

Other times, if I led him from the room to take him to the bathroom for a shower/wash etc he thought he was being rude by leaving company behind and would become quite het up. He would also feel embarrassed that his wife had come to take him away from his social gathering when things were in full swing!

Things went better if I replaced tv programmes with soothing background musical like listening to a classical radio station before attempts were made at personal care.

It also helped if I let him make the decision as much as possible, so that he had a sense of being in control. For instance I would say, would you like me to help you get cleaned up? Would you like a shower, bath, clean clothes? etc

Mostly he would say yes, but if he said no, I would just ask again 15mins later and so on - never making it seem like a big deal to me, even if I was bristling underneath the calm facade. Eventually the thought and desire to be cleaned up would stick long enough for him to say yes and for me to get the job done.

So that he didn't forget what was going on part way through proceedings I would then talk him through each step and keep offering encouragement eg
I'm going to help you take your trousers (socks, top, pants etc) off - thanks for helping me do that.

The only real problems with personal care came once he went into mental health unit temporarily. Instead of having just one person helping him with personal care he had a minimum of two - and things didn't often go well. I am sure much of it was down to different surroundings and faces - but in part I think he also felt out-numbered.

I appreciate that your dad is immobile and it needs two people but if your dad has only been used to one person until now, it might take a bit of time for him to adjust.

I wonder if both you and mum are talking to him and/or each other while carrying out the personal care? That in itself could become overwhelming as your dad will have a lot of information to process while feeling quite vulnerable.

My husband coped better if he only had one voice to concentrate on. Sometimes my son would be nearby to pass me a towel or whatever else was needed, but it was just me doing the speaking - and I made sure to say everything very calmly and to keep to as few words as possible.

As I say, it might be that none of the above is relevant to your own particular situation - but I wanted to share, just in case some of it might help.

 

[silver'lantern]

As I say, it might be that none of the above is relevant to your own particular situation - but I wanted to share, just in case some of it might.

Thats it exactly LynneMcV we share our thoughts as that might just be the key to unlock the situation...... we keep passing the keys and collecting a bunch that might be useful.

 

[Kay111]

Thank you everyone. Just back home from Mum & Dad's now. Would you believe halfway through the last change of the day I heard a weird noise and went to investigate - a bag of unused pull ups had managed to catch fire on a candle in the bathroom (there to disguise the pong!). As if there wasn't drama enough We did take on board what you said @LynneMcV and it was so helpful - we had no telly on and though I was there hovering (to the side of dad so he didn't see my face, but I continued to hold his hand) only mum spoke to him and she was brilliant and this morning's change went really easily. Less so in the afternoon, but nothing too bad. And everything was going well in the evening until the fire fiasco but hey ho!

@Helly68 - it's such a relief to know that carers are used to it and will know how best to deal with everything. I said to mum, we're trying our best but we're not trained so hopefully people with experience will be able to make it less fraught for dad.

@silver'lantern and @Alex54 I like your approaches! We're all just trying our best aren't we, in crazy circumstances.

 

[MaNaAk]

Do you mean this one @MaNaAk?
https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggression-and-dementia

Dear Cat 27,

The factsheet I meant is:

Factsheet 509 Aggressive Behaviour

I phoned 0300 222 1122 after I came home from a rehearsal to find dad had been very aggressive with a carer and the neighbours had to calm him down. I still remember how awful I felt when I came home and read the carers notes. I also got in touch with my local dementia friends coordinator who sent a dementia nurse and put dad's donepezil up to 10 mg. I had to change the care agency and then we worked through another agency whilst looking at the inevitable care home. All I can say is that my heart goes out to those of you whose PWD has reached this stage.

MaNaAk