Acts of aggression

[tubbie]

My Dad has started hitting (i.e. punching, slapping) other residents and members of staff at his care home. He has had 3 outbursts in 6 weeks that I am aware of, possibly more. I am finding this REALLY distressing, although my sister and husband seem to be taking it all in their stride, as are the staff, so much so that we only know about the problem by chance. I have spoken to the Deputy Manager who has assured me they are managing the situation and that we shouldn’t worry. I am somewhat concerned that each member of staff I have spoken to only seems aware of incidents that they have actually witnessed, i.e. they are not 'joining up the dots'. I did point this out to the Deputy Manager so hopefully they are now aware that a trend is developing.

I know that such behavioural problems are not uncommon with Alzheimer’s (I’ve read the fact sheet) but I still can’t stop worrying about it. Dad is much bigger, stronger and more able bodied than all the other residents and I am concerned for their welfare in case he really lets rip one day. And what would happen if a relative decided to press charges? I feel so full of remorse, I want to apologise and make amends on his behalf but how can I when this is not an isolated incident. Where is this going to lead, are his outbursts likely to increase in frequency and severity? If they do what can be done to manage the situation and what happens if it can’t be managed, will the home evict him? I offered to go in and meet with the staff to discuss matters but was assured that it isn’t necessary, at least not yet, so I am without answers at the moment. I could call back but I really hate communicating by telephone and usually end up feeling less reassured than when I started in such situations.

If anyone has been here already I’d like to hear from you, if only to know I’m not alone in this, it’s so frightening.


Thanks
Tubbie

 

[blue sea]

This is a really distressing situation for you and one I have experienced with my father. The care home cannot just 'evict' your dad, but they could reach a point where their view has to be that for the safety of other relatives that particular home is no longer suitable and he needs to be in an environment with higher levels of staffing, more specialised in dealing with such behaviour. They would then involve social services support in helping you find a more suitable home and your dad would need a full assessment of his needs. However there is lots that can be done before this stage is reached. I would ask the GP for a referral to the psychiatric service, if this hasn't already happened, and get a full review of your dad's medication. A CPN (community psychiatric nurse) can also advise the home on how best to manage this challenging behaviour. If a resident were to be hurt I know you would feel dreadful, but it would not be your or your dad's fault; ultimately it is the responsibility of the home to ensure everyone's safety. Your dad is a vulnerable adult who cannot be held responsible, legally or morally, for the consequences of his actions.

If things do get worse, don't panic. This happened in my father's case, he was sectioned and moved to an assessment unit. I was heartbroken at the time but it was actually for the best as he received much more appropriate care for his needs at that time. They worked on his medication and gradually found a mixture and level which kept him calm without drugging him. In most cases, however, the person can be treated within the home they are in and only rarely does it result in their having to move somewhere else. I do think it is useful to be proactive, however and just check that his case is under active review by the psychiatric service. GPs do not usually have the level of specialist knowledge to deal with the most challenging behaviour. Also the situation can change very suddenly with the home changing its view and it is wise to be prepared for this. One final point, sometimes the aggression is merely a short phase and changes of its own accord with the shifting nature of the illness.
Hope above is helpful and not causing further worry to you.
Thinking of you. Keep strong. You will come through to calmer times.
Blue sea

 

[tubbie]

Blue Sea,

Thank you for your reply, it helps a lot to know I'm not the first person whose relative has behaved like this. It doesn't matter how many fact sheets you read, only real life experiences of other people seem to count. Dad does have a phsychiatrist, they had a first meeting 2 weeks ago before I was aware of the problem, otherwise I would have mentioned it. We are actually awaiting a date for a routine follow up appointment to arrive by post, which we were told would be in approximately 3 months time. I guess if Dad keeps lashing out we, or the home, might want to bring this forward.

One of the reasons I'm panicing is that we really, really like the home he's in and desperately don't want him moved. The location is good, the standard of care is fantastic and Dad seems happy and settled there. I am consequently very afraid of any issue that undermines his being there; we went through 9 months of hell prior to his going in to care and I'm feeling a bit 'post traumatic' about it all. I am hoping like made that this is only a phase and that it will pass in a few months without anyone ending up in casualty.

Thank you, again.
Tubbie

 

[blue sea]

Hi Tubbie

It is harrowing to go through all this, I know. I would try to deal with each situation as it arises, while knowing that the psychiatrist can be contacted if things escalate. One of the things that hurts most is seeing someone you love behaving in such an out of character way. My dad was the most gentle and courteous person and it broke my heart to see him lashing out in a way that could hurt other vulnerable people. He would have been devastated if he had understood what he was doing. Keep remembering it is the illness that is causing this, not your dad. So feel sad, but not guilty. I made a point of not apologising when I was told dad had struck out at someone. I just said I was so sorry that dad's illness had resulted in someone being hurt. It is more than likely that your dad will settle down into a calmer phase soon, so I would try not to anticipate ahead too much. Stay positive.
If it's any help, I'm happy to respond to a personal message if you want to talk things through at any time.
Blue sea

 

[Natashalou]

I was shocked in January to receive a call from the hospital mum was at that time in , telling me she was violent and was this "typical " behaviour? I honestly thought there was some mistake until I asked to speak to her and could hear her screaming abuse and threats in the background!

The staff were fairly philosophical and just said "dont worry she cant do much harm we are all a lot bigger and faster than her!"
(She did manage to throw a cup but luckily it didnt hit anyone)

Her behaviour then calmed down to aggresive rather than violent, but she regularly swears at the staff in the home, and has told me of people she is going to hit "when she gets the chance" .

She isnt really much of a danger as she is about 45 kg and 160cm tall, with severe mobility and sight problems, but its awful to think what must go on in her mind.

 

[connie]

Thats the rub, isn't it:

but its awful to think what must go on in her mind.

This is something we will never know. Do they percieve some actions as threats against them, do they think they are in danger, so they lash out?

As lLionel is now 'bedridden' he can only use his arms which thrash wildly about, and his swear words, well they make me ashamed to hear them. The rest of the time he has hardly any speech anyway.

Wish we knew what frightens them so.

 

[alfjess]

Wish we knew what frightens them so.

Hi
I really wish I knew what frightenens them, then I could try to make it better for Mum. She is always soo agitated and since being in care, she is frightened to go to her bedroom at bedtime and sits in the lounge until 4.00 am. Carers assure me they are no problem, but it can't be good for Dad, he gets tired.

Now Mum has something against the dining room. She hates it, She is frightened to go there. I wish I knew why. If we could reason it, then we could find a solution and deal with it, but with this illness, who knows?

I so admire you in your care for Lionel, as I do many others on this forum.
It sometimes makes me feel such a wimp, that I have given in too easily and my parents are now in permanent care.

I know Lionel is in care, but your devotion puts me to shame.

Take care
Alfjess

 

[Brucie]

Now Mum has something against the dining room.

It may not be the seemingly obvious, that is the problem.

It could be that she is losing the ability to understand cutlery and how to use it, and the dining room may be the focus of that. It took ages for me to recognise that happening to my Jan.

My Jan wouldn't put a coat on to go out in the cold. It turned out to be that she couldn't remember how to do up buttons...

There could be other things about the dining room - colour, or something.

Her spatial awareness may be failing and she is afraid of falling or something.

she is frightened to go to her bedroom at bedtime and sits in the lounge until 4.00 am

again, it could be spatial awareness and stairs.

I really wish I knew what frightenens them, then I could try to make it better for Mum

I recognise the frustration.. it is with me all the time

I know Lionel is in care, but your devotion puts me to shame

Each case is different, and there are always different needs. While a carer may feel shame, it is one of those things that is caused by our lack of ability to be able to make things better. There is no shame, in reality.
best wishes

 

[Grannie G]

It sometimes makes me feel such a wimp, that I have given in too easily and my parents are now in permanent care.

Alfjess

Dear Alfjess,

You are not a wimp and you did not give in too easily.

You have had a short time without the total responsibility of your parents, you are not as tired, not as anxious, not as fraught, not as worn down. You know your parents are safe, you know they are being cared for. You are probably sleeping better and you can go about your business without that niggling doubt that something might have gone terribly wrong, while you were out.

In fact, to some extent, you are refreshed. You might have forgotten just how tired and worn out you were, looking after two highly dependant parents, and now you have renewed energy, you are feeling you could have done more.

I know, because this is how I felt when my mother went into the home. I only had one parent to worry about, you had two.

You could have done no more.

Love xx

 

[tubbie]

I would try to deal with each situation as it arises ... I would try not to anticipate ahead too much.

I think this is what's causing me more angst than anything Blue Sea, it's not so much what's happened that bothers me, although it does, but what MIGHT happen next. I guess I could work on that. I'm a bit of a perfectionist really, I like things to be all neat and tidy and dementia just doesn't allow for that does it?

I don't know why Dad lashes out really, maybe it is fear, but I have a sneaky suspicion it's more likely that he has forgotten the social ettiquette we all get taught as children, ie that you don't whack someone just because they have annoyed you. He does also sometimes make some rather *too* suggestive remarks to some of his female carers which I think stems from the same loss of restraint.

tubbie

 

[blue sea]

Hi Tubbie
It's worth working on the 'living by the day approach'. I found that difficult too as I like to be in control! In the end, though, I found what worked best for me (and everyone has different ways of coping, of course) was to : a) find out everything I could about possible options, b) talk through with family and 'experts' possibilites, then (and this is the crucial bit!) c) take any decisions that could be taken or accept that nothing else could be done for now and deal just with things as they happened. Sometimes the latter is the best option but the hardest. Unfortunately with some stages of dementia there is such a huge unpredictability about the person's behaviour and condition, sometimes on a daily basis, that you really cannot maintain your own health if you worry about every possibility that might (or might not!) lie ahead.

As to the cause of the aggression, like you I think it is a mixture of things. Yes, inhibitions go, and social skills (dad suddenly started trying to eat everyone else's meals!). Also, in my dad's case, he became very difficult about any personal hygiene, dressing and bathing. As he was double incontinent by this time this became a real issue. Basically he was aggressive because 'strangers' were trying to get him to undress, or whatever. Some care staff managed him better than others, of course. Generally if they were very patient and relaxed about the whole thing and took plenty of time it was better, which is not always possible in a busy home of course. It all is so sad, and embarrassing and demeaning and undignified. It's a tough illness to deal with, as everyone who posts here knows. You seem to be doing really well. Sometimes it is good to be strong, sometimes it helps to have a good cry. Go with how you feel.

Anyway, good luck with it all. Keep us posted.
Blue sea

 

[alfjess]

You have had a short time without the total responsibility of your parents, you are not as tired, not as anxious, not as fraught, not as worn down. You know your parents are safe, you know they are being cared for. You are probably sleeping better and you can go about your business without that niggling doubt that something might have gone terribly wrong, while you were out.
In fact, to some extent, you are refreshed. You might have forgotten just how tired and worn out you were, looking after two highly dependant parents, and now you have renewed energy, you are feeling you could have done more.
love xx

Hi Slyvia
I am feeling better and I am sleeping now, and I had forgotten how things were when I was caring for them full time. You are soo right. I hadn't really thought of things in this way. Thank you.
It is still hard when Mum is pleading with me to get her out of here (the care home) and please bring her to my house, just for to-night
After many attempted diversions and excuses, which don't work, I just have to say NO and then I feel horrible.
She was so agitated the whole time I was there to-day visiting and I came home really upset.
My husband who is very supportive said, "there is no alternative to Mum and Dad being in care, it is either, you or them"
I am not as strong as I thought I was, I thought I could cope with Mum and Dad and maybe that is where I am disappointed in myself

Thanks again for your support and advice.
Where would we be without TP.

Alfjess

 

[Grannie G]

Hi Alfjess,

If you still feel awful about your mum and dad being in a care home, just look back on your previous posts and read the first lines of some of them.

Love xx

 

[Nell]

Dear Alfjess,

You are not a wimp and you did not give in too easily.
You might have forgotten just how tired and worn out you were, looking after two highly dependant parents, and now you have renewed energy, you are feeling you could have done more.

You could have done no more.

Love xx

As usual, Sylvia is exactly right (IMHO!). Alfjess, please do not think you could have done any more than you did. Many of us on TP could not imagine doing half of what you did!

Now is the time to develop a new relationship (in so far as it is possible) with your parents in care. Less of the "hands on caring" and more of the "social support".

Also, you can quite justifiably reclaim (at least some!) of your life without feeling in the least guilty!!

Thinking of you.

 

[Canadian Joanne]

Tubbie,
It is very frightening and upsetting when our loved one behaves in a violent fashion. My mother was so violent in the home she was removed to hospital for 6 weeks while they adjusted her meds. It was a long and difficult time but eventually I got her back to the home.

She hit many residents, she hit staff and she topped it all off by hitting one of the three the police officers who had come to take her to hospital in the testicles.

So I understand where you are coming from. But let it go. You may not necessarily be able to figure out what happens. Let me tell you, Alzheimer's is not something we can plan for or necessarily figure out. We do the best we can with the situation we have. So perhaps moving up the specialist appointment might be a good idea. It's probably a phase for your dad.

Take care and post again.
Love
Joanne

 

[tubbie]

Hi Joanne

Thanks for your post, I was wondering, what is the reason for removing aggressive residents to hospital to sort out their meds, could this not be done in the care home? My Dad had two weeks in hospital before moving him in to care because we (my sister and I) couldn't cope anymore and I have to say it was just awful. He was on a 'general' ward, ie not a geriatric ward, and they were clueless as to how to care for someone with dementia. He was very confused and very scared by the whole thing and it set him back a long way. He even started asking for his Mum, which broke my heart, but up until that point he hadn't been that bad. The care home have just been fantastic with him, they have 75 beds half of which are dementia beds and boy do they know how to look after the dementia residents. I can't help but feel moving him to hospital, even for a brief spell, would just make matters worse. I'm quite sure he'd become even more aggressive because he'd be so scared. Can you understand the logic for this strategy? I have come across it 2 or 3 times recently but am struggling to get my head round it.

Thank you and you take care of yourself too

Love tubbie

 

[Ashburton]

Just wondering what peoples experiences have been with aggression, how long does this period last for. Thankfully during the day my mum is fine and most nights she is fine, however sometimes during the night my mum does wake up , it is hard to understand her sometimes as when she talks it makes no sense, and she can become aggressive i.e. pushes me, has pinched me a couple of times. As said thankfully the aggression is only bad on some occasions, but what have peoples experiences been with this stage, how long on average does it last, and what lies in store next.

 

[Margarita]

however sometimes during the night my mum does wake up ,

Sounds like your mother may be going in to that stage that she gets nights days Mix up .

and she can become aggressive i.e. pushes me, has pinched me a couple of times.

Does she do that when you tell her to go back to bed ?

As my mother was in that stage before she was given medication for AZ 5 years ago , she use to she use to walk into my daughter room turning the lights on looking for me in the middle of the night and scream at me arms flying around , if I told her to go to bed its night time .

 

[Ashburton]

Sounds like your mother may be going in to that stage that she gets nights days Mix up .


I'm not sure, she will go to bed and sleep for an hour and then wakes up, it will be difficult to understand what she is talking about, sometimes it is ok and she will go back to sleep and sleep as normal, sometimes she will say she has to go home and I explain she is at home, and that she has loads of brothers which she does, then she can snap, but thankfully this does not happen too often, the waking up does seem to happen often though, sometimes my mum ends up going back to sleep straight away other times she can stay up for maybe 30-45 mins before going back to bed. One thing that consistently upsets my mum when waking up is that it is dark outside.





]

 

[Grannie G]

It`s impossible to know what`s going through their minds isn`t it? Your mother could have been dreaming, could be confused, frightened, anything, and you just have to tread carefully and hope you react in the right way.

The trouble is, it may not be the right way, the next time.