Aggression, continued. Help!

[Kay111]

I'm sat here with Dad, he's in respite care at the moment. He's perfectly happy 95% of the time but as soon as anyone comes in to help with his personal care he's wild and violent. Punching, kicking etc. He's comparatively strong too, as he's only 70. We hoped he'd settle down but if anything it's getting worse.

The carers were saying today that they were nearly beyond being able to help him and I just don't know what to do. They said he's the worst they've seen, which I found really upsetting. They said that normally once they explain to people what they're doing they calm down, but even when we explain to Dad he writhes and kicks off. One agency carer here walked out during personal care because she didn't want anything to do with him.

What on earth happens when aggression can't be managed?

 

[Lanny1Norma]

My partner has been in a care home since 24th September. He gets very agitated some times because he just wants to come home. He has tried to smash his bedroom windows with a chair, and got a knife to try and cut through the windows. He gets really agitated when I leave and kicks off. Luckily the CH is visited by the same surgery we are under at home and our Doctor visits the CH every Friday. They have prescribed larazapam when he becomes agitated which absolutely works. He cannot have it every day because they said he could become addicted (my thoughts are so what he is 85 does it matter) but I suppose I can see their point. Ask if your father can be prescribed this drug.

 

[Sirena]

I think your dad is incontinent, which makes it vital that he gets this care? It sounds as if they carers are approaching him the right way, explaining what they are going to do etc. I wonder if he is in pain, which is made worse during personal care, and this is making him aggressive? The only time my mother lashed out was in hospital after an operation, when the staff tried to do something which hurt her.

The staff must have experience of this, what do they suggest? Has medication been discussed at all? Pain relief, sedation?

 

[Kay111]

@Lanny1Norma That sounds like a really tough situation, Lanny1Norma, I'm sorry. The only "good" (and I use that lightly!) thing is dad is immobile so he cannot take his aggression elsewhere. It must be really distressing for you. How have the CH been? I will definitely try pin down the GP tomorrow.

@Sirena - yes, doubly so, so unfortunately it needs to get done. The staff haven't been that helpful to be honest in suggesting things, other than "speak to the GP", but the GP never seems to turn up! Apparently Dad did see the GP once when he first arrived, and she tried to take a blood test but he was aggressive and they couldn't get it done (how do doctors deal with aggressive people?! Genuine question, I've never thought of it). And then they just haven't been back, which is dreadful and I'm going to kick up a bit of a stink if they don't come tomorrow.

I did overhear the carers that if meds don't help we'd have to be referred to "bacs" (??) - does anyone know what that means?

 

[Kay111]

@Sirena - I forgot to add dad is currently on meds for the aggression, but it seems to do nothing.

 

[Lanny1Norma]

@Sirena - I forgot to add dad is currently on meds for the aggression, but it seems to do nothing.

 

[Lanny1Norma]

I have to say I thought all care homes had regular visits from the doctor. Our doctor goes in every Friday just to check the residents and their medication. I thought this was usual or are we just lucky. I couldn't wish for a better CH and as I only live ten minutes away I have got to know all the staff and they know me and welcome me when I go. I am only there five minutes and tea and biscuits arrive.

 

[LynneMcV]

@Sirena - I forgot to add dad is currently on meds for the aggression, but it seems to do nothing.

It sounds like they haven't yet found a suitable medication. My husband was like that when he was admitted to a dementia secure unit during a crisis. He simply didn't respond well to the usual sedatives/anti-psychotics, in fact most of these actually escalated his anxiety and challenging behaviour.

The other thing that didn't help was that some care agency staff there did not wear uniform. Two in particular were burly looking guys dressed from top to toe in black. My husband got particularly agitated around them, and put up such a fight against personal care at the start that even five members of staff working together could not deal with the situation.

I wonder if all the the care agency staff at your dad's home wear a uniform? My husband was generally less agitated around health care assistants who looked the part.

Once folk in uniform took over, and the right meds were found, they could normally get through my husband's personal care with a couple of health care assistants. He still struggled a bit, but nothing like the levels of anxiety that he had been displaying.

 

[Kay111]

@Lanny1Norma I suspect because dad's only here for a few weeks' respite, the GP doesn't really want to know. The carers all say how busy she is.

@LynneMcV did any meds work at all, or is it just one of those things that doesn't work for everyone do you think? Good point about the uniform. Most do, but the agency ones don't. There was one lady who was in from agency yesterday and she was AMAZING with dad. He was almost calm, the way she handled him. Well ok, not quite but it was about half as bad as it usually is.

 

[Roseleigh]

The other thing that didn't help was that some care agency staff there did not wear uniform. Two in particular were burly looking guys dressed from top to toe in black. My husband got particularly agitated around them,

Who can blame your husband too? To his raddled brain these two guys must have looked terrifying.

 

[Roseleigh]

I'm sat here with Dad, he's in respite care at the moment. He's perfectly happy 95% of the time but as soon as anyone comes in to help with his personal care he's wild and violent. Punching, kicking etc. He's comparatively strong too, as he's only 70. We hoped he'd settle down but if anything it's getting worse.

The carers were saying today that they were nearly beyond being able to help him and I just don't know what to do. They said he's the worst they've seen, which I found really upsetting. They said that normally once they explain to people what they're doing they calm down, but even when we explain to Dad he writhes and kicks off. One agency carer here walked out during personal care because she didn't want anything to do with him.

What on earth happens when aggression can't be managed?

I wonder if he's had some experience which hurt or alarmed him? Something minor such as slipping getting on the toilet or a shaving cut might be blown out of all proportion in his damaged memory and he fears they are out to hurt him. Can you pinpoint what particular personal care he fears and maybe reassure him.

 

[TNJJ]

@Lanny1Norma That sounds like a really tough situation, Lanny1Norma, I'm sorry. The only "good" (and I use that lightly!) thing is dad is immobile so he cannot take his aggression elsewhere. It must be really distressing for you. How have the CH been? I will definitely try pin down the GP tomorrow.

@Sirena - yes, doubly so, so unfortunately it needs to get done. The staff haven't been that helpful to be honest in suggesting things, other than "speak to the GP", but the GP never seems to turn up! Apparently Dad did see the GP once when he first arrived, and she tried to take a blood test but he was aggressive and they couldn't get it done (how do doctors deal with aggressive people?! Genuine question, I've never thought of it). And then they just haven't been back, which is dreadful and I'm going to kick up a bit of a stink if they don't come tomorrow.

I did overhear the carers that if meds don't help we'd have to be referred to "bacs" (??) - does anyone know what that means?

Sometimes there is a best interest meeting and an assessment.
If the person needs personal care and is aggressive they can apply “restrictive practice “.which can take up to 3 people to do.Usually though it is more for mobile people.

It can only be used by certain carers that are trained in this.
But all this is the last resort so they may need to do a medication review first

 

[TNJJ]

Sometimes there is a best interest meeting and an assessment.
If the person needs personal care and is aggressive they can apply “restrictive practice “.which can take up to 3 people to do.Usually though it is more for mobile people.

It can only be used by certain carers that are trained in this.
But all this is the last resort so they may need to do a medication review first

No idea what “bacs” is

 

[TNJJ]

I'm sat here with Dad, he's in respite care at the moment. He's perfectly happy 95% of the time but as soon as anyone comes in to help with his personal care he's wild and violent. Punching, kicking etc. He's comparatively strong too, as he's only 70. We hoped he'd settle down but if anything it's getting worse.

The carers were saying today that they were nearly beyond being able to help him and I just don't know what to do. They said he's the worst they've seen, which I found really upsetting. They said that normally once they explain to people what they're doing they calm down, but even when we explain to Dad he writhes and kicks off. One agency carer here walked out during personal care because she didn't want anything to do with him.

What on earth happens when aggression can't be managed?

I forgot to ask is he being hoisted?

 

[LynneMcV]

@LynneMcV did any meds work at all, or is it just one of those things that doesn't work for everyone do you think?....

Quetiapine was the only anti-psychotic that helped my husband. It was given as and when needed, not as a daily medication. He also had promethazine on his list of medications, which worked as a sedative - again given as and when needed. Eventually though, the disease progressed to a point where even these ceased to work.

Having said that, the medication doesn't suit everyone, it really was a case of trial and error before we found something that worked for my husband with minimum impact on his day to day life.

Who can blame your husband too? To his raddled brain these two guys must have looked terrifying.

Definitely. Strangely, it wasn't something they'd even considered when I first raised the issue, even though he was on a dementia specific ward. They tried to use uniformed staff for my husband's personal care from then on, and the situation improved greatly, in that he was still anxious but more accepting of their help.

 

[Kay111]

I wonder if he's had some experience which hurt or alarmed him? Something minor such as slipping getting on the toilet or a shaving cut might be blown out of all proportion in his damaged memory and he fears they are out to hurt him. Can you pinpoint what particular personal care he fears and maybe reassure him.

He's never had a fall or slip or anything when doing personal care type things as far as me (or mum) are aware. Our best guess is he doesn't like water, as he struggles with washing basically. If it's just changing a top he's fine.

 

[Kay111]

I forgot to ask is he being hoisted?

With the hoist he's a little bit resistant is generally ok.

Hmmm no, I couldn't find anything on google about "bacs". maybe vacs?

 

[Kay111]

Quetiapine was the only anti-psychotic that helped my husband. It was given as and when needed, not as a daily medication. He also had promethazine on his list of medications, which worked as a sedative - again given as and when needed. Eventually though, the disease progressed to a point where even these ceased to work.

Having said that, the medication doesn't suit everyone, it really was a case of trial and error before we found something that worked for my husband with minimum impact on his day to day life.



Definitely. Strangely, it wasn't something they'd even considered when I first raised the issue, even though he was on a dementia specific ward. They tried to use uniformed staff for my husband's personal care from then on, and the situation improved greatly, in that he was still anxious but more accepting of their help.

I've inisisted on seeing the GP today, but the nurse hmmm'd and haaa'd and said she'd see what she can do to get her round. Why are they so obstructive?!

 

[Banjomansmate]

The Banjoman would react violently when in hospital after his hip operation, lashing out and swearing at all medical staff, they couldn’t do blood tests or anything. He calmed down a fraction on returning to his Care Home but still over reacted to any form of touch by shouting out. He would let me hold his hand but shouted the place down when I tried to gently kiss his cheek!
The Care home staff would try to get him washed and dressed etc. but he often objected so they would leave him alone for a little while then maybe send in another member of staff. They were told to always inform him of what they were going to do. As far as I am aware he was never given drugs to calm him down.

 

[silver'lantern]

I know nothing about aggression behaviour in people with dementia. So please dont think I am some know it all treading on toes or butting in, but, one thing I am wondering is .... maybe he is embarrassed and frustrated he cant do for himself? embarrassed he has soiled or that someone has to do personal care. lashing out is how it is shown. in their mixed up world I often wonder if awareness of events is still there even though they cant vocalise their distress. I read posts and learn for future reference, thats why i am asking.... just wondering if this is possible? No idea how to solve it, but knowing why might help.