Aggressive behaviour - but only in certain situations

Discussion in 'ARCHIVE FORUM: Support discussions' started by Charlie, Oct 13, 2005.

  1. Charlie

    Charlie Registered User

    Apr 1, 2003
    161
    #1 Charlie, Oct 13, 2005
    Last edited: Oct 13, 2005
    We have been told that dad is occassionaly getting agressive when being bathed or helped in the toilet. Its both verbal and sometimes physical but only in these situations.

    Due to this they want to continue dads low dose of Haloperidol 500mg daily. It has just been reduced. from 1000mg. We are concerned as to what is triggering this and it could possibly be an incident in another home that we have not been given the full details of.

    Looked at a few factsheets including:
    http://www.alzheimers.org.uk/Caring...entia/Unusual_behaviour/advice_aggressive.htm on agressive behaviour

    Under possible reasons/situations that may make someone with dementia, it says:

    "Feel their independence and privacy are threatened because they are forced to accept help with intimate functions such as washing, dressing or going to the toilet. These are areas of life which have been private since childhood. It is not surprising that these situations become particularly stressful. "

    Currently, the home seems OK with the situation and are doing their best to deal with the it (they are being very open and helpful). But I'm not happy with the continuation with the medication (Haloperidol) for the long term.

    I'll speak dads GP but wondered if anyone else had come across similar situations, specifically with bathing and toileting?

    Also, has anyone had any experience of Haloperidol been prescribed for long periods of time?

    thanks
    Charlie
     
  2. Norman

    Norman Registered User

    Oct 9, 2003
    4,348
    Birmingham Hades
    Charlie
    have a look at the bathing posting on this site.
    There are some answers there I think
    Norman
     
  3. connie

    connie Registered User

    Mar 7, 2004
    9,519
    Frinton-on-Sea
    Charlie, with regards toileting and bathing, so much is down to individual behaviour.. I was speaking to Lionel's incontinence nurse only this morning, and I commented that Lionel does not have an embarasment problem with regard to virtual strangers. She commented that this was a great issue with a lot of people, so we do have to find a way round this.

    The recent posts on 'bathing' offer a lot of practicle advice. Good luck, Connie
     
  4. Sandy

    Sandy Registered User

    Mar 23, 2005
    6,847
    Hi Charlie,

    This article from the Merk Manual of Geriatrics might be helpful:

    http://www.merck.com/mrkshared/mmg/sec5/ch41/ch41a.jsp

    I suppose part of the question (which can't be answered) is - how long term is long-term? Over time, your father may no longer object in the same ways to assistance in these areas.

    If you feel that the care home is open and willing to work with you that is half the battle over. Seems like talking to the GP (assuming they have a fair amount of experience dealing with this type of medication/situation), getting the best medical advice possible and then monitoring the situation closely seems to be the best you can do for the moment.

    Take care,

    Sandy
     
  5. Charlie

    Charlie Registered User

    Apr 1, 2003
    161
    Thanks everyone!
    Sandy, that is a great article you posted a link to, very very informative!
    Lots to chew on..
    Charlie....
     
  6. blue sea

    blue sea Registered User

    Aug 24, 2005
    270
    England
    Sandy
    What a great guide to resources you are! I also found the article very interesting. It's shocking how little research has been done into behavioural issues with dementia.

    Blue sea
     
  7. Stimpfig

    Stimpfig Registered User

    Oct 15, 2005
    135
    Germany/India
    Aggressive behaviour/Haloperidol

    Hi everybody

    I am new and just about feeling my way through. I am not sure if what I am going to post will enter the right thread or not but here I am and am glad to have found an online support group after some search.

    I live in Germany but am originally from India. Due to my mum's Dementia, I brought my mum to live with me here in Germany to be able to take care of her. My mum's a widow, 79 and I am her only child. Although I would still say she is in between stage 1 and stage 2, there have been periods when she has been aggressive and just two weeks back, she broke the front glass door with a tiny wooden sculpture. On gentle questioning, it transpired that she had been getting commands (auditory hallucinations) directing her to do awful things including throwing all the food in the bin, which is when we reverted to Haloperidol. With 20 drops per day (still low dosage), she was continuously dazed and had lost her appetite and refused to drink enough. I have now reduced the dosage to 10 drops and so far, she seems to be manageable.

    Sue Stimpfig
     
  8. Canadian Joanne

    Canadian Joanne Volunteer Moderator

    Apr 8, 2005
    16,105
    Toronto, Canada
    Haloperidol

    Isn't Haloperidol an older drug? There are others which may prove to be better for your loved one. I know I keep repeating myself (God, that's so scary, but at least I KNOW I'm repeating myself) but meds are such an individual thing - what works for one may not work for another. Keep checking the meds, keep researching and keep gentle, polite relentless pressure on the home.
     
  9. Stimpfig

    Stimpfig Registered User

    Oct 15, 2005
    135
    Germany/India
    Other drugs

    Have tried Resperidone (risperidone ?) , Sizodone and Clozapine but it seems like Haloperidol's, though old, is more effective than the rest. A brain scan in my mum's case shows clear atrophy. Am open to suggestions but as I have to pay for all her medical expenses here in Germany, am reluctant to try very expensive drugs.

    Sue Stimpfig
     
  10. Canadian Joanne

    Canadian Joanne Volunteer Moderator

    Apr 8, 2005
    16,105
    Toronto, Canada
    My mother is also on Paxil, Ebixa, Zyprexa and Ritalin (long story). She can be quite aggressive but has certainly calmed down since starting the Ebixa. It has helped her a great deal. Plus, I think that since most AD patients have lost a lot of their ability to express themselves verbally, they lash out physically instead. Although my mother has been aggressive, she has been in situations she found provoking. So the aggression is not completely out of the blue with no logic to it. There is logic but sometimes it's hard to figure out.
     
  11. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    There does appear to be logic

    Canadian Joanne,
    I just wanted to say you hit the nail on the head. I have found that there is always a kind of logic behind my father's actions as well. Sometimes it is very hard to work out what it is that is causing his behaviour but I don't think it is ever random in his case.
    For example:
    * Toilet: Dad hates family members changing him more so than he does non-family members and yells murder if we try and then hates our guts for about an hour after we do change him (sometimes we have had no choice) and looks at us very angrily. He will try to have revenge on you if he can in this situation. Just like a little kid does when they are mad at you. I have found that I can now help to change him if I talk him through it the whole time telling him I know he hates it and I won't look at his private parts and if I have a helper I just get him to keep looking at my eyes so he knows they are only looking at his eyes;

    * Reflections: Dad thinks reflections are real people (though this stage is not so savage any more) so whether he saw them in my glasses, in windows, in mirrors, in car windows and so on he would yell and scream at them, bash anything nearby, shake things. Again I have found that talking calmy to him through it can calm him down, explain to him that they are just reflections, show him by touching his and my faces that they are reflections, and so on. I also warn him of when he's going to see reflections and to try and remember that they are just reflections.

    * Bowel/Bladder movements: Dad appears to find this bodily function extremely uncomfortable. I don't know whether it is the feeling inside his stomach, the feeling of it coming out, the knowledge that he is doing it in his pants, or the feeling of it in his nappy, but I can always tell when Dad is going to the toilet because he comes out with intermittent yells and angry gestures. Its good to know the cause because otherwise you think its something you have said and done and take it to heart as we do. But its just dirty pants and its time to change him;

    * Hallucinations: Dad appears to see things that can terrify him, making him lash out, throw things at them, or just yell. Again distracting him and talking to him appears to work. I acknowledge that he can see them but let him know that I can't and that he really shouldn't worry about them. I don't know if its the explanation or just the calm talking but it does seem to settle him down.

    * Angry days: Sometimes Dad is just angry for angry's sake, who wouldn't be when your life is reduced to this?! On these days he just wants to walk and walk and walk, we just clear a path for him and make sure nothing breakable is around and let him burn it off.

    I think its important to remember that our loved ones don't have the temper control of an adult anymore and anger is one of the few ways they can now overtly express themselves and get their situation noticed. So try not to take it to heart, if you do just let it hurt for a little while and then remind yourself that this person would never have done this but for the disease, and had the done it before the disease you would have been able to tell them why it hurt you and resolve it. I found it frustrating when my step-daughter of 8 used to get angry at me and she wasn't old enough to understand why I did things, with Dad it was 10 times worse. We need to just let it go, try to understand, try to alleviate the causes and roll with the punches.

    Good luck all!
     
  12. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    * Bowel/Bladder movements:

    there was a radio programme recently where they were discussing children.

    One Mum called to say that she had tried to potty train her baby a bit too soon and the wee thing was scared stiff when she saw this stuff that had come out of her. The Mum had to put the baby back in pads at once and continue to use them thereafter. The baby would scream the place down if the potty was produced.

    Perhaps some people with dementia are really scared at this whole thing too.
     
  13. SmogTheCat

    SmogTheCat Registered User

    Sep 1, 2005
    45
    Italy
    My grandmother has became very aggressive (verbally and sometimes phisically).
    She is taking Serenase (5 drops morning, 5 drops afternoon and 10 in the night) and Talofen (20 drops 3 times a day) tio keep her calm but they don't work a lot.
    We notice she is very confused (and now aggressive) when weather is changing... is it normal?
    Sometimes she refuse drugs or simulate to drink them and then trhow them away...
    An other problem is that Talofen is very hard to find in Italy (it seems it hasn't been available in Italy and we can buy only if drugstore has it in the store ) and doctor is looking for an other drugs like it.
    I think grandmohter is at stage 6... we are waiting to find a place for her in a nursery home for Halzheimer but in the meantime we have to "fight" against her aggressivity.
    Sometimes "she imagine" people who say her what to do (generally strange things) or she think all people are against her.
    Sometimes she understand her situation (she says "my brain isn't working. I'm loosing memory" and becomes depressed).
    What we can do when she is aggressive and refuse drugs?
     
  14. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    A suggestion

    Smog (and anyone else interested) I don't know if it is translated into Italian (your English is probably good enough anyway) but a brilliant book for learning how to cope with the behaviours of Alzheimer's sufferers is:

    Learning to Speak Alzheimer's : A Groundbreaking Approach for Everyone Dealing with the Disease by Joanne Koenig Coste

    I cannot recommend this book enough! I have read many books on the topic and most have frustrated me, but this one is brilliant!

    Just remember fighting against an agressive Alzheimer's sufferer will generally mean you will lose, they will get angrier and more agressive, possibly begin to resent you and lose trust. You need to get very clever with this disease and find ways around things. Don't fight against them try to move with them, sometimes it can take a while to figure out how to do this, but there is nearly almost always a way. And even when there isn't a way, the current stage passes and the old problems disappear only to be replaced by new ones!

    Can you mix her medication with a favourite food, can you talk to her and tell her how you worry about her and hope the medicine will help and then leave it with her for a bit and see if she takes it on her own? I'm sure I'm not much help here and you've probably tried these things, i hope someone else can be more helpful.
     
  15. Brucie

    Brucie Registered User

    Jan 31, 2004
    12,413
    near London
    Hi Smogthecat

    changes in weather mean many things.

    • The quality of light changes
    • the air pressure changes
    • the level of humidity changes
    • rain can be noisy
    • wind can be disturbing
    • heat can be uncomfortable

    she may get aggressive because the person nearest is
    • not doing anything to make things better
    • is near them and it is all their fault
    • can't see they are not suffering with the weather
    • just closer and the easiest thing to hit or shout at

    I have not seen the book that Nat suggests but try and get it. All these things help us to cope!

    Best wishes
     
  16. SmogTheCat

    SmogTheCat Registered User

    Sep 1, 2005
    45
    Italy
    When she is aggressive, the first thing she does is refuse to eat and drink.
    Then she says she needs nothing and everybody is against her.
    Generally she shouts to everybody to go out of her house and try to sen them away....

    Sometimes we are able to "calm" her after some minutes shouting more then her but we know it isn't a good solution.
     
  17. Canadian Joanne

    Canadian Joanne Volunteer Moderator

    Apr 8, 2005
    16,105
    Toronto, Canada
    Nat,
    Regarding the fact your father hates family members changing him. I read somewhere that it can be easier to change the person standing behind them. Can't remember if it was this website or the Canadian one. Don't know if it would help but it's always worth a shot. Everything and anything is.
    Joanne
     
  18. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    Good advice

    Thanks Joanne, pretty much got it sorted these days anyway. Sometimes coming from behind can get a nasty reaction too and then when you are in a normal house toilet (in Australia we have a wee, tiny room just for the toilet) there ain't no from behind option anyway!!

    Others may find your advice useful though. Thanks again.
     
  19. Stimpfig

    Stimpfig Registered User

    Oct 15, 2005
    135
    Germany/India
    Dear Smog

    I can understand the weather thing - bad weather definitely has an adverse effect on human beings, even when they have no Dementia. There is plenty of research that proves that sunlight does positive things to the brain/brain chemicals. I read somewhere that it is essential to keep all the rooms well lit so that rooms look bright and cheerful. Shaded lamps and other forms of lighting that result in shadows can be threatening to people suffering from dementia.

    In my mum's case, when she went through this phase of aggression (due to auditory hallucinations), apart from medication, I would sit next to her and give her a hug and gently talk and distract her - asking her questions about what she mostly liked to talk about - her answers were hardly accurate but the distraction served the purpose. I would also reassure her and sit with my arms around her for a couple of hours.

    With my mum, this kind of reassuring and body contact has worked wonders but I know that I have to be prepared for just about anything, anytime.

    Good luck !

    Sue Stimpfig
     
  20. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    Sue, I'm so glad you found that the loving tactic works so well, it worked wonders for Dad too. I think they need reassurance and comfort, afterall that is the main reason behind most aggression, feeling threatened.

    Also your mention of lighting I also found spot on. You have to look at the room they're in when they get agressive, does it have shadows, reflections, things that move, strange smells and so on. Something changes with Alzheimer sufferer's sight or perception. I often think that maybe it is like when I was a kid I would imagine all sorts of boogey men in the shadows, I remember being petrified in bed for a whole night when I was a kid watching what I thought was a big man's boot standing in my room (logic of a kid and perhaps alzheimer's I didn't think about the fact that I could not see a leg attached to the boot! :p ), when morning came it turned out to just be my school bag!!!! :rolleyes:

    I will again recommend the book I mentioned in a previous post in this thread, it is written by a woman who's husband got dementia when they still had young kids, in it she offers practical advice and explains a lot of how she came to understand her husband's erratic behaviour and what she did to alleviate the stress. Something about her love for her husband throughout it comes through and the book also has a calming effect, it allows you to take a deep breath and see dementia from the sufferer's side. Gives you new ways of handling the situation. I recommend read it once, you will notice a positive change in yourself and the person you care for and then if things start to get tough again, go back and read it again, old habits die hard and so you may need to get re-focused again.

    Smog you said:
    What you need to do at this point is stop fighting against her. Walk away from the aggression come back to her when you are ready and be all smiles and love and jokes, very relaxed, reassure her and so on, let her know that you don't hold a grudge by your actions. Dad used to watch Mum incessantly when they had fought about something with a hurt but angry look, then she would try to get him to do something again and he would fight her, she needed to let him know she wasn't angry and then he was good again. Ignore her aggressive behaviour if you can, or simply say 'I'm sorry thats how you are feeling, what can I do to help?' the trick is to keep reassuring and not make a big fuss or fight about the aggressiveness. Sometimes yes you need to step in, like Dad used to try throwing chairs around the house. In that case we would just calmly go around and remove what was throwable and let him wear himself out (by the agression stage we could always move & think faster than him). They can't keep it up forever especially if they have noone to fight against. Once your mother is calm again try talking to her about the medicine. We've told Dad how we are really scared that if he doesn't take his medicine he won't be able to hold on long enough for us to find a cure or that we don't him to be sick when he doesn't need to be. These days he watches the guy that gives out the medicine at the home and yells at him if he doesn't hurry up and give him his medicine! Maybe he's addicted? Though I never heard of dementia drugs being addicitve!
     

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