Murder Case Illustrates Importance of Taking Steps to Lower Aggression in Those with Dementia
News outlets reported over the weekend that 98-year old Laura Lundquist faces a murder charge in the death of her 100-year-old nursing home roommate, Elizabeth Barrow. Lundquist is accused of strangling Barrow and then smothering her with a plastic bag. The alleged murderer has a history of dementia; in fact, the district attorney and the defendant’s attorney filed a joint motion for a competency examination because of the Lundquist's dementia and own fear of being strangled.
The Boston Herald.com reporter O’Ryan Johnson wrote: “Court papers paint a chilling picture: Before she was killed, Barrow complained to a nurse that Lundquist had put a table at the end of her bed blocking Barrow’s way to the bathroom, documents show. Over Lundquist’s objections, the nurse moved it. Barrow was last seen getting up to use the bathroom about 6 a.m. When the nurse arrived to wake her at 6:20 a.m., Barrow was dead and the table was back to the end of the bed. ‘The defendant harbored hostility . . . because she believed the victim was taking over the room,’ court papers say. ‘The defendant made statements prior to the victim’s death that she would get the victim’s bed by the window because she was going to outlive her.’ After Barrow’s death, the nursing home moved Lundquist to another room, where she saw a plastic bag and told her new roommate, ‘I hope I don’t have to use that,’ court records state. Lundquist was then taken to Norwood Hospital."
This sad case unfortunately could happen again as the U.S. population ages and dementia becomes more prevalent. Many families who have a loved one with dementia have been surprised by the exhibition of sudden aggressive behaviors. The Fisher Center for Alzheimer’s Research Foundation reported, “Someone afflicted with Alzheimer's may go through periods of swearing, screaming, throwing objects, resisting care, or attempting to hit others. Verbal assaults are more common than physical ones. Fortunately, such hostile behaviors are usually temporary. Disruptions commonly occur if a person with Alzheimer's feels their personal space has been invaded, for example, during dressing, bathing, or a doctor's appointment. It's important to understand that someone with Alzheimer's is more likely to misinterpret certain actions and respond aggressively. Aggression can also arise as a result of a physical illness such as constipation or infection, pain, depression or anxiety, or lack of sleep.”
So what can you do to avoid a confrontation? Here are some suggestions:
Separate the Individuals – This, I believe, is where the Massachusetts nursing home failed. They should have found ways to separate the two, especially at night when the women were alone with each other. CNN reported, “District Attorney C. Samuel Sutter said Barrow repeatedly complained that Lundquist was making her life ‘a living hell’ in the weeks leading up to the woman's death, and that Lundquist remarked that she would outlive her roommate. A nursing home spokesman said the facility twice presented Barrow with the chance to change either rooms or roommates, but she declined each time. He compared the pair to ‘sisters,’ saying they took ‘daily walks together ... ate lunch together every day, and were heard at night saying, 'Good night, I love you,' to each other.’" Because dementia can cause such wide mood swings in a person, I think the nursing home staff misread Lundquist’s growing aggressiveness that Barrow. And based on my own experiences being at a nursing home with Mom, I would hypothesize that the nursing staff may have encouraged the pair’s closeness by seating the two together at lunch and having them take walks together. This closeness could also have been a result of staffing issues, especially if the same nurse’s aide was assigned to work with both Lundquist and Barrow.
I believe that at the first signs of aggression, the nursing home should have gone on high alert and kept records of what was happening. If the situation was escalating (as it seems based on CNN’s report of Lundquist’s comments), the nursing staff should have made the decision to separate the two by moving them to different rooms so that they would not have been left unsupervised.
Separation worked well in both situations that I experienced with Mom. For instance, within a few months after her admittance to the nursing home, Mom – who had been a strong-willed, independent and kind woman before Alzheimer’s set in – slapped another female resident in the nursing home. I can still remember when I pushed Mom in her wheelchair past the other woman soon after this incident; the two locked eyes and glared at each other as they passed. From then on, the nursing home’s staff members did everything they could to ensure that Mom and the other woman were at opposite ends of the common room.
Another situation happened a year later when Mom and her roommate became equally enamored of a stuffed monkey holding a banana. Both claimed that the doll was theirs and wanted it nearby. I finally just put the monkey on top of the TV at the center of the room. I hoped that each woman would think she had ownership of that monkey since it was located in plain sight. I also hoped each woman would forget about the other woman’s existence since a curtain was often pulled between the two beds to divide the room and to give each one some privacy.
Be Ready for Overreactions, Which May be a Signal of Pressure Building – In their informative book, “The 36-Hour Day,” Nancy Mace and Peter Rabins note that people who have brain diseases can become excessively upset and experience moods that change very rapidly, especially when facing strange situations. They use the term “catastrophic reaction” to describe the behavior that the person displays when he or she is facing strange situations or experiencing confusion. Mace and Rabins wrote, “Often a catastrophic reaction does not look like behavior caused by a brain illness. The behavior may look as if the person is merely being obstinate, critical, or over-emotional.” The best way to manage these types of reactions is to stop them before they happen. And yes, one way to do this is to remove the person from the situation in a quiet, unhurried way. Also, by maintaining a calming presence that exudes being in-control, a caregiver can head off a catastrophic reaction.
Take Notes about What is Happening – It’s important to document what is happening when a loved one with dementia becomes aggressive. “The caregiver should also keep a written journal of events that lead to aggressive behavior. Describe what happened just before an outburst, how the person acted, and what ensued. The journal should also list how often aggressive behaviors occur and what, if anything, reduces the outbursts,” according to The Fisher Center for Alzheimer’s Research Foundation. This information may be shared with the loved one’s doctor who may prescribe medications to ease aggressiveness. The journal also may serve as a useful checklist in determining how one can help a loved one avoid aggressive (and violent) behaviors.
The situation in Maryland provides a cautionary tale of which all caregivers need to take note. Aggression can escalate and, in some cases, prove to be fatal. Taking steps through separation, anticipating these overreactions, and documenting the facts about the aggressiveness can help caregiver take steps to assist a loved one in lowering his or her level of aggression.