Mental Health Month: Caregiver Guide to Dangerous Behaviors in Alzheimer's
May is Mental Health Month and I want to talk about the very difficult and emotive issue of dangerous behavior in people with Alzheimer's. Over the years many people have asked our advice about some aggressive or violent behavior a loved one is exhibiting, and what they should do about it.
Violent incidents or threats of violence occur for a number of reasons. As Alzheimer's disease progressively causes more and more brain damage and neuron cell death, it can lead to behavior totally out of character for that person. Alzheimer's is associated with impairments of judgement and this can result in the person affected being unable to work out the consequences of their acts. Alzheimer's disease also reduces the person's capacity to reason and they are unable to appreciate how their behavior affects others.
A number of studies have found that the presence of anosognosia, a lack of awareness or denial of a neurological defect or illness, is associated with a significant increase in the risk of dangerous behaviors. This can lead to threats and acts of violence because of misinterpretation of events, paranoid delusions, inappropriate reactions to individuals and to caregiving procedures such as dressing, washing, having a shower.
Caregiver perception of danger varies
To complicate the issue, the way in which we as caregivers, perceive dangerous behavior in someone with Alzheimer's does vary. The overt, very obviously dangerous situations are the same for us all, for instance, being violently assaulted, threatened with a gun caregivers, being driven by someone with Alzheimer's at dangerous speeds.
Some caregivers find being shouted at or pushed aside less worrying than others and this alone can have a major impact on care planning and placement. It can sometimes be the case that neither aggression nor violence is the problem, but agitation or anxiety is. This can lead to situations of grabbing and pulling where the caregiver is left bruised and upset. Given the fact that many caregivers are themselves frail and elderly, the situation may be quite dangerous for them. This isn't always the case and sometimes the ability to cope is more due to perception and past experience. For example:
The perceived (real or otherwise) threat to personal wellbeing.
Previous experience, perhaps through jobs, sporting activities, socialization, and life experiences
Physical, social and emotional support
Preventing Escalation, Responding to Danger
We all want to make decisions that are in our loved one's best interests. It is sometimes a balancing act involving human rights and maintaining individualism under the banner of ‘doing good/doing no harm.' But when harmful or dangerous behavior is involved your primary consideration must be safety. You must get help, so my strong advice is not to deal with this alone.
The following agencies may be able to assist or advise:
If you believe you or the person with Alzheimer's is at immanent risk contact the police.
You may need to contact a lawyer and plan for Power of Attorney.
Alzheimer's affects legal status in a number of different ways. Having information can help guide you at this difficult time is important. You must also think about the human rights of someone with Alzheimer's who needs protection and legal services.
Contact the doctor who can advise you on medical care such as medication changes, investigations on any causes besides Alzheimer's and any treatments that may stop or reduce incidence of dangerous behavior. The doctor may also be able to help you decide on options for the involvement of other agencies, such as Social Services. He/she may help you decide on moves to a care facility for assessment or permanent placement if necessary.
Social Services can provide information and support on the care options in your local area. They can also support you and your family.
It is helpful and supporting for caregivers to involve other members of close and extended family. Knowing their opinions, getting advice, understanding how they will help (or not), can all contribute to you making important decisions about the care of someone with Alzheimer's who is exhibiting dangerous behavior.
Other Support Agencies
Your local Alzheimer's Association can offer support for caregivers, give advice and suggest help you may not have considered.
Eur J Neurol. 2007 Apr;14(4):455-60.
Insight and danger in Alzheimer's disease.
Starkstein SE, Jorge R, Mizrahi R, Adrian J, Robinson RG.
School of Psychiatry and Clinical Neurosciences University of Western Australia, WA, Australia. firstname.lastname@example.org
Agronin, M. E. (2004). Dementia a practical guide. New York: Lippincott Williams & Wilkins.
Downs, M., & Bowers, B. (2008). Excellence in dementia care. Open University Press