When someone living with dementia is distressed or violent, de-escalation is vital

Today’s news story of the alleged taser of a 95-year-old woman living at Yallambee Lodge aged care home in New South Wales brought into focus the question of behaviors and psychological symptoms of dementia.

Over half of those living in residential care are diagnosed with dementia, and up to 95% of those living with dementia will experience such behaviors at some point during their transition through the disease. Common behaviors that may be exhibited by those living with advanced dementia include agitation, anxiety, attempts to leave care, aggression, apathy, sleep disturbances, aimless pacing, psychosis, and aggression.

The full circumstances of Wednesday’s events are unclear and are subject to a police investigation. It may take some time. What is clear, however, is that there is much room for improvement in the way the behaviors and psychological symptoms of dementia are managed in residential care. Situations that end up involving the police should be avoided.

Read more: Unhelpful treatments: Antipsychotic drugs are rarely effective at ‘calming’ dementia patients

Call for help

In its final report of March 2021, the Royal Commission in Aged Care Quality and Safety recommended that all workers employed by providers who are involved in direct contact with people seeking or receiving services in the aged care system undergo regular training on dementia care and palliative care.

Currently, it is not uncommon for the police to be called in to respond to incidents in nursing homes. While programs have been implemented to better equip the police to respond to the specific needs of those living with dementia, this work is still in its infancy.

Aggression and agitation are two of the most common behavioral symptoms leading to referral to specialist support services.

Dementia Support Australia is a Commonwealth funded service which has supported aged care homes and carers in managing the behaviors and psychological symptoms of dementia since 2016. There were 8,702 referrals to the service between January and June 2022. The number of referrals has increased in recent years.

As a frontline dementia support organisation, we extend our deepest condolences to the 95-year-old resident, her family, the staff of Yallambee Lodge and all others affected by this devastating incident.

One of the benefits of having a national service such as this is that it has enabled the development of a national database documenting not only the nature and severity of deferral behaviors, but also those factors that are most commonly identified as triggers for them. behaviors.

the assistant puts his hand on the hand of the elderly person, who is holding a walking stick
When people with dementia exhibit worrying behaviors they have unmet needs.

Read more: Why is my loved one with dementia sometimes ‘there’ and sometimes not?

3 main causes

Aggression and agitation are not diagnoses in themselves, but symptoms. Symptoms have causes and these must be identified in order to adequately address the behavior.

The main contributing factors that we have identified in relation to the behaviors are:

1. Unidentified or undertreated pain

This is relevant in over 50% of the cases we see. Previous research on pain management in the setting of advanced dementia has shown that those with a diagnosis of dementia who are admitted to hospital with hip fractures tend to be prescribed only a fraction of the analgesia given to those without dementia.

2. Caregiver approach

Care staff receive only minimal levels of dementia care training as part of their core qualification and are often unfamiliar with communication strategies tailored to people with cognitive impairment.

Currently, the minimum qualification for a personal assistant does not have compulsory units in dementia expertise. While we don’t know the full circumstances of this week’s events, the Royal Commission has made recommendations to improve care for those living with dementia. The caregiver approach is a problem in about a third of the cases we see.

3. Over and under stimulation

Boredom and loneliness and/or an environment that does not cater for the specific needs of those living with dementia are a problem in around a quarter of Dementia Support Australia cases.

Other common causes of changed behavior include mood and anxiety disorders, communication difficulties, delusions, sleep problems, and a caregiver’s lack of knowledge of the specific likes/dislikes of the people they care for.

People with dementia can react to uncertainty in unexpected ways.

Read more: Should we move our loved one with dementia to a nursing home? 6 things to consider when making this difficult decision

Prevent and calm things down

The best way to manage most behavior changes is to prevent the circumstances leading to their development in the first place. Prevention is always better than cure.

Once behaviors happen, there is no single right way to scale them. The appropriate de-escalation strategies will always be specific to what caused the altered behavior in the first place.

Unfortunately, when the behaviors have escalated to the point of requiring police presence, intervening officers are unlikely to have the necessary information about the person and their circumstances. This means they will not be equipped to respond with effective and specific de-escalation strategies.

A 2020 US case involved the arrest of a 73-year-old woman with dementia who left a local store without paying for items of modest value. A lawsuit filed following the arrest claimed it resulted in a broken arm and dislocated shoulder and raised nationwide concerns about how first responders interact with those with cognitive disabilities.

Australia must learn from yesterday’s events and respond.

If you are caring for someone with dementia, there is help available. Dementia Support Australia is a free service, fully funded by the Australian Government. Reports can be made 24 hours a day by calling 1800 699 799.

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