There can be a lot of mystery in dementia care, but there are ways to shed light on things if we learn to look beyond, behind, and beside to find clues.
In this dementia care workshop, How to be a Better Dementia Detective, dementia-care coach Susan Macaulay teaches us how to find clues to unlock the mysteries of dementia care.
You will learn how to:
- Find clues you’ve missed in the past
- Solve mysteries of “strange” behaviors
- Build a better care environment
Please watch the replay by clicking below:
Or listen on the go:
Download the audio file by clicking the down arrow below:
As discussed in the workshop, to help you continue your educational process, here are the resources we mentioned:
- 10 Dementia Detective Basics – Susan’s “cheat sheet” to help you find clues to better understand what is really happening
- 29 Normal Behaviors You Would be Sedated for – first in a series of vignettes by Susan
- Nursing Home Behavior Problem Scale – antiquated system still being used today to evaluate behavior
- An Analytic Approach to Behavioral Intervention – a pdf to help us move away from antipsychotics by seeing negative behaviors as communications rather than symptoms
- Dementia Beyond Drugs – book recommendation
We also had a 30 minute follow up conversation as part of the Together in This Dementia Conversations series.
Be a Better Dementia Detective
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Questions or thoughts? Let me know by commenting below:
Sue Noble says
Hi Susan and Mike,
I am feeling so guilty for giving my husband with Alzheimer’s drugs, but he has become so agitated and violent. He is at home. I have looked at environment, activities, what has happened before an incident, and there is no common denominator. I am beginning to think that he might be better in a care home, but if I did that the way he is now, they would just drug him anyway.
There is no tv on, there is plenty of light, and there hasn’t been any change in his schedule or routine.
I can now see in his face when he starts to get angry, and basically just stay back, and try to make sure he doesn’t hurt himself. He will throw things, tear off screens, pull things off the wall and push shove or kick anyone that gets in his way.
He gets more angry if we try to distract him, or talk or touch him while this is going on, or just before this happens.
He is in late stage Alz, and was diagnosed at the age of 57. Any thoughts or suggestions?
Susan Macaulay (@AmazingSusan) says
I’m sorry for what’s going on with you and your husband. It would be helpful to have more details and I invite you to contact me directly here: Susan at amazing women rock.com; perhaps we could talk.
These are some of the questions I have, and which a doctor should also have:
Is this behaviour new? What medications did you start giving him? When? In what doses? Are they helping? Who prescribed them? What other medications is he taking? In what doses etc.?
How long do these outbursts last? How frequently do they occur? Do you feel threatened?
Do you think he might be in some kind of pain? Has he been tested for a urinary tract infection? Does he have any other illnesses?
You are right, if you put him in a home and he’s behaving like this, it’s highly likely he will be given more medication. That said, it may be possible to find a facility that will help him get off all medications, which is one option. It may be that if he is on multiple medications, some of them are reacting negatively with each other.
However, it may also be that this is a case where medication is required. Coincidentally, this afternoon I had an hour-long phone conversation with a palliative care specialist in Halifax, Canada. She and I agreed that there are circumstances in which there is no other choice but to medicate somebody who is in deep distress, and or who poses a significant threat to themselves or others.
As an example, she mentioned the case of one of her patients, who was trying to strangle his wife. In another case, a husband kept fleeing his home and running into traffic to such a degree that the police said if they found him again, they would institutionalize him. Everything had been tried, nothing had worked, and medication was the only solution.
The doctor’s name is Paige Moorhouse and you can listen to her most recent webinar with the brain exchange at this link: https://vimeo.com/163709960 . You may find it helpful to hear the cases she talks about because she clearly mentions the stress that all of this puts on caregivers. It may help to assuage your feelings of guilt.
It sounds like your preference is to keep your husband at home if possible rather than to place him in a long-term care facility. If that’s the case, medication may be your only alternative to keep him and yourself safe and secure in your own place of residence.
You mentioned that if you try to distract, talk or touch him he gets even angrier. Clearly, you should stop doing anything that adds fuel to the fire, which I’m sure you already know. Have you tried playing soft/soothing music?
I know how you must feel. However, you are doing your best, and there is no reason to feel guilty, even though I know that’s easy enough to say and we feel what we feel even if it makes no sense.
If medication is the only solution, one thing to remember is that reducing the medication should be tried after a period of time. The guidelines in Australia say reducing the medication should be tried after 12 weeks, and a new set of guidelines recently published for the United States say try reducing after 16 weeks. As the disease evolves, this behaviour might simply stop on its own, in which case medication would no longer be required after a while. One of the problems with medication is that once people are on it those whose prescribe it seemed to be reluctant to de-prescribe it.
Sue, I’m not a doctor, and as such I’m not qualified to give medical advice. These are simply my opinions based on my experience.
If you’d like to talk, please feel free to contact me by email.
Standing with you,