Dementia patients can benefit from the same de-escalation techniques and calming methods used by healthcare workers and first responders. They’re trained to de-escalate tense situations, mostly by talking. But their training goes beyond what to say. It’s understanding their body language and that of the other person, validation, understanding the room they’re in, mitigating risks, and protecting everyone involved.
Typically when we think of healthcare and law enforcement de-escalation we think of tense situations involving a weapon like a gun or a knife, and a person angry about something that happened. The comparison to dementia patients is uncomfortable, but aggressive dementia exhibits a lot of the same responses from people: agitation, aggression, pain, uncontrollable or unknown behavior, and escalating tension with others in the room. And, sometimes, dementia patients can use objects in a room aggressively, like knives or needles.
To de-escalate a situation, caregivers can help manage patients safely by meeting a person’s immediate needs. That may require emotional, physical, and mental effort on everyone’s part.
Rules and boundaries may fail as dementia progresses
Dementia is a disease that impairs a person’s cognitive function. Often, it’s difficult for us to imagine someone who might have been easy-going and considerate to suddenly become uncooperative, combative, rude, or angry. The expectation of caregivers is often to place rules and boundaries. But, we know at least two dozen sources can cause dementia. Everything from a head injury to Alzheimer’s. In every situation, a person’s ability to process problems and their environment degrades.
To better understand ways of communicating with someone who is upset, recognize that dementia comes in three broad phases:
- Mild dementia. Forgetfulness is the most common indicator. Often perceived as a normal sign of aging and blamed on stress or over-work, dementia here can be managed with reminders, notebooks, calendars, etc. It’s likely the patient recognizes their memory is failing, and this can elicit fear and sadness. Most loved ones are still recognizable, however.
- Moderate dementia. This manifests in the form of repeated questions, paranoia, anxiousness at what were common tasks or events, depression, and loss of control. Hygiene and self-care, often in the form of not eating or sleeping, and withdrawing from friends, family, and past interests are also problems at this stage.
- Severe dementia. Daily living is no longer possible without assistance, even for brushing teeth or bathing. The patient may become non-verbal, lose control of their arms, hands, and legs, and may require admission into a specialized facility.
What to do when a dementia patient is aggressive or escalating
We train healthcare staff and first responders to handle escalating situations. We tell them to:
- Avoid aggressive body language, like clenching your fists, crossing arms, or scowling.
- Maintain eye contact, but don’t stare aggressively.
- Keep your breath under control.
- Stand at a slight angle. This makes you seem “smaller” and less aggressive. It also reduces the amount of your body that’s exposed if they start to punch, kick, or throw objects.
- Speak firmly and calmly.
- If they’re family, say something that triggers the relationship, like, “Dad, I understand you want to do X. I can help.” Otherwise, use their first name if you know it.
- Keep your voice low and modulated.
- Don’t argue or use negative words like “No” or “You can’t”. This can be challenging, but it’s critical that a person doesn’t perceive you as combative or a barrier.
- Allow only one person to talk. This is critical for families who want to help, but multiple voices add confusion.
- Even if you’re right, don’t try to prove it. This is just another way of saying they’re wrong, which can make them agitated.
- Try to release or undo whatever caused their aggression. If they didn’t request food and you insist on feeding it to them, give them time for a little while.
- Never be patronizing or treat them with anything but respect. Remember, they’re still adults with feelings and rights.
Securing the environment during de-escalation
Safety is priority one — for you, your loved one, and everyone else in and around the room.
- If someone seems aggressive and could hurt you, place a piece of furniture like a chair between you and them.
- Always know where the exits are and keep doors open.
- Remove objects like glassware, knives and utensils, and glass ashtrays.
- If they’re still living at home and have a firearm, remove the firearm from the house entirely, place it in a safe if it’s not already, or change the combination on the safe. It may feel unsupportive, but it’s the single greatest threat in the house.
- You may find it helpful to have favorite shows or music handy on the television or speaker. You can also attempt to shift focus to a different activity.
What to do after an aggressive event
We learn from past work practices, we take note on tactics that are successful and those that are not. You can, too, by asking these questions after an episode:
- Understand what happened and why.
- Ask them how they feel and if they know what happened.
- Ask yourself if there’s a way to prevent the situation from happening again.
- Consider ways to ask for support — such as home health aides, nurses, medication changes, and moving.
Remember, too, that dementia has a way of being wholly unpredictable. What works today might not next week.
Vantage Point offers de-escalation training for law enforcement, healthcare, and first responders. If your team needs training and wants to ask more about how to help dementia patients along with other dangerous situations, contact us or request a class.