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Dealing With Elderly Anger Outbursts & Hostility As healthcare professionals many of us if not all has encountered a resident that is not having a good day. It is not all that unexpected however, in our line of work to experience outbursts and hostility mood swings. They may result from dissatisfaction, poor health, stress, pain, and a loss of dignity can easily lead to surprising and potentially harmful behaviors cause undue emotional hardships on both staff and residents alike. These scenarios are emotionally stressful for all parties and may need a considerable amount of energy, patience and empathy, to redirect. Research studies report that “mood disorders are frequent in old age and their prevalence is increasing with population aging.” https://companionsforseniors.com/2019/04/mood-swings-elderly-seniors/#:~:text=Another%20prominent%20research%20study%20notes,therapy%2C%20or%20a%20medication%20regimen Getting older can magnify our unique character traits, often in undesirable ways. Someone who was crabby in their younger years may be prone to full-on bouts of range in the aging years. Unfortunately, fellow residents and our professional staff members often are the target of these outbursts, and although in many cases it may seem at times as though there was no apparent clinical “trigger” such as a diagnosis of Alzheimer’s or prolonged chronic pain that may be attributed to the root cause; these behaviors are non-the-less and often enough, the most challenging to overcome. Know Your Resident That said, there are tried and true strategies and techniques that you will need to master to turn around a bad day into a pleasant (uneventful) good day. Below you can learn about several well described options that offer alternatives to reduce the tension and redirect even the most “crankiest of crannies” and help preserve your own mental wellbeing in the process. Simply stated, one of the most effective “tried and true” strategies is to know your resident. A thorough and comprehensive understanding of the elements that have potential to trigger your resident long before it leads down that unwanted behavior rabbit hole will always save the day. Clearly, this is not going to happen as quickly as one would hope for but with consistent observation/evaluation and comprehensive documentation such as Behavior Logs, will greatly identify the root cause of the problem be implemented in the resident Care Plan as Behavioral Interventions. Most importantly, be mindful to ensure that every staff member (all shifts and disciplines) are aware of these triggers. Communication and consistent unilateral Interdisciplinary staff support are major factors to this success story. Note that is can take up to “TWO” weeks for a resident to give up unwanted behavior because the behavior has become a coping pattern and is all the resident knows to find comfort. How to Handle Elderly Anger Outbursts The first step to dealing with these problems is to understand that these negative emotions are not personal. Pain and disease has an undeniably strong potential to cause very inappropriate behavior. The best strategy when dealing with difficult elders has a great deal to do with (Four C’s) - communication, clarity, consistency and compassion. Be mindful that optimum communication breakdowns between staff and resident may be further compounded by receptive and expressive resident impairments. Be consistent, repetition will enforce the concept of desired change. Cursing and Abusive Language Verbal abuse and harsh language can be an even more complicated story. Profanities that are “out-of-character” are often the result of Alzheimer’s disease, which can make it particularly difficult to manage. While there’s no cure for some conditions that present cursing and abusive language, mitigating the behavior can often be achieved by using distractions in the form of redirection. For example, divert your residents swearing bout by introducing another scenario that you are certain will be well received as more desirable and enticing by your resident. Example: “Mary I need your help today to make your favorite dessert – let’s go to the kitchen to get the ingredients ready.” Paranoia and Hallucinations Residents may believe that others want to cause them personal harm. In some instances the clinical team has already noted that the resident suffers from paranoia or hallucinations or another disorder that is a known root cause. It is not uncommon for paranoid behavior to be associated with a diagnosed disease such as Alzheimer’s disease but there are other illnesses that will also lead to paranoia. In these cases, the best solution to the problem of paranoid behavior is to try and use relaxation and validation techniques. Additionally, this may need to be combined with medication management. You generally won’t be able to convince someone what they’re experiencing is unreal, and doing so may increase the residents’ frustration or anger. Note that it is reasonable to go along with the residents’ allusion when the experience in of itself is clearly pleasant and does not have the potential to cause harm to self or others. Attentive patience and consistent caring oversight has everything to do with your residents’ success story and yours. “Perseverance is not a long race; it is many short races one after the other.” -Walter Elliot https://www.agingcare.com/articles/how-to-handle-an-elderly-parents-bad-behavior-138673.htm https://www.griswoldhomecare.com/blog/2015/july/dealing-with-elderly-anger-outbursts-hostility/ Have a topic request or question for Celeste? Send them over to firstname.lastname@example.org Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2022 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2810 US HWY 190 W Ste 100-A9 Livingston, Texas 77351
View this email in your browser Wandering Residents In residential aged care facilities there are many factors that may influence residents to wander. These commonly include: Inactivity/boredom – lack of activity may lead the person to wander around looking for something to do. In some instances wandering dissipates loneliness and the behavior in and of itself, is often a substitute for lack of social interaction. In contradiction, wandering surprisingly may also be a response to overstimulation and overwhelming situations. Fear, agitation, and confusion commonly lead to “dementia” wandering outdoors or in public environments. Some emotional cues that can cause wandering include: increased levels of stress or fear. Residents with “dementia” who wander are moving about in ways that may appear aimless but often have purpose. People may wander in response to an unmet basic need like human contact, hunger, or thirst; a noisy or confusing environment; or because they are experiencing some type of distress, like pain or the need to use the toilet. Wandering can be helpful or dangerous, depending on the situation. The Balancing Act It’s a balancing act for sure but it is important to look beyond the words or behaviors to discover the feelings that the resident might earnestly be trying to express. Strong emotions may also be caused by unmet needs. Staff must implement the process of deduction to work out what needs are not being addressed and meet the resident “where they are” when possible. Residents may wander for any number of reasons: Physical needs Psychological and social needs Cognitive needs Non-goal-directed wandering requires a response in a manner that addresses both safety issues and an evaluation to identify root causes to the degree possible. Moving about the facility aimlessly may indicate that the resident is frustrated, anxious, bored, hungry, or depressed. Although people who wander may gain social contact, exercise, and stimulation, the resident may consequently become lost or exhausted. Hence, they may become overwhelmed and over tired, which predictably causes sudden outwardly hasty behaviors such as wandering or higher probability of injuries to self and/or others. Person-Centered Care for Wandering Behavior Simply stated, some basic principles for people with dementia stems from understanding and supporting the residents’ rights. To be sure, the onset of dementia does not preclude inherently due personal rights. Understand that the individual beyond the “dementia” is becoming increasingly hidden rather than lost. This means that he/she is still there, and it’s your mission to reclaim the essence of the individual that once was and bring them out of hiding. Those who were highly sociable and had an active lifestyle prior to having mental decline are most likely to wander. The use of certain antipsychotic medications can cause side effects that increase the desire to wander and be in perpetual motion. Sedating medications can also increase the risk for wandering due to confusion. Other causes of wandering include the following: Memory deficits Poor vision Disorientation Language deficits Searching for security Searching to fulfill an unmet need such as to relieve hunger, thirst, pain, constipation, and the need to urinate Searching for a loved one Boredom Person centered care plans must consequently demonstrate this principle. Here are some examples of appropriate goals: Personalize the resident’s surroundings. Interpret behavior from the resident’s viewpoint. Acknowledge and validate the resident’s feelings. Involve the resident with dementia in decision-making. Create target goals for the resident to achieve based on resident history and his/her skills that have not yet been lost. Focus on the journey- not the results. Evaluate the Behavior Physical Needs: Does the resident need to use the bathroom? Is the behavior due to medication side affects? Is the resident: Hungry, thirsty, or generally uncomfortable? Searching for a place that is warmer or cooker, darker or lighter? Looking for a place that is more familiar (does the resident have familiar belongings in his/her room)? Responding to physical illness, e.g., dehydration, infection, congestive heart failure, etc.? Psychological and Social Needs: Is the resident: Restless or agitated and trying to relieve anxiety? Bored, lonely, or seeking company? Following a previously familiar imprinted routine: acting out movement to and from the bus stop to pick up the children – going to work? Cognitive Needs: Is the resident: Disoriented or lost? Disoriented due to medication side affects Overstimulated or understimulated? For the resident, wandering may be positive if it fulfills a need for exercise, sensory stimulation, or purposeful behavior. Many nursing homes provide a safe environment on a locked unit for this reason. The negative side of wandering is it may lead to falls, excess fatigue, anxiety, accidental exposure to certain chemicals, altercations with other residents and unintended wandering outdoors where more danger may be waiting to cause harm. Make it your mission to find the balance in the day and life of your resident by looking beyond the words or behaviors to discover the feelings that the resident might earnestly be trying to express. Have a topic request or question for Celeste? Send them over to email@example.com Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2021 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2810 US HWY 190 W #100-A9 Livingston, Texas 77351