02/10/2014
This is a great blog article on Alzheimer's and Agitation
Alzheimer's, Agitation, Infection, P*e, and the Full Court Press
Studies indicate that agitation or aggression is seen in up to 80 percent of Alzheimer's patients.
I think about this all the time because the number of emails I receive about Alzheimer's, dementia, agitation, and meanness are hard to keep up with.
By Bob DeMarco
Alzheimer's Reading Room
Alzheimer's Ostrich
Believe it or not at times I looked like this
Obviously, agitation or aggression can lead to an Alzheimer's patient being placed in a nursing home, or a specialized memory care facility.
Placement of this type can lead to the use of pharmacological agents (antipsychotic medications) to "control the patient".
There is clear cut clinical evidence that the use of antipsychotics can increase risk of death in dementia patients.
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After reading the emails and comments for years, talking to people throughout the Alzheimer's community, and relating back to research on the problem of agitation and aggression, it seems to me that many of these behaviors can be treated without drugs, and possibly in the home environment.
Example number one.
It took me years to discover that Dotty was suffering frequent urinary tract infections. Her core temperature was 97.6. So when we went to the doctor and the nurse got a reading of 98.4, the perception was that Dotty was fine and dandy. It was only by accident that we discovered the problem. I asked our doctor to check my mother's hydration level. The results showed that she was hydrated; the result also showed that Dotty had a urinary tract infection.
Dotty suffered from silent urinary tract infections. Or, lets put it this way. She has never said to me, I'm sick, or I think I have a "bladder infection".
As it turned out, I learned to take Dotty's temperature frequently. Subsequently, we caught 7-8 urinary tract infections that would not have been detected otherwise.
It is now clear to me that two things happened when Dotty had a urinary tract infections.
She got agitated. Or, sometimes very dull like "not there".
By checking her temperature daily we caught these infections quickly, long before they worsened, and before Dotty became meaner than a junkyard dog.
However, it is not unusual for Alzheimer's patients to end up in an emergency room more or less, "out of it" as a result of UTI that goes undetected.
The "out of it" and a big spike in temperature leads to the emergency room visit. At that point the infection gets diagnosed.
The problem here.
Frequent, or strong infections can lead to memory loss.
Memory loss that might never be regained. Infections in dementia patients can lead to hallucinations, agitation, and aggression.
Read the previous sentence closely and several times.
The single best way to prevent urinary tract infections is with frequent toileting.
In other words, don't ever go longer than 90-120 minutes without "prompting a p*e".
You don't want someone sitting around with even a little bit of p*e in their briefs or panties. This is the breading ground for E Coli.
Problem behaviors with dementia patients are more prevalent than most of us realize, this certainly included me.
Dotty was mean to me when I arrived on the scene in Delray Beach to take care. A meanness I had never seen or experienced from here before.
She was meaner than a junkyard dog.
Most people assume that Dotty was a model Alzheimer's patient. Happy and sweet all the time.
Well she was a model Alzheimer's patient for sure. Mean, confused, angry, agitated, and you might have called her Doctor NO.
We had to work through problems like the above one at a time.
I know I sometimes make it sound easy, but the truth be known, I was still learning after eight and a half years with Dotty. And, still solving problems.
Here is the good news. I continue to new and better ideas all the time which explains, in part, why I am still here.
Like I already said, when AD first set in, Dotty was meaner than a junkyard dog. This lasted for about 3 years. The first 15 months was the period of greatest burden, and the next 21 or so was the period of lessoning burden.
Then we finally make it far enough along the path called Joy that the burden began to lesson.
Who knows? Maybe Dotty and I just decided to call a truce.
It now seems to me that I stumbled on the long term solution to mean behavior by accident.
My first important decision was exercise in a gym. So let me ask you, if you have an agitated or aggressive patient are they getting "real" exercise everyday? Are they engaging in activites? Are they living life?
Is your agitated or aggressive patient living in a very fertile environment? Is the person receiving constant stimulation via conversation and socialization? Or, when they are mean, do you leave them all alone while you "stew" about it.
Well I stewed about so many things I can't remember them all. Thank goodness.
Have you tried introducing music into the environment? Most cable systems now have music channels.
Are you making sure that the agitated or aggressive patient is getting heavy doses of bright light daily?
If you have an agitated or aggressive patient, are there patterns to the behavior?
Does the bad behavior come near the same time of day? In near darkness or darkness?
After they have been ignored for a long period of time?
Do you go out and leave them alone for hours at a time? This by the way, is one of the biggest causes of agitation and meanness.
Are you giving your loved one constant positive communication? Touching them? Holding their hand? Reassuring them with your words?
Keep in mind, dementia patients can't remember, so they need more. More attention, more positive reinforcement, and more touch.
If you have an agitated or aggressive patient you can try and change the environment by doing all of the above.
You might also consider giving them a hug, or putting your arm around them when they are mean or agitated. Try keeping your mouth shut while you are at it. This is called nonverbal communication.
Ah time for me to brag a bit. I am so good at the hug I could take your breath away, and your agitiation and meanness if necessary, without saying a world and by hugging you just the right way. I sell this information and how to do it to men for a $1,000 a pop. ;>)
If you try the above, and try hard over an extended period of time you might be able to avoid the admission to a nursing "home".
And, get on the path to Joy.
I call all of this the full court press which is a basketball term.
In other words, the best offense is sometimes the best defense.
Have you tried the full court press that I described above?
Agitated or not, I promise you, try the above and you might very well get a positive outcome that you could have never anticipated.
I did.
