20 questions to change the direction of dementia anxiety and aggression

20 questions to change the direction of dementia anxiety and aggression

I discovered through personal experience, research and observation that people living with dementia (PLWD) behave in logical, natural and understandable ways to stressful situations, just like most of the rest of us do. Although they react as any “normal” person would, their behaviour is more often than not mistakenly attributed to the disease rather than to whatever catalyst actually sparked it.

People living with dementia are people; they respond normally when they are threatened, demeaned and made to feel powerless: they resist, lash out, become agitated or try to flee. Blaming the disease leads us in the wrong direction. What we should be doing is asking ourselves questions to reset the compass ; questions such as:

1. What might I and/or others have done to precipitate this situation, and how can I rectify it as quickly as possible with as little disruption as possible?
2. Would I behave the same way in similar circumstances? How would I feel? What would I want?
3. How can I defuse the situation? (Hint: do not tell people who are upset or agitated to “calm down!”)
4. What is threatening the person? How can I remove the threat?
5. How can I help this person feel more at ease?
6. What unmet need might this person be expressing? Is s/he in pain or experiencing some other kind of physical discomfort? Is s/he hot, cold, wet, thirsty, hungry, etc.?
7. What environmental factors might be contributing to his/her anxiety, and how can I neutralize them?
8. Is my tone of voice conciliatory and respectful?
9. Is my body language relaxed and open?
10. Can the person see and hear me properly?
11. Have I surprised him/her in some way?
12. What action can I take right now to restore calm?
13. How can I meet her/his immediate need?
14. How can I meet her/his deeper need?
15. Have I said I’m sorry?
16. What more can I do to empathize?
17. Could I ask for the support of someone else who might be more effective in dealing with this situation?
18. What could I do differently next time?
19. What can I learn from this?
20. How can I share that learning with others? How can apply my knowledge to engage more effectively with this person and others who live with dementia in the future?

Too many people with dementia end up needlessly medicated for behavioural expressions that are provoked by the environment and the people around them, including paid care workers and family members such as myself who are drafted into caregiving roles with little or no experience or training.

By questioning and reframing, I believe we can transform the way we see dementia and the people who live with it; we can also find ways to deliver better care. Specifically with respect to the issue of aggression, putting ourselves in the place of PLWD will help us discover what might underly behaviour we find challenging or problematic. We can then address the underlying causes instead of inappropriately prescribing antipsychotic medications.