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  • Patricia Riley

Managing Residents With Aggressive/Combative Behaviors

In the early states, people may experience behavior and personality changes such as irritability, anxiety and depression. In later stages, other symptoms may occur including aggression and anger, anxiety and agitation, general emotional distress, physical or verbal outbursts, restlessness, pacing, hoarding, hallucinations (seeing, hearing, or feeling things that are not really there), delusions (firmly held belief in things that are not true), sleep issues and sundowning.

While the above behaviors are symptoms of Alzheimer’s and other Dementias, Vista Cove’s professional team takes steps to rule out other factors such as medication, environmental influences and medical conditions that can also cause these symptoms or make them worse. Assessments are conducted by the Med Techs under the leadership of Vista Cove’s Executive Director and Director of Resident Services (who are both nurses), Vista Cove’s Medical Director and the resident’s physician to determine if there are any conditions that may be contributing to the challenging or combative behaviors. During this process, the following questions are answered:

  • Is the resident in physical pain? Due to their loss of cognitive function, residents are unable to articulate or identify the cause of physical comfort and, therefore, may express it through physical aggression.

  • Is the resident tired, hungry or thirsty? The ability to verbalize the need for sleep, food or water may be impacted by the resident’s cognitive impairment, resulting in agitation, wandering and restlessness.

  • Do the resident’s medications need to be adjusted because they’re causing side effects? Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions.

In addition to the above, an initial workup and lab tests may be conducted to rule out infection and the resident’s medications may be adjusted to address side effects or increase medication efficacy.

Nonpharmacologic approaches are also used by Vista Cove Caregivers to manage behavioral disturbances. These approaches include establishing a routine for each resident, providing physical cues, approaching residents in a calm, collected manner and explaining each activity before touching the resident (a person who doesn’t expect to be touched may view the gesture as a threat and strike back), and using one-step commands. All of these actions have been proven to reduce agitation, irritability and aggressive behaviors.

Even with the above actions being taken, sometimes medications are also needed. These medications may include Seroquel, Depakote, Zyprexa, Ativan, anti-depressants, etc. When this occurs, the physician and family members of the resident are consulted by the Vista Cove Med Techs prior to any changes in medication as well as any new medications administered. It is important to note that at any time when medications are given, adjustments in the type of medication, dose and frequency may be required.

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