They told me Millie was “mean”. They also used the words “aggressive”, “combative”, and “violent”.
Millie was a tiny, older woman with a diagnosis of Dementia with Behavioral Disturbances. The caregiving staff reported that she resisted self care and would hit, claw, and bite them whenever they tried to feed, bathe, dress, and toilet her.
The first time I met Millie, I sat at the table with her to help her eat. Her eyes were closed, her face was relaxed, and her arms were loosely folded across her chest. She seemed calm (and probably medicated).
I tried several gentle approaches to arouse Millie- easy conversation, a little shake of the shoulders, and calling her name over and over. When I tried to cue her mouth to open by touching the spoon to her lips, I finally got a response. Millie shoved the spoon away, picked up the bowl of oatmeal and dumped the contents onto my lap (she would have thrown the bowl at me too if she’d been able to release it), and glared at me with a wild, angry expression. I managed to keep my voice calm as I asked her politely not to throw her oatmeal on me and wrestled the bowl out of her hands. Once the bowl was free from her grasp, she latched onto my forearm and sunk her nails into my skin, grunting with clenched teeth and a hostile glare. The staff rushed over to help. It was chaos.
Other useless phrases I might have tried: “Now Millie, that’s not nice.” “Now look what you’ve done.” “Would you prefer the grits instead?”
Score: Mille (1), DQ (0)
I left Millie alone for a few minutes and regrouped. I asked myself a few questions:
- What do I know about “managing behaviors” in dementia (and why do I hate that term)?
- What is Millie trying to tell me?
- What other back-door techniques can I use other than the front-door ones I just tried?
Ok, new game plan.
The degenerating brain is sometimes incapable of reason. When someone is as violently reactive as Millie, there is some reflexive, protective, survival mechanism at play. It’s not that Millie is intentionally violating the rules of social conduct, it’s that the part of the brain responsible for solving problems with patience, language, and reason are impaired. Beneath those skills is the undercurrent of all animal behavior- fight or flight.
So if I can’t convince Millie that I mean no harm with verbal communication and modeling social standards, I need to figure out why Millie is so reactive in the first place. Is she hurting? Is she hypersensitive? Is her sense of wellbeing, position in space, and context identification distorted into a mass of confusion and instability? Or has Millie’s brain just deteriorated to a point that she has lost all higher cortical centers and this is the best Millie can do?
Well until we rule out the all the other possibilities, we can’t assume that the last question is true.
So I started at the bottom of the neurological system and worked my way up.
Tune in to the next post to see how I approached this issue.