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Managing Challenging Elders | |
Usually these patients have been difficult their whole lives, and are now addicted and trapped in their own bad behaviors, which they have always used to manipulate a situation. Often the family doesn’t even realize that they have spent years creating their own nightmare, and that they have trained the loved one that their bad behavior will be tolerated, with the payoff being control. Then, with the intermittent onset of dementia, behaviors worsen as the same methods are used, but over things that are now illogical and irrational. Understanding that manipulative behaviors will still occur, even with the onset dementia, and that demented does not mean stupid, can help make managing a challenging elder a bit easier to cope with. My True Story I have lived this nightmare and can attest to how devastating it is. I was a television executive when my life suddenly took a left turn into eldercare and I had to go take care of my aging parents. My once-adoring father turned against me verbally and even physically twice, and I sobbed my heart out to have lost his love. Yet, when I’d take him to the doctor, he’d act totally capable, loving and normal. I had grown up on his raging temper tantrums, so I assumed that this was just more of his bad behavior of a lifetime getting intensified with stress and old age, which is was, but it was also the beginning of dementia, namely--Alzheimer’s. Unfortunately, since I had no experience with dementia, I just didn't get it, and shockingly, neither did the professionals I turned to. When my father threw two little dilapidated hand towels at me, screaming and swearing at me for throwing them out, I was stunned. With the knowledge I have now I'd say, "This seems illogical, this seems irrational. BIG red flag--it is!” I wouldn’t get mad, I’d realize that I was experiencing a warning sign of dementia (poor judgment), and I’d get him to the best geriatric dementia specialist I could find to be evaluated right away. I'd know not to waste a minute with his regular doctor who didn't specialize in dementia, and that I needed a doctor who would take the time to do the necessary tests to uncover it. Help Families Recognize Dementia Symptoms The stereotype that most people have of a person with dementia (Alzheimer's is just one of many types) is that of someone who doesn't know what they are doing at all. That’s way down the line, Stage Three (1-3 years), but there is a long road through Stage One (2-4 years) and Stage Two (2-10 years) first. One out of every ten persons by the age of 65 starts to get some form of dementia, and it rises to one out of every two persons by the age of 85. The fastest growing segment of our population is the 85+ group, which means there are a lot of elders who need help, and many families and professionals who need to understand the subtleties of the beginning of the disease. Dementia starts very intermittently and is generally ignored by families and many doctors for four years, because they incorrectly believe that these occasional strange behaviors are just senility and a normal part of aging. Because there are periods of normalcy in-between, the tendency is to want to forget about the irrational incident as soon as the loved one is back to acting normally, instead of seeking treatment immediately. It is called denial. It is imperative for the family to be shown the ten early warning signs of Alzheimer’s because with early diagnosis and medication (Aricept, Exelon or Reminyl) the dementia might be slowed down by 2-4 years, keeping behaviors more manageable. Had I been shown this list, I would have realized what was happening to my father right away. The 10 Warning Signs of Dementia: Recent memory loss Difficulty performing familiar tasks Problems with language Disorientation of time and place Poor or decreased judgment Problems with abstract thinking Inappropriate misplacing of things Rapid mood swings Changes in personality Loss of initiative Behavior Modification Techniques Once the brain chemistry is balanced for slowing down the dementia, and the often-present depression is treated with an anti-depressant, and the possible aggression is medically treated, behavior modification can be used on a challenging elder if they are still in the early stage of dementia and short-term memory is still relatively good. As amazing as it sounds, the use of tough love, coupled with rewards and consequences, worked to turn around the most obstinate man on the planet, my father--even with the onset of dementia. By being 100% consistent, never rewarding his bad behavior and using tons of praise to encourage his good behavior (extra dessert worked well too), he finally changed his life-long behavior pattern of screaming and yelling to get his way--no, not 100%, but the majority of the time. He finally learned that he could (as Mom would say), "catch more flies with honey than vinegar." We learned not to argue with him, and practiced using calm distraction instead. We developed a serene attitude, using direct soothing language and simple directions. Since he loved the affection he suddenly got for good behavior and hated that we walked away from him when he was screaming at us, he gradually started to behave better and finally accepted the changes we were making to help him. By validating his frustrated feelings, giving him a sense of control over as much as we possibly could, he felt more in charge of his life and there was less frustration for him. How Professionals Can Help Professionals can make a huge difference in the lives of the families they meet. They need to listen to the overwhelming frustrations of the family with compassion, offer solutions, and strongly recommend support groups. If there hasn’t been an accurate diagnosis yet, the use of a hidden mini tape recorder can help the doctor hear how difficult the behaviors really are, and so there may be help with medication sooner than later. Socially adjusted elders will rarely show their “Hyde” side to anyone outside the family. Professionals can help families understand that the techniques that a loved one used during their lifetime to gain control, will be the same methods they use now, but they will be over things that are “over-the-top” even for them. When behavior modification with rewards isn’t working, reminiscence might, by distracting the elder to talk about something from his past and making use of his long-term memory bank. If that doesn’t work, validation may help, by being there in the moment with them and validating their feelings that are underneath the bad behavior. Understanding the subtleties of dementia helps prevent families from a reaction of being harsh when an elder is being abusive to them. A Success Story After turning around a seemingly impossible situation, I knew it was all worth the horror and heartache to hear my father say he loved me again. I was so compelled by what I had lived through, I wrote a book so that others won't have to struggle as I did. Elder Rage, or Take My Father… Please! How To Survive Caring For Aging Parents, is written with a humorous tone to make a difficult subject palatable. Renowned dementia specialist, Dr. Rodman Shankle, contributed, "A Physician’s Guide to Treating Aggression in Dementia," which helped Elder Rage become required text at two universities for graduate courses in geriatric assessment and management. The bottom line message is that there can still be a good life after a diagnosis of dementia, if it is properly managed medically and behaviorally 44 endorsements include: Hugh Downs, Regis Philbin, the late Steve Allen, Robert Stack, Art Linkletter, Dr. Bernie Siegel, John Bradshaw, Dr. Dean Edell, Dr. Nancy Snyderman of ABC News, Duke University Center for Aging, Johns Hopkins Memory Clinic, Dr. Eric Tangalos/Mayo Clinic, Dr. Rudy Tanzi/Harvard Medical School, Senator John D. Rockefeller IV, and the National Adult Day Services Association. | |
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