The first time I saw someone with behavioral disturbances was when I worked in a nursing home. I was a teenager, and the idea that an adult would do some of the things I saw was astounding. Before we could do anything, the person had hit a caregiver with a fire extinguisher and chased several more with his cane. There is no doubt in my mind he intended to use it as a weapon.
This helped me to understand things that have happened since. Dementia patients can display behavioral disturbances and some of them can be dangerous. Here are things you need to know.
Minor disturbances: While it is extremely unpleasant, words are considered minor unless a threat is involved. Even wishing someone would “die and get it over with” is considered minor. Other things you might see in this are endless walking, tossing items on the floor and facial expressions that show extremes of emotion.
Minor disturbances can be handled solely by redirection or by validation and redirection. There will be times when there is nothing in a statement made by the patient can be validated, as in the example above.
Major disturbances: The introduction story is an example of major behavioral disturbances. These events usually require medical intervention. When the staff is lucky it is medication. There are times when restraints may be required both for the safety of the patient and the staff. Allowing someone to go wild with a cane cannot be allowed.
Medications: There are two types of medication we have used in the family. One is an antipsychotic, the other is a strong tranquilizer. Both of them have black box warnings, so unless it’s an absolute necessity we don’t use them. However, I can tell you that regular doses of the antipsychotic have truly reduced the number of minor disturbances and has probably prevented major disturbances.
What to ask the doctor: When the first noticeable disturbance occurs, contact the doctor immediately. Detail the experience. If it is appropriate, the doctor may prescribe medication. If those who are dealing with the situation feel they can handle it by redirection there probably won’t be much, if any, prescribed.
Behavioral disturbances are very difficult on those around the patient. Even those who have prepared for them can be shocked…especially if that person is a family member. Knowing in advance that this is possible can help you get through the experience and help the patient get into a better frame of mind.