Aggressive behaviour in elderly persons.
Aggressive behaviour in elderly persons with dementia is very common.
Nearly half of the patients I see develop behavioural and psychological complications of dementia.
These behavioural complications are major cause of Carer stress and need for nursing home placement
Older people with aggression, agitation, paranoid delusions and other challenging behaviours can have spectacular improvements in their overall condition, general function and quality of life with holistic comprehensive geriatric medical care
These serious behavioural complications include-
Verbal and physical aggression
Wandering and getting lost
Agitation
Sexual disinhibition
Depression
Distressing visual and auditory hallucinations
Paranoid delusions accusing spouse, relatives or friends of stealing things from them or accusing their spouse of having an affair
Acting out delusions such as wanting to call the Police for strangers in the house who are not there
Afternoon “sundowning” agitation where the dementia sufferer becomes more irritable, agitated and aggressive in the afternoon when they become tired
Insomnia, getting up constantly at night, wandering around the house
Day/night disorientation so they get dressed at midnight to go to work or demand breakfast at 1am
There are medications available which can help control these distressing symptoms. These include cautious use of anti-psychotic medication, anti-depressants or other sedative medication in low dose.
Most of the patients whom I see with advanced dementia and serious behavioural complications require drug treatment to manage their challenging behaviours and distress.
Playing old movies, favourite music, looking at family photos and holding a doll just don’t work for psychotic, paranoid and aggressive dementia patients.
Lately there seems to be a big push for “non-drug behavioural strategies” to control these difficult and frequently aggressive behaviours which just don’t work particularly in nursing homes where the dementia is usually more advanced
Focusing on the “whole patient” including diagnosing and managing pain, depression and other symptoms and co-morbidities results in a better outcomes
For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.