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jaksen
04-09-2011, 08:10 PM
I am hoping some AWers have the answer to this question. I have researched the disease online, but I do not know anyone personally with the disease (or condition.)

Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

I do not need to know anyone's personal family history (unless one wants to share) as I can only guess how difficult the whole situation must be for those going through this. I empathize whole-heartedly.

But I have read personality changes can be part of the disease, incl. frustration and anger issues. I also know, until the very end, patients with dementia can have moments of lucidity, though these moments decrease as time goes on...

Any insight into this area would be greatly appreciated.

brainstorm77
04-09-2011, 08:19 PM
YES! And it happens quite often, sometimes requiring various types of sedation depending on the case and severity.

I'm a nurse and I worked in longterm care for 12 years before moving into acute.

The thing is, no two cases are alike. Some never get angry or violent, they are just happy. Others can be very violent. I found this happening most often whenever we had to approach a resident(what we call them in longterm care) for various types of personal care.

I have been injured myself and so have many co-workers. Some injuries can be severe.

ETA: I have been punched, kicked, hit, slapped, scratched and spit on.

Pyekett
04-09-2011, 08:20 PM
My word, yes. This is not uncommon.

There are family resource sites that offer help in understanding how and why this happens, along with suggestions to deal with it. Let me see what I can dig up.

---

Edit:

This is a good overview: Alzheimer's Aggression (http://alzheimers.aplaceformom.com/articles/alzheimers-aggression/)

This is a 12-page PDF from the national Alzheimer's Association with suggestions for how to cope with problem behaviors of someone with AD: (updated) link to brochure (http://www.alz.org/national/documents/brochure_behaviors.pdf)

(the suggestions don't always work, but in a story, you might have caregivers trying them with whatever level of success fits your needs as a writer)

Lil
04-09-2011, 08:26 PM
The answer is yes, the person can hurt someone.

I have no medical background, but my impression in the two cases with which I am familiar is that the sufferer struck out because he did not recognize the visitor (in both cases a child) but sensed that he was supposed to. The violence, either physical or verbal, seemed to be produced by a combination of humiliation and frustration.

brainstorm77
04-09-2011, 08:30 PM
This all depends on how advanced the disease is too. There are various stages that a person with Alzheimer's goes through. I also found dementia to be much different.

Shakesbear
04-09-2011, 08:31 PM
Sadly, yes. One of my aunts became violent at times. She slapped her sons' step daughter across the face for no apparent reason. The force of the slap knocked the girl over and left a bright red hand print on her face. I say 'no apparent reason' as the girl was known to try to provoke her brothers and she may well have provoked my aunt. Her violent reaction was totally out of character though.

Old Hack
04-09-2011, 08:41 PM
I'm reading a wonderful book about Alzheimers at the moment: Keeper, by Andrea Gillies. It's a fabulous read, and will probably answer your questions and then some.

Ari Meermans
04-09-2011, 08:43 PM
Definitely not uncommon. While Pyekett is digging up info for you, I'll tell you my take as a former caretaker of a family member. At first, the bouts of forgetfulness are easily missed because we all forget where we put our keys and soforth and the person denies to himself or herself that these occurrences are becoming more frequent and are unusual types of forgetfulness. Family members may finally begin to notice when something extraordinary happens, such as the person's forgetting the way to the store a half mile away and getting lost for a couple of hours or just wandering away.

Then, the patient starts to feel the frustration and can become a tad snappish.

When dementia is firmly established, forgetfulness is all encompassing and includes not knowing the people even in the household. The person may get cranky wanting their lunch when they've just left the table.

The rage kicks in. A lot of what you read mentions personality changes. From my own observation this is not necessarily the case. In our situation, it was as if all her inhibitions—those curbs we both learn and self-impose in order to deal in society—dissipated as she began to withdraw into herself. She no longer had the ability or desire to govern her language or actions; ex. sudden foul mouth on a "sweet little old lady", leaving the house in her underwear to find someone to help her dress, etc.

There are many symptoms to this insidious and devastating disease. Some people will have a few of the textbook symptoms and others will have them all.

hth

jennontheisland
04-09-2011, 08:47 PM
Acting out in an aggressive manner is quite common actually. And in some nursing homes it's treated with what equates to chemical restraint (dope em up until they can't move anyway).

Aggression may be related to fear. Particularly in the earlier stages. Moving in and out of lucidity, suddenly finding yourself in a room you don't recognize, surrounded by strangers who are being much too familiar with you can be terrifying, and anger is a recognized fear response.

My ex is a nurse who specialized in gerontology, mental health and addictions (there's nothing quite as complicated as treating a 75 year old schizophrenic heroin addict who is presenting symptoms of alzheimers).

brainstorm77
04-09-2011, 08:54 PM
And in some nursing homes it's treated with what equates to chemical restraint (dope em up until they can't move anyway).



Some being the key word here. In my 15 years of working in a nursing home, I have never seen someone 'doped up until they couldn't move'. For one, that can send someone into respiratory distress, especially if they are elderly and face other chronic medical conditions.

In every facility I have ever worked in, chemical restraint was looked at better than physical restraint. Most places now no longer allow for physical restraints.

Maryn
04-09-2011, 09:03 PM
Yes, it happens, and a decent staff knows how to deal with it.

My husband's mother, a woman whose basic nature was sweet and trusting, suffered from dementia in the final years of her life. We helped her at home for as long as we could, them put her in a nursing home.

A half dozen times in the 18 months she lived there, we learned she had been combative and resistant to whatever they were trying to do, such as dress or feed her. This state does now allow physical restraint of patients in residence facilities (in hospitals it's allowed), but they worked hard to find the minimum dosage to deal with these issues. Although she was not 'officially' depressed, the drug which worked best was an antidepressant.

The staff at any good skilled care facility can tell you of many patients who seem horrible and hateful, to the shocked embarrassment of their families. The staff knows this is the illness and resulting brain damage saying those awful things, not the patient, and it rolls right off them. Some of those patients are not tiny little women wasting away but strong men and women whose rage takes a physical form. I only saw a little of this, but the staff was more willing to be bruised than to cause a bruise. I remain impressed.

Maryn, who heard racial and ethnic insults she hasn't heard since the 50s, from people who probably haven't entertained those thoughts since the 50s

brainstorm77
04-09-2011, 09:07 PM
The staff at any good skilled care facility can tell you of many patients who seem horrible and hateful, to the shocked embarrassment of their families. The staff knows this is the illness and resulting brain damage saying those awful things, not the patient, and it rolls right off them.



Great point and very much true. Families are often taken aback at how easily we do deal with it.

I've was in a room with a elderly woman(this one sticks out), and she was calling be a bitch, slut and some other not so nice words while I was giving her a drink of water through a straw. The daughter looked on totally mortified. She apologized for her mother. My response was, "Don't worry yourself about it. It's just words. I don't take any offense to anything she says."

shadowwalker
04-09-2011, 09:18 PM
My mother was combative, angry, and extremely paranoid for a period of 3-4 weeks. Because it appeared suddenly, I wasn't really sure if it was going to last or not, and the doctor agreed that we should wait before adding yet another medication. When the paranoia got to the point where she threw her coffee cup at me when I tried to give her her medications, he gave her a low dose of anti-psychotic (forget now which), and increased this slightly a couple of times before she became her usual self again. It was difficult to get her to take the pills, of course, until I had my brother (not sure if she knew it was her son or if she just liked the only man she had visit) tell her it was an antidote to any poisons I was trying to give her. Once it took effect, as I say, she was alright again, given the other effects of the dementia.

aruna
04-09-2011, 09:26 PM
My husband is now in a care home and I spend many hours a day there. Several of the residents have dementia and the there's a huge variety of behaviour. There's one lady in particular who is very aggressive, bur more verbally so than physically. What impresses me most if the patience and good humour of the carers. She often spits at them when they ar etrying to feed her and they just keep smiling and trying to persuade her to eat. She hurls verbal abuse at them and they always respond with calm and a big smile; otherwise she just sits there grumbling all day and saying nasty things about people.

BarbaraKE
04-09-2011, 09:59 PM
I am a nurse in a nursing home and, to answer the OP's question, the answer is definitely 'Yes'.

But I wouldn't say it happens to *all* or *most* or even *many*.

CACTUSWENDY
04-09-2011, 10:26 PM
Years back I remember a man that had A. and when it kept getting worse he would revert to being a sexual predator. I was told then that this type does happen. His wife lived with him at the care site. He would go into other female rooms and try to have sex with them, so they had to really keep an eye on him.

One of the ladies in the care place reverted back to a shy little girl. Very sweet. Even her voice and vocabulary was child like. All her memories were of herself as a child.

brainstorm77
04-09-2011, 10:29 PM
He was a sexual predator at some point in his life before Alzheimer's?

PinkAmy
04-09-2011, 10:32 PM
I worked in a state psych hospital and there were some previously nonviolent folks who couldn't be handled by nursing homes who were sent to our facility. It was really sad and upsetting for the family. Nobody was ever doped into catatonia, but some of the folks were on medications and if the person became out of control so she was a danger to herself or others, there was the rare option to tranquilize with a shot. Workers had to jump through hoops and try all other interventions before a psychiatrist would authorize the shot-- as per JCAOH guidelines. It wasn't taken lightly.

PinkAmy
04-09-2011, 10:36 PM
Years back I remember a man that had A. and when it kept getting worse he would revert to being a sexual predator. I was told then that this type does happen. His wife lived with him at the care site. He would go into other female rooms and try to have sex with them, so they had to really keep an eye on him.

One of the ladies in the care place reverted back to a shy little girl. Very sweet. Even her voice and vocabulary was child like. All her memories were of herself as a child.

That happened with my friend's father, who was a sexual predator. They found him masturbating in female patients rooms. He raped his ex-wife who was near catatonic with alzheimer's. She used to get phone calls from staff saying, "Your father did____" The staff tried to keep track of him, but he kept getting away with it. My friend wanted charges pressed against him, but because he usually chose non-verbal victims, they couldn't do anything. She was so pissed off, because she wouldn't want a loved one unwittingly subjected to him. The police didn't seem too interested.

muse
04-10-2011, 01:53 AM
I am hoping some AWers have the answer to this question. I have researched the disease online, but I do not know anyone personally with the disease (or condition.)

Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

I do not need to know anyone's personal family history (unless one wants to share) as I can only guess how difficult the whole situation must be for those going through this. I empathize whole-heartedly.

But I have read personality changes can be part of the disease, incl. frustration and anger issues. I also know, until the very end, patients with dementia can have moments of lucidity, though these moments decrease as time goes on...

Any insight into this area would be greatly appreciated.

So strange to come across this question tonight. I've just come home from celebrating my parents' 50th Wedding Anniversary. My dad has Alzheimers and in answer to your question yes, they can become so angry and confused that they lash out physically, (and verbally) even when such behaviour is contrary to their personality.

They have no filters, what they think they say; no boundaries, no inhibitions. It's a terrible, awful disease.

Saying that, there are high points, they love, to the point of tears, laugh to extremes and they can see the beauty in a single moment - it is quite weird, but nice. They live in the moment, which is great, as long as the moment isn't the scary void of their lost memory.

rhymegirl
04-10-2011, 02:41 AM
Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

Yes. My mother had Alzheimer's and was in a nursing home for a few years. One time she got angry with a man who lived there and punched him in the face. (He was okay, don't worry.)

(my mom was a feisty lady!)

jaksen
04-10-2011, 02:49 AM
Wow.

This thread boggles the mind. What some of you have been through, and are still going through...

Thank you all for your honesty, openness and insights. My mother-in-law is 98 and my mother is 88; neither have dementia, though they are forgetful. But I have heard them speak about some of their friends through the years and how difficult it was to see them decline this way.

So wow again. Your personal experiences have certainly helped me.

aruna
04-10-2011, 10:56 AM
One of the ladies in the care place reverted back to a shy little girl. Very sweet. Even her voice and vocabulary was child like. All her memories were of herself as a child.

One of the women in the nursing home--I feel so sorry for her, but also very curious. Most of the time she cries out for Daddy! Daddy! And I mean she really yells, at the top of her voice. Daddy! Come and get me Daddy! Don't leave me, Daddy! Where are you, Daddy! Put on my shoes, Daddy! She can go on like that for hours on end; she is almost hysterical sometimes. But she too can also get verbally aggressive towards the carers.
But this is really the exception. Most of them are quiet but just have one or two idiosyncarcies. One of them is really sweet natured, always smiles and waves, and repeats all through the day "I'm Jane Maud Moore, nurse" (not her real name, of course.) She calls everyone "nurse" and tells them her name, again and again. She's very lovable.

ConChron
04-10-2011, 01:37 PM
Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

I'm just chiming in to say, yes. Even people who have never been violent before can become violent, either on some occasion or over all.

My grandfather had moments of anger. I was on vacation with him and grandma when I first experienced it. He slammed doors and pushed furniture around and looked as if he was about to explode. It was scary to see because the grandfather I knew wouldn't hurt a fly. Grandma never talks about it but I do think he did attack her on occasion.

There was a priest where we live. He turned totally. From being a good and mild mannered person to being loud, screaming and cursing and more often than not trying to beat his wife. He was at a home and visitors saw how he was and gossiped about it. The family had articles in the local news paper trying to explain to people that it was the illness that changed him.


But I have read personality changes can be part of the disease, incl. frustration and anger issues. I also know, until the very end, patients with dementia can have moments of lucidity, though these moments decrease as time goes on...

The moments of lucidity sometimes feeds the anger and frustration. (In the cases I've seen.) They realize how messed up things are and the sadness and confusion turns into anger and frustration.

My grandfather didn't understand his emotions or how to deal with them anymore. The outburst on the vacation was because he was in pain but didn't know how to tell it to us. (He had shingles.)

backslashbaby
04-10-2011, 02:04 PM
I was a kid when my maternal grandmother had had Alzheimer's for a few years. One little anecdote sticks in my memory.

We were all sitting around chatting, and she had some brass trinkets on the coffee table. They were turtles. They'd been there forever.

She looked down and asked one guy if those were real turtles. He laughed.

She got humiliated, and you could tell that she nearly picked up the turtle and threw it at him! Totally out of character.

She caught herself and just laughed instead.

She got much worse as the years went on, though.

Pyekett
04-10-2011, 05:20 PM
I think it's critical that we share these sorts of stories with one another. For too long, these were the secrets shut up in institutions with the people. Trying to maintain bridges or most any sort of normalcy was too hard because it so often meant starting from scratch for each person.

Stories about how hard the times can be, so scary, so dangerous. Stories about how precious and cherished those times can be, too. What sometimes works to make it better, and what sometimes makes it worse. This is what a certain stage of life is for some people, and that may change with more understanding and different resources, but for now it's what we have.

These times and these people are still a part of our lives. They should stay a part of our lives -- a part of bigger-picture Life for everyone -- insofar as that is possible. Talking about that makes it more likely, not less.

Tsu Dho Nimh
04-10-2011, 06:29 PM
Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

Yes. My former father-in-law had serious Alzheimer's, became outraged at something my ex BIL did and started beating on him with the hand tool he was carrying. The BIL backed way off and got out of range.

It blows over fairly quickly, but it's definitely possible for serious harm if the object of the aggression was not able to defend themselves or escape.

PinkAmy
04-10-2011, 07:15 PM
I think it's critical that we share these sorts of stories with one another. For too long, these were the secrets shut up in institutions with the people. Trying to maintain bridges or most any sort of normalcy was too hard because it so often meant starting from scratch for each person.

Stories about how hard the times can be, so scary, so dangerous. Stories about how precious and cherished those times can be, too. What sometimes works to make it better, and what sometimes makes it worse. This is what a certain stage of life is for some people, and that may change with more understanding and different resources, but for now it's what we have.


Did you see the HBO series of documentaries Maria Shriver produced about Alzheimer's? It was wonderfully done.

Pyekett
04-10-2011, 07:41 PM
Did you see the HBO series of documentaries Maria Shriver produced about Alzheimer's? It was wonderfully done.

Yes, it was.

I also got a lot out of Terry Pratchett's BBC documentaries on his search for understanding about his diagnosis.

WriteMinded
04-10-2011, 08:01 PM
I am hoping some AWers have the answer to this question. I have researched the disease online, but I do not know anyone personally with the disease (or condition.)

Can a person with Alzheimer's (or other forms of Dementia) become angry or confused enough to hurt someone? Like hit a caretaker, spouse, family member, etc.?

I do not need to know anyone's personal family history (unless one wants to share) as I can only guess how difficult the whole situation must be for those going through this. I empathize whole-heartedly.

But I have read personality changes can be part of the disease, incl. frustration and anger issues. I also know, until the very end, patients with dementia can have moments of lucidity, though these moments decrease as time goes on...

Any insight into this area would be greatly appreciated.My mother, while a dementia patient in a nursing home, took a bite out of a physical therapist because the physical therapy hurt. 'Course, she was pretty feisty before she ever got sick. Also, I've seen a person afflicted with Alzheimers swinging his cane at another man.

Buffysquirrel
04-11-2011, 02:24 AM
Hmm, yeah. When my mother was hospitalised and waiting to go into a care home, she rabbit punched me when I wouldn't let her leave the building. As I was concerned that the hospital could not (or would not) do anything to make me safe, I had to leave. Before I left, I demanded that the duty psychiatrist see my mother. Over the phone--and only after I had repeated the demand to the next nursing shift--s/he prescribed a sedative for her. Now I knew damn well that the sedative in question had been implicated in negative outcomes for Alzheimer's patients, but at that point I was at the end of my rope. I had been staying with her in the hospital because otherwise, every time she caused a rumpus, they phoned my 80-year-old father to drive over there (forty miles?) to sort out the problem. Whenever I got tired towards the end of the day, and couldn't give her the attention she wanted, she would start making trouble. Leaving her room, confronting the nurses, demanding to be sent home. It was the shittiest time of my life, and I've had some damn bad times.

So, in short, yes.

not_HarryS
04-12-2011, 07:20 AM
When my grandma's Alzheimer's started getting serious, she began having violent episodes with some regularity. One time I remember her having slapped my mom REALLY hard in the kitchen. At the time, she thought my mom was her sister (whom she absolutely hated) and decided to give her a taste of angry granny palm. Another time she thought my sister was a demon. Tried to slap her, but my sister was quick on her feet :) She was very slappy.

But she had her sweet moments too. I remember asking her what kind of candy she liked (this was shortly after Halloween). She told me she loved lemon candy. So I ran back to my room, sifted through all the candy I had, found a few lemon ones, and then brought them out to her. When I said, "Grandma! I found some lemon candies. They're your favorite!", she looked right through my head as if she'd never seen me before and asked, "How on earth did you know that lemon candies were my favorite?"

Scared the crap out of me as a kid, but now it's one of my fonder memories of her.

shadowwalker
04-12-2011, 08:00 AM
But she had her sweet moments too.

Sometimes I think those moments are actually the hardest. When they aren't acting like themselves, it's almost easy to get 'clinical' about it and remind yourself it won't last. But then, those moments when you see the old spark in their eye, that little smile like they're sharing a secret... and you know that won't last either.

not_HarryS
04-12-2011, 08:07 AM
Sometimes I think those moments are actually the hardest. When they aren't acting like themselves, it's almost easy to get 'clinical' about it and remind yourself it won't last. But then, those moments when you see the old spark in their eye, that little smile like they're sharing a secret... and you know that won't last either.

You're exactly right. For me, it's kind of strange, because when my grandma was going through this, it was a neverending whirlwind of confusion for me, because I was only about eight years old at the time. No matter how many times your parents reassure you that granny's sick, or her head isn't in the right place, etc., you can't really wrap your mind around it. She's wearing granny's skin, so why isn't she granny? That sort of thing.

Her sweet moments were more of a relief than anything else.

But now that my dad's going through the same thing, and getting worse by the day, I know what you mean: you get more clinical when they're "normal" than when they're not. Which isn't necessarily the best approach, I think.

Regardless, having experience this at two different levels of understanding is strange... and I honestly can't say which is better. Kids are quick to forgive -- I know that. And although adults are quick to understand, sometimes the outbursts and abnormal behavior can't help but hurt you, even if you know better than to let yourself get hurt.

Does that even make sense?

shadowwalker
04-12-2011, 08:49 AM
And although adults are quick to understand, sometimes the outbursts and abnormal behavior can't help but hurt you, even if you know better than to let yourself get hurt.

Does that even make sense?

Tons. Because you're always questioning - is it them, or is it the disease talking? Even when you know which it is, really.

But through all the heartache during, after sometimes is worse. I find myself wishing I could take back those times when I was just totally worn out and I snapped at her. Or wondering why I didn't do more for her, even though, objectively, I know I was doing all I was capable of at the time.

It's just a cruel disease for everyone involved.

aruna
04-12-2011, 10:44 AM
Yesterday I practically witnessed an attack. I walked passed the dining room in the nursing home and I saw the handyman, Richard, sitting at a dining table repairing a drill. Opposite him sat P., a dementia resident, with her back to me. She was just sitting, watching him.
I had just walked past when I heard the crash of a glass. I rushed back and there was a broken wine glass on the floor, and Richard had blood running down his forehead. P. had thrown the glass at him, a propors of nothing. They hadn't even been talking. She wasn't angry. She just threw thr glass.
Once she threw a (plastic) cup full of coffee at me. It bounced off my leg. Mostly, though, she is good-natured and actually quite droll. You can't help being fond of her.
I've noticed among "normal" people a reluctance to deal with the subject of dementia. A couple of times I've tried to speak with friends about the various residents, about the subject in general, and almost invariably, somebody changes the ubject abruptly -- quite rudely, too. It's as if they are pushing it far away from themselves.

shadowwalker
04-12-2011, 04:19 PM
I've noticed among "normal" people a reluctance to deal with the subject of dementia. A couple of times I've tried to speak with friends about the various residents, about the subject in general, and almost invariably, somebody changes the ubject abruptly -- quite rudely, too. It's as if they are pushing it far away from themselves.

Fear. I'm not up on the literature, but as far as I know (and this probably holds true for the general public), dementia/Alzheimer's can strike anyone. And that's scary. Very scary.

I don't mind talking about it, probably because it's a bit of a relief to be able to. But deep down, there's a horrific fear that I could lose all my memories, forget who my family is, be unable to care for myself... On the one hand, I'd rather be dead. On the other, I think of my mom on her 'good days', when she was happy and smiling even if she didn't know who I was. I don't know. I suppose if one doesn't remember what they've lost, being happy in the moment is acceptable...

Argh. Whole 'nother discussion, that...

WriteMinded
04-13-2011, 06:36 PM
Fear. I'm not up on the literature, but as far as I know (and this probably holds true for the general public), dementia/Alzheimer's can strike anyone. And that's scary. Very scary.

I don't mind talking about it, probably because it's a bit of a relief to be able to. But deep down, there's a horrific fear that I could lose all my memories, forget who my family is, be unable to care for myself... On the one hand, I'd rather be dead. On the other, I think of my mom on her 'good days', when she was happy and smiling even if she didn't know who I was. I don't know. I suppose if one doesn't remember what they've lost, being happy in the moment is acceptable...

Argh. Whole 'nother discussion, that...Fear. Right. My mother "lost her mind" to dementia. It doesn't help one bit that it was called alcohol induced dementia. My great-grandmother lost her memory too and her lips never touched liquor. Mom used to smile (after they medicated her with anti-depressants) but I could see her eyes moving around trying to find a tether to whatever I was saying to her. Shudder. Every day I forget something and every day I feel that dread niggling through my belly.