Kitwood's model, shows that when caring for, and supporting people with dementia, we must remember six psychological needs: love, comfort, identity, occupation, inclusion, and attachment.
What Are the Seven Stages of Dementia?
- Stage 1 (No cognitive decline)
- Stage 2 (Very mild cognitive decline)
- Stage 3 (Mild cognitive decline)
- Stage 4 (Moderate cognitive decline)
- Stage 5 (Moderately severe cognitive decline)
- Stage 6 (Severe cognitive decline):
- Stage 7 (Very severe cognitive decline):
Answer From Jonathan Graff-Radford, M.D. The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression or ignoring directions.
Behavioral symptoms are persistent or repetitive behaviors that are unusual, disruptive, inappropriate, or cause problems. Aggression, criminal behavior, defiance, drug use, hostility, inappropriate sexual behavior, inattention, secrecy, and self-harm are examples of behavioral symptoms.
Anxiety and agitation may be caused by a number of different medical conditions, medication interactions or by any circumstances that worsen the person's ability to think. Ultimately, the person with dementia is biologically experiencing a profound loss of their ability to negotiate new information and stimulus.
Damage to the frontal lobe of the brain eventually causes problems with intelligence, judgment, and behaviour. Damage to the temporal lobe affects memory. And damage to the parietal lobe affects language. Alzheimer's is the most common form of mental decline, or dementia, in older adults.
Cholinesterase inhibitors and memantine may be effective to treat BPSD. Indeed, donepezil may alleviate the following BPSD in mild to moderate dementia: apathy, depression, tension, irritability. There are similar findings for galantamine and rivastigmine.
Generally, people with dementia become agitated due to three potential trigger categories: Medical, physiological and/or environmental. Medical triggers can include sickness, fever or pain, but it can also include issues that you might not initially think about, such as: Medication side effects.
The middle stages of dementia are when anger and aggression are most likely to start occurring as symptoms, along with other worrying habits like wandering, hoarding, and compulsive behaviors that may seem unusual.
Behavioural disorders are a common feature in dementia, especially in the later stages of the disease. The most frequent disorders are agitation, aggression, paranoid delusions, hallucinations, sleep disorders, including nocturnal wandering, incontinence and (stereotyped) vocalisations or screaming.
Verbal aggression/threats (54%) and physical aggression/agitation (42%) constitute the 2 most frequent behavioral disturbances reported in patients with Alzheimer's disease and related disorders.
In the later stages of dementia, some people with dementia will develop what's known as behavioural and psychological symptoms of dementia (BPSD). The symptoms of BPSD can include: increased agitation. aggression (shouting or screaming, verbal abuse, and sometimes physical abuse)
Ten Tips for Communicating with a Person with Dementia
- Set a positive mood for interaction.
- Get the person's attention.
- State your message clearly.
- Ask simple, answerable questions.
- Listen with your ears, eyes, and heart.
- Break down activities into a series of steps.
- When the going gets tough, distract and redirect.
Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast. More common causes of dementia, such as Alzheimer's, Lewy body dementia and frontotemporal dementia, typically progress more slowly.
What are the symptoms of sundowning? Sundowning is a distressing symptom that affects people in mid to late-stage Alzheimer's and other forms of dementia, and as the condition progresses, the symptoms tend to worsen.
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms of dementia, such as psychosis, aggression, agitation, and depression.
The 5 R's: Refuse, Reduce, Reuse, Repurpose, Recycle.
Types of behavioral disturbances
- most common reported symptoms. depression or dysphoria. indifference or apathy. anxiety. shadowing caregiver. worrying.
- other common symptoms. agitation, including. arguing or complaining. easily getting upset. repetitive questioning. pacing. hoarding. rejecting care.
Behavioral disorders involve a pattern of disruptive behaviors in children that last for at least 6 months and cause problems in school, at home and in social situations. Nearly everyone shows some of these behaviors at times, but behavior disorders are more serious.
Signs of late-stage dementia
- speech limited to single words or phrases that may not make sense.
- having a limited understanding of what is being said to them.
- needing help with most everyday activities.
- eating less and having difficulties swallowing.
- bowel and bladder incontinence.
10 tips for dealing with aggressive behavior in dementia
- Be prepared with realistic expectations.
- Try to identify the immediate cause or trigger.
- Rule out pain as the cause of the behavior.
- Use a gentle tone and reassuring touch.
- Validate their feelings.
- Calm the environment.
- Play their favorite music.
Summary: Physical aggression among people with dementia is not unusual. A study showed that one-third of patients with the diagnosis Alzheimer's disease or frontotemporal dementia were physically aggressive towards healthcare staff, other patients, relatives, animals and complete strangers.
