MANAGING ABERRANT BEHAVIOR IN PATIENTS WITH DEMENTIA
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Alzheimer’s disease and most other dementias are not fatal diseases. Patients often survive many years after the diagnosis is made. During this time their mental functions deteriorate and their personality often changes. This is distressing and unnerving to caregivers and loved ones who often are at a loss: they simply do not know how to handle their loved one anymore.
Caregivers have to be constantly vigilant, twenty-four hours a day, seven days a week, fifty-two weeks a year. They become apprehensive, restless, sleep deprived, mentally and physically exhausted. Their loved ones with dementia appear to be so unpredictable and their behavior aberrant so much out of line with the person they knew, respected and loved before dementia set in.
Caregivers often state that they do not know when a catastrophic reaction will unexpectedly erupt. They find themselves sucked in, trapped, unable to change course and unable to avoid the catastrophic outcome. They feel powerless and sometimes guilty.
It is our contention that many of these aberrant and unpredictable behaviors are in fact predictable and often can be anticipated and defused.
In this series of cases, based on real patients, we explore how some “aberrant behaviors” develop and may have a catastrophic ending. The first part of each case study is a description of the scenario showing how the catastrophic situation arose, escalated and reached its climax. It is followed by a step by step examination of what went wrong in the caregiver/patient interaction and how that catastrophic outcome could have been avoided, averted or defused. Each case study concludes with a brief rationalization of the aberrant behavior in patients suffering from this particular type and stage of dementia and includes tangible advice to caregivers in order to avoid that particular behavior from developing, escalating and erupting.
We hope that clinicians and health care professionals will find this material useful advice to caregivers who might seek their help with similar problems.
Finally, as a result of the collaboration between Gerontology and Geriatric Medicine and the Southern Medical Association, interested clinicians may wish to test their knowledge and earn CME credits by answering a few multiple-choice questions1.
1This accredited continuing medical education Journal-based CME series has been developed in cooperation with the Southern Medical Association, a regional, multi-specialty membership organization accredited by the ACCME (with a mission: To improve quality of patient care through multidisciplinary, interprofessional education”), physicians from the Departments of Gerontology and Psychiatry at East Tennessee State University, the Gerontology and Geriatric Medicine, an on-line peer-reviewed open access medical journal, and SAGE Publications.