Mailbox Response

The question was submitted 20/12/2007

Subject: Dementia

why do dementia sufferers get aggressive and abusive?
and what is the correct procedure when considering the use of restraint , physical and chemical?

Answer from DementiaNet

The diseases that cause the syndrome of dementia not only affect the memory storage area of the brain. The parts of the brain that monitor and influence emotional and psychological state are also involved. So this is why behaviour can be altered with dementia. The behavioural changes can be quite different from one patient to another. Aggression and agitation is common and this is often triggered by the frustration that sufferers have with their memory problem. Paranoia and hallucinations also occur occasionally. At the other end of the spectrum of behaviour change is inertia and apathy. The person may sit all day doing nothing. Low mood is another common change and this can trigger aggression too. There are medications that can be used to modify these behavioural changes.

Restraints should be considered a last resort in the management of behaviour change. Strong tranquilisers are occasionally needed for very aggressive behaviour but these drugs need to be used very carefully as they can be toxic if used in the wrong dose. Physical restraint is needed rarely and is only used if the patient is a risk to themselves or their caregiver. There are many strategies short of restraint use that are very effective for managing altered behaviour in dementia.

If altered behaviour is a problem then the first step is to obtain an opinion from the GP and then consider a referral to a geriatrician.

The answer was published on DementiaNet 24/01/2008