20 questions to change the direction of dementia anxiety and aggression

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Change the direction of dementia aggression

I discovered through personal experience, research and observation that people living with dementia (PLWD) behave in logical, natural and understandable ways to stressful situations, just like most of the rest of us do. Although they react as any “normal” person would, their behaviour is more often than not mistakenly attributed to the disease rather than to whatever catalyst actually sparked it.

People living with dementia are people; they respond normally when they are threatened, demeaned and made to feel powerless: they resist, lash out, become agitated or try to flee. Blaming the disease leads us in the wrong direction. What we should be doing is asking ourselves questions to reset the compass ; questions such as:

  1. What might I and/or others have done to precipitate this situation, and how can I rectify it as quickly as possible with as little disruption as possible?
  2. Would I behave the same way in similar circumstances? How would I feel? What would I want?
  3. How can I defuse the situation? (Hint: do not tell people who are upset or agitated to “calm down!”)
  4. What is threatening the person? How can I remove the threat?
  5. How can I help this person feel more at ease?
  6. What unmet need might this person be expressing? Is s/he in pain or experiencing some other kind of physical discomfort? Is s/he hot, cold, wet, thirsty, hungry, etc.?
  7. What environmental factors might be contributing to his/her anxiety, and how can I neutralize them?
  8. Is my tone of voice conciliatory and respectful?
  9. Is my body language relaxed and open?
  10. Can the person see and hear me properly?
  11. Have I surprised him/her in some way?
  12. What action can I take right now to restore calm?
  13. How can I meet her/his immediate need?
  14. How can I meet her/his deeper need?
  15. Have I said I’m sorry?
  16. What more can I do to empathize?
  17. Could I ask for the support of someone else who might be more effective in dealing with this situation?
  18. What could I do differently next time?
  19. What can I learn from this?
  20. How can I share that learning with others? How can apply my knowledge to engage more effectively with this person and others who live with dementia in the future?

Too many people with dementia end up needlessly medicated for behavioural expressions that are provoked by the environment and the people around them, including paid care workers and family members such as myself who are drafted into caregiving roles with little or no experience or training.

By questioning and reframing, I believe we can transform the way we see dementia and the people who live with it; we can also find ways to deliver better care. Specifically with respect to the issue of aggression, putting ourselves in the place of PLWD will help us discover what might underly behaviour we find challenging or problematic. We can then address the underlying causes instead of inappropriately prescribing antipsychotic medications.

Download the 20 questions pdf here.

Note: I developed a process called “BANGS” to help myself and others avert “shoot outs” with people who live with dementia. It’s easy and it works. You can learn the steps and use it too. The BANGS model is outlined at these links:

“B” is for breathe.

“A” is for assess, accept, and agree.

“N” is for never, never argue

“G” is for go with their flow, let go of your ego, get over it, get on with it, get down to it

“S” if for say you’re sorry

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11 Comments

  1. Pingback: 20 things & beings i love & am grateful for today

  2. Yes!! I spend so much of my time at work (I work in an acute hospital in a liaison team, where we support with patients with dementia) trying to help staff understand why those with dementia behave the way they do. This article is brilliant, and I love BANGS! X x

    • Welcome Anna, I don’t know why it shows as anonymous – think it has something to do with the choices you make when you leave a comment. But I’m glad you left a comment and yes, we must work hard to help all care partners “get it!” Love that you love BANGS 🙂

  3. As I was reading this, I kept wanting to get a highlighter out and was saying in my head “yes, this one, and this one, and this one’ and realized I would have highlighted the entire list! The questions are great to ask oneself in a _number_ of contexts. Thank you, Susan! I will share this with my partner and other family members.

    • thanks for your comment lemony, and sorry for my delayed reply. It means a lot to me that my posts are useful to you. Thanks again, and thanks also for your wonderful photography that infuses moments of joy in my days <3

  4. Perhaps you have an answer for the same troublesome difficulty. First, I understand how and why my husband reacts but I have NO answer. He becomes extremely stubborn and physically combative with me when trying to change any of his clothing whether it be a pullover, his slacks and most specifically his underwear. He is totally incontinent, and if he is wet or worse, I want him clean and dry. I have been caring for him for eleven years with this horrid disease and other than the clothing issues, I am able to cope fairly well.

    • Faye Reid, curious if he is only that way during the day time hours?

      My wife is that way during the day. It is a battle every time.

      After going to bed and falling a sleep if she is moving around more than normal i can get her up take her to the bath room and no problem. Sometimes a couple times a night. Also first thing in morning when waking up i take her straight to bath room and most time during that time no problem.

      After that no dice. 🙂

    • Faye, thanks for all you do for your husband, and I’m sure you’re doing a great job. I think you are in Canada, and I’m happy to have a short telephone conversation with you to see if I can help. Also, Wilbur had some interesting observations which might be helpful. You can reach me here: susan@amazingwomenrock.com

    • LOL! Yep, my favourite technique when all the questions failed was to walk away. Everybody needs some breathing space. Close the door, go to another room, step outside – – do whatever it takes to get away and regroup and then start again with breathe. it’s not easy. no, it’s not easy. but it’s worth it in the end. more about BANGS here.

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