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Caring for Abusive Elderly Residents – Strategies and Advice

Abusive elderly residents are by no means a new challenge for care providers, but as the size of the elderly population increases along with the number of dementia cases, it is important to have strategies for dealing with agitation in elderly patients with dementia and for finding ways to help providers deal compassionately and effectively with the issue. Abusive behavior in elderly patients can range from verbal abuse of other residents and staff to physical assault.

Where to Start?

The first step is to understand the source of the problem—agitation in elderly patients with dementia—which can help inform our solutions. To understand how to care for elderly patients with agitation of abusive behaviors, start by asking:

  • Could this behavior be a sign of the onset or presence of dementia?
  • Are there pre-existing mental health conditions?
  • Could the resident have an undiagnosed urinary tract infection that is causing more aggressive behavior?
  • Are there any issues with medications that could cause the behavior?
  • Are the elderly patients currently being cared for at the appropriate level of care?
  • Are there environmental triggers that are likely to result in abusive behaviors?
  • Is their behavior simply an extension of maladaptive behavior from earlier in their life?

Evaluating the Behavior

If medical causes can be ruled out, then the first step in addressing the problem is getting to know the resident. What is the resident trying to tell us with this behavior?

  • If the resident is newly arrived in the facility they may simply be dealing with the loss of control over their lives. Face-to-face meetings and other communication efforts with the resident and/or family members can be effective in helping to identify those ways in which the resident can maintain some semblance of control—accommodating meal requests, bathing times, adjusting the times at which the resident is awoken in the morning, etc.
  • Some abusive behavior is the result of personality differences. Not every staff member is going to mesh well with every resident and that might be more likely to happen when the resident is already struggling with a loss of control. Making adjustments to resident care assignments may be necessary in this case. If the conflict is between residents, the solution may be as simple as separating the residents during activities, meals and in common areas.
  • Evaluate environmental factors. Is the environment so loud or busy that it is contributing to the resident’s agitation?

Addressing the Behavior

The first step in addressing the behavior is for the caregiver to be aware of their own feelings. It is critical to the de-escalation process that a caregiver maintains their own composure and is able to be mindful of their tone, body language, and facial expressions.

While being mindful of our own feelings, there are some additional strategies to engage with the resident in a peaceful and calming manner.

  • Evaluate the resident to ensure that the behavior is not a reaction to physical stress or stressful environmental factors.
  • Do not attempt to touch the resident. This is frequently over-stimulating and can increase agitation.
  • Refrain from disagreeing with the resident, particularly if dementia is or may be a factor. Disagreeing never works and will usually exacerbate the situation.
  • In the process of agreeing with the resident, attempt to re-direct their attention to a meal, activity, exercise, or a favorite doll or toy.
  • Evaluate staff response. At the conclusion of the interaction, was the resident successfully calmed and re-directed appropriately? Whether the answer to this question is yes or no, take the time to reflect on what could have gone better.

Supporting Resident Care Staff

Dealing with abusive residents can be incredibly frustrating and difficult for staff. Regular training on best practices and strategies is the best way to ensure de-escalation for the resident and protection for staff.

Learn How to Use Workforce Development and Training to Improve Your Employees’ Care of Elderly Patients and Residents.

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