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Management of Aggression in Dementia

Aggression

What is Aggression?

"Physical/verbal behaviour which may harm or repel others.”

(Eg. Hitting, kicking, screaming)

Approximately 50% of individuals with dementia experience aggression

~50% of individuals with dementia experience aggression

My Experience

Student Experiences

Inappropriate administration of PRN antipsychotics to a non-agitated patient

Your Experience

Your Experience

Have you experienced inappropriate administration of PRN antipsychotics to non-agitated patients?

Brain Function in Dementia

Understand Brain Function in Dementia

Typically: Neurons transfer messages between brain regions and from the brain to the muscles and organs.

Dementia: Neuronal communication disrupted, causing reduced function and cell death.

Neurons Destroyed

Neurons Destroyed

1. Neurons destroyed in entorhinal cortex and hippocampus (responsible for memory)

2. Neurons destroyed in cerebral cortex (responsible for language, reasoning, and social behaviour).

3. Neurons destroyed in additional brain regions (reduces ability to function independently).

Vascular issues - reduction in blood flow and oxygen to the brain

1. Assess Safety

1. Assess Safety

Ensure safety of patient, caregiver, and others.

Remove other residents from the situation if needed.

2. Reduce Potential Factors

  • Physical discomfort
  • Environmental factors
  • Poor communication

3. Non-Pharmacological Interventions

  • Identify and reduce cause
  • Rule out pain as cause
  • Consider feelings, not facts
  • Validate and reassure
  • Clear and calm communication
  • Limit distractions, modify environment
  • Music, exercise
  • Simplify tasks
  • Create routine
  • Distractions (objects or snacks)

4. Pharmacological Interventions

Antipsychotics IF symptoms present a danger.

4. Pharmacological Interventions

Risks

Antipsychotics may increase risk of:

  • MI
  • Stroke
  • Death

5. Restraints

IF patient continues to be a risk to themselves and others, consider restraints.

5. Physical Restraints

Risks

Restraints may increase risk of:

  • Restriction of freedom → frustration, reduced confidence, decreased self esteem
  • Risk of harm/injury
  • Loss of cognitive and physical abilities
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