Reader Question:

I have a question regarding how to handle a combative dementia patient. My husband and I care for my 51 year old daughter. She is in her 5th year of dementia and hates bath time and getting re-diapered. She is also getting more and more agitated in general.

We have zero outside help as she has no insurance and so far has been denied any government assistance.

My concerns are for her safety as well as mine… she hits and trys to bite … she poops when she gets excited and angry which is a problem when I have to put the clean diaper on her.

It takes 2 people to get her bathed and dressed and her diaper is soiled by the time I get her “anti-strip pj’s “on her!

She does have a doctor the free clinic at the county hospital system… but I have to figure out a lot of this on my own… should I ask for a mild sedative to use for her bath time… we try to bathe her 2X a day.

Thank you! Sincerely,
Yvonne

 

Hi Yvonne,

When it comes to how to handle a combative dementia patient, I am not a medical professional, so my advice is purely from my experience. I’ll do my best!

Agitation is a very common symptom with dementia. My advice is to look for both clinical and non-clinical solutions.

Non-Clinical Dementia Care

Dementia is scary for the person experiencing decline. As a person who has had a minor stroke, I experienced the tiniest touch of cognitive impairment.

I can remember looking around at my family. My head knew they were important, but I couldn’t remember why. I could see by the looks on their faces that something was wrong with me, but I couldn’t grasp what that might be. The experience was disorienting and terrifying to say the least.

I imagine this is how it is for someone experiencing dementia. So, the goal is to reduce stress and agitation while preserving safety, health and freedom.

Take note of activities that cause agitation. Does your loved one seem more agitated at night (very common) or morning. Is agitation mainly due to a certain task like meals, bathing, or bed?

Once you notice of what triggers agitation, avoid it.

I know I know, no kidding right, but stay with me.

If bath-time stresses your loved one, then consider doing it less frequently (as long as there is not a soiling issue).

Your loved one may have bathed daily for 60 years, but dementia brings many new normals. It could be time for a routine change.

I met a creative woman who COULD NOT get her husband into the shower, but he would sit with her in the hot tube where she could wash him. Small wins.

Maybe showering is out right now, but your loved one would stand for a sponge bath or wipe down with a disposable cloth. This article is about giving bed baths, but many of the same principles apply to dementia bathing.

Dementia care is less about getting the task done and more about making sure your loved one is safe, healthy, and comfortable. If it isn’t really necessary, ask yourself if it must be done.  Creative care is dementia care.

Now, lets address non-negotiable care. You cannot leave a loved one in a soiled adult diaper, but often this is a highly stressful activity for both you and your charge. Try your best to keep the environment calm. You might find that taking breaks between tasks gives you both a minute to compose.

For instance, waiting to re-diaper might give skin a chance to breath and your loved one to relax.

Try putting on a favorite song or show while completing a task that is unpleasant. Trying singing something you both loved to trigger a calmer atmosphere. Make a cold bathroom warm before shower time.

Remember, with dementia care, we go where the patient is. They rarely come to us.

Clinical Dementia Care

Sometimes, no matter how comfortable the environment, your loved one will still experience anxiety, and care will still need to take place.

This is where a close relationship with your physician is a must.

You are not a doctor BUT you are an advocate. This is one of your most important roles. The doctor may spend 10 minutes with a patient, but you see that person all the time.

If something isn’t working in the best interest of your loved one, speak up. If your doctor doesn’t like it, get a second opinion.

I would set an appointment and share your situation with your doctor. A sedative may not be what he or she prescribes. But, there are medication options that might make everyone more comfortable.

I have seen clients who hit and bite transform with the proper medications. This a journey. Meds may need to be adjusted or changed as dementia progresses. Do not hesitate to communicate with your doctor if meds don’t work or results change over time.

If you don’t feel you are getting the proper support from your doctor, request a specialist. Neurologists specialize in conditions that affect the brain. You for sure could use one of these experts in your court.

Support

Dementia care may feel lonely, but you are not alone. Often, it seems the only options are private paid care – like what Green Tree Home Care offers – and government assistance.

Unfortunately, many people fall into a care gap where private pay is out of reach and they don’t qualify for government help.

There is a large number of non-profit organizations that exist to fill in this gap!

For those caring for loved ones with dementia, the Alzheimer’s Association is an amazing resource. There should be one in your area.

In San Diego, where I am based, we have Jewish Family Service. This organization has programs to help older adults with hands on care and care management (you do not have to be Jewish to receive help).

The Parkinson’s Association also has a large presence.

These organizations can help you better understand what resources are available in your area.

There are professionals called Care Managers who help people manage the medical and non-medical ageing landscape.

They generally charge for their services unless they are connected with an organization. But, it may be worth a call to see if one in your local area has any resource ideas.

These professionals are often nurses or social workers and have a strong understanding of the local care landscape.

While there is no simple solution to how to handle a combative dementia patient. Small adjustments can have a big impact!

If you are in the San Diego, Orange County, or Riverside areas of California, please feel free to reach out to use for more help.