Combative Behaviors in Alzheimer's Patients

Alzheimer’s and dementia care isn’t easy. Just ask “Elizabeth’s” son, “Robert.” He cared for Elizabeth at home for almost seven years, from the time she was diagnosed with Alzheimer’s disease to the day he brought her to “The Springs,” an assisted living facility. I met her there a few months later when I took a position as Director of Patient Care.

  Elizabeth was a seventy-eight-year-old woman in excellent physical health except for a slight limp. All of five feet two inches tall, she had a shock of short, frizzy red hair with only a few touches of gray, and big, brown, expressive eyes. She had the face of a woman her age, but her wrinkles were not deep, and her skin looked soft and fragile.

  I expected a smile when I greeted Elizabeth but was disappointed. She didn’t smile much, probably because of advancing Alzheimer’s disease. The nursing assistants told me that she appeared to be in a miserable mood most of the time. Nothing seemed to make Elizabeth happy. In fact, her negativity, combativeness, and bizarre behaviors were the topic of an emergency meeting I had with the staff. This was how I spent my very first day on the job. It seemed that Elizabeth was combative when the staff awoke her in the morning, striking out and hitting whatever nursing assistant was unlucky enough to have Elizabeth on their assignment sheet.

After altering our approach to Elizabeth several times, we realized nothing we did improved her morning moods. We altered the time we woke her, changed the lighting, changed the person who woke her and even tried waking her to music. Nothing was helping. It took a while for us to figure out how to help Elizabeth, but eventually we succeeded. The lesson we learned during the process was a valuable one. Elizabeth simply taught us how to apply common sense to the way we provided her care.  

Elizabeth’s son came to visit one day and before he left, he gave me a small bag of chocolate kisses. Asking me to give his mother a few each day, he explained that she had loved them as a child and when she was healthy, always had a few in her kitchen to nibble on. This gave me an idea.

The next morning I asked the nursing assistant to do me a favor and I watched from the doorway as she approached Elizabeth.  “Elizabeth, please get up,” she said, ready to jump back to avoid Elizabeth’s fist. “Look what I have for you. A chocolate kiss.”  With that, Elizabeth jumped up, opened her eyes and smiled broadly. She grabbed the chocolate and popped it in her mouth.  Elizabeth had no teeth and refused to wear dentures so as she happily gummed the kiss, the nursing assistant was able to get her up, washed, and dressed for breakfast. Elizabeth smiled the whole time. And….surprisingly stayed in a good mood all day long.

What we learned:

This was my first and most important lesson in dementia care. It was simple common sense. Caregivers could change the moods and behaviors of people with dementia by giving them something pleasant. Something that made them feel good. Call it a bribe, but it worked. Most of us do this for ourselves when we are in a negative mood. We call it “comfort food.” Sometimes we pamper ourselves in other ways as well. I just hadn’t thought about the fact that people with dementia can’t do this for themselves. I was overthinking the problem instead of looking for the simple common sense solution. If you feel negative, indulge in something positive!  

This story is true

This lesson stuck with me for over 20 years and has almost always worked well with people who have dementia.  To read more about Elizabeth and her story, go to kissesforelizabeth.com