Behavior change is a natural part of aging, even without dementia. Seniors often face significant life transitions, such as retirement, relocation, loss, and health issues, requiring new patterns of living like healthier eating, regular exercise, and following medical advice. These behavioral changes can often lead to stand-offish attitudes that instil conflict and hence need addressing through the introduction of beneficial behaviors that, though challenging, are crucial for well-being.
However, when dementia is involved, these challenges intensify. Dementia significantly alters behavior and personality, making management difficult for families and caregivers. The disease’s impact on the brain affects memory, focus, motivation, and emotional regulation. For instance, frontal lobe damage can reduce impulse control, leading to inappropriate actions and making it hard for individuals to process their environment, causing frustration and anger.
Caregivers must employ strategies to de-escalate conflicts and create a supportive atmosphere. Understanding the root causes of behavior changes and addressing medical issues that exacerbate problems is essential to improving the quality of life for both seniors and their caregivers.
Dementia, Medication, and Other Causes of Behavioral Change
Behavioral changes in the elderly can be attributed to various factors, including dementia, medications, and emotional stress, each intertwining to create complex challenges. Dementia, resulting from physical changes in the brain, significantly impacts memory, mood, and behavior, often leading to increased irritability, aggression, and confusion, as the disease affects different parts of the brain responsible for emotional and cognitive control.
Additionally, medications play a crucial role in behavioral changes. Many elderly individuals take multiple medications, some of which can cause adverse drug reactions (ADRs) such as aggression, irritability, and violence. Drug classes commonly associated with these aggressive behaviors include anti-epileptics, antidepressants, immunomodulatory drugs, and benzodiazepines. These medications can alter neurotransmitter levels, such as serotonin and dopamine, leading to behavioral issues that complicate caregiving.
Emotional stress further exacerbates behavioral changes in the elderly. Older adults often face significant life stressors such as bereavement, retirement, social isolation, and declining health, which can lead to psychological distress manifesting as depression, anxiety, and increased agitation. What doesn’t help is that many elderly individuals experience ageism and abuse, severely impacting their mental health and behavior and contributing to a cycle of stress and behavioral problems. For many, sources of behavior change can be multifactorial, meaning that encouraging healthier behaviors may be far from simple. Caregivers must be wary of these facts so that should intervention be needed, it is implemented in a way that has the care of the elderly in mind.
Behavior Change and Conflict
Before instigating behavior change interventions, caregivers must be wary about the reasons why conflict may occur. Conflict among elderly individuals and their families often stems from several key sources. Firstly, defining the problem and assessing care needs can be contentious, as different family members might have varying opinions on the level of care required. Role expectations can also cause friction, especially when there’s ambiguity or disagreement about who should take on caregiving responsibilities. This may be particularly relevant to elderly men who have once taken the outdated but traditional role of being the family breadwinner, who may now struggle with the concept of having to be cared for.
Differences in values, attitudes, and beliefs often lead to conflicts, particularly regarding care decisions and lifestyle choices. Hence, decision-making processes can become battlegrounds, with disputes over who has the authority to make crucial health and financial decisions. Unresolved prior conflicts can resurface, compounding current issues and adding emotional strain.
Moreover, communication issues, such as lack of communication or miscommunication, often exacerbate these conflicts, leading to misunderstandings and resentment. Finding suitable solutions that satisfy all parties can be challenging as differing priorities and perspectives come into play.
De-escalating The Situation
De-escalation techniques are essential for managing conflicts involving highly agitated, frustrated, angry, or fearful individuals. These techniques, which use both verbal and non-verbal methods, are effective but require practice, as they go against our natural fight-or-flight responses. Most importantly, the individual instigating the techniques remains calm and detached during a confrontation.
Physically, it’s important to maintain a safe distance—about four times the normal space or at least two arms’ lengths. Encourage the individual to sit, and if they stand, the instigator should stand too to maintain the same eye level while avoiding direct eye contact that can otherwise be perceived as staring.
Emotionally, it is recommended that the instigator appears calm and centered, breathing normally and deeply to help control emotions. When speaking to an agitated elderly individual, one must speak clearly and slowly in a moderate tone of voice and be respectful even when setting limits or calling for help.
The bottom line is for individuals to trust their instincts—if de-escalation is not working, it’s essential to know when to stop, seek help, or safely remove yourself from the situation. Practicing these techniques can help manage and reduce conflict, creating a safer environment for everyone involved.