By Oran Aviv, Reflexologist & Validation Teacher
One of the biggest challenges faced by both family caregivers and professionals is managing aggressive behavior in individuals living with dementia. Rather than simply attributing the behavior to dementia itself, it is crucial to take a closer look at the underlying reason. By identifying the root cause, it is often possible to diffuse aggressive behavior.
Additionally, it is essential for both caregivers and professionals to learn how to protect themselves emotionally when the person they so lovingly care for, will often blame or scold them.
Find the Reason Behind the Behavior
In Naomi Feil’s Validation Method we believe that there is a reason behind every behavior, and we try to understand the reason or need behind this behavior. We accomplish this by connecting at a deeper “heart to heart” level to try to understand why this older person is acting the way they are.
Although we can use The Validation Method on everyone, the greatest results are seen in older people who began being disoriented from around age 80 or older.
Even before we approach a client, we use the Validation Technique of Centering to clear our own thoughts. By putting our thoughts to the side, we are better able to understand and feel what the other person is feeling. This allows us to better understand what is causing a specific behavior.
Centering also helps us remove our own emotions so we won’t be hurt. Instead of taking it personally if the older person blames or scolds us, we can focus on what is causing the person to act this way. Then we can try to help them, rather than feel hurt by the person’s aggressive words towards us.
You can learn more about Validation Method and the Centering in our previous blog post: If a Person with Dementia Blames You
Physical Cause Behind a Behavior
It is important to always first check for physical factors that can play a role in changes in behavior in people living with dementia. Some common outside factors include:
Hunger: Being hungry or dehydrated can lead to changes in behavior, such as confusion, agitation, or irritability.
Fatigue: We all know what we are like when we don’t get enough sleep. Being tired can lead to changes in behavior and cognition.
Pain: Even a constant dull pain that we barely notice, like an earache or toothache can affect our mood and disposition. Pain can cause confusion, agitation, or aggressive behavior..
Urinary tract infections: UTIs are common in older people, and they are often the reason for confusion, agitation, or aggressive behavior. It is always important to check for a UTI if there a sudden behavioral change. It is also important to consider other possible illnesses as causes.
Environmental factors: Changes in the environment, such as it being too hot or too cold, can cause discomfort and anxiety
Medications: Some medications can cause changes in behavior, such as confusion, drowsiness, or agitation. If there has been a change in medications or doses, you should report and check with your health professional.
Constipation: Chronic constipation can cause discomfort and pain, leading to changes in behavior.
Try to identify and address any outside factors that could be the cause of changes in behavior in an older person living with dementia. .
Sensory Cause Behind a Behavior
Dementia not only causes memory loss and confusion, but it also frequently impacts the five senses. Many individuals diagnosed with dementia, as well as those who care for them, may not be aware of these sensory changes and may not realize that their changing and/or declining senses can impact their behavior. Below are some examples:
Vision: Dementia can cause individuals to perceive objects in unexpected ways. Simple, everyday items can suddenly become a source of trouble or fear. For example, a black welcome mat in front of a door may appear to a person with dementia as a black hole, causing them to be afraid to enter.
Elevators with dark floors can also appear as holes and become even more frightening if they contain mirrors. The mirrors can create the illusion of people staring, which can add to the fear and confusion.
Hearing:
Our hearing is constantly bombarded with a variety of sounds throughout the day, and we often can filter out background noise and focus on the sounds that are most important to us. However, this ability can decline in people living with dementia, making it challenging for them to concentrate on speech and understand what is being said. This can result in frustration, irritation, and even anger, as they struggle to make sense of the sounds around them.
Additionally, hearing difficulties can also cause sensory overload, leading to confusion and disorientation. Loud noises can cause startle responses and increase anxiety.
Sensory changes can lead to increased anxiety and agitation that may cause aggressive behavior. It's important to be aware of how the environment may impact individuals with dementia and make necessary adjustments to help ease their fear and confusion.
You can learn a more about sensory changes in our blog post: “Dementia and Sensory Changes”
Find the Need Behind the Behavior
Once we have ruled out that there is not a physical or sensory reason for the aggressive behavior, then we can use Validation Techniques to help us discover what the other person may be feeling. In this way we can try to understand what might be causing their behavior.
It is important to remember that even the most challenging behaviors are a form of communication - perhaps the only means some people have to let us know something is wrong. Fear, sadness or other emotions may be causing a person to be aggressive.
In Validation, we look for the unfulfilled need that may be the reason for the behavior People who are living with dementia still have the same needs that we all, for example:
To feel safe and secure
To feel useful
To feel loved
Once we discover the need behind the behavior, we can find ways to make the person feel safe, or useful or loved. It's all about accompanying our client where they are at that moment.
With time and applying Validation techniques, the behavior will lessen or cease all together.
In this clip you can see Naomi Feil who developed the Validation Method and her daughter Vicki de Klerk, the director of the Validation Training Institute (VTI) use roleplay, based on their own experience using Validation on old people with dementia, to demonstrate how to diffuse aggressive behavior.
In the clip each of the Validation Techniques that are used are listed. You may have to turn off closed captions to see the text. In this example we can see that the aggressive behavior was actually sadness. The anger dissipated when the older person was able to express herself to someone who was there to listen.
Attuned Emotions Affect Behavior
In last weeks blog post, “Listen and Care”, I discussed that as cognitive abilities decline, people become more attuned to emotions and feelings and can sense whether someone is truly caring and honest with them or not.
This heightened sensitivity to emotions and feelings can cause people living with dementia to become more easily agitated or aggressive if they sense that someone is not being honest or genuinely caring towards them. This is one of the reasons that we never lie in the Validation Method. We want to build trust with our clients and they can sense when we are not being honest, even if we are telling a therapeutic lie.
As cognitive abilities decline in people living with dementia, their emotional recognition and perception of others can become stronger and they can sense how another person is feeling.
During the pandemic in France, a validation worker went to visit a client at a nursing home. When they met, her client immediately asked her why she isn’t smiling as she normally does. The Validation worker was so surprised because the older woman could not see that she wasn’t smiling because due to covid, she was wearing a mask! Sadly this Validation worker’s relative had recently died and the older woman who had dementia was able to sense this loss immediately.
It is important to always center first, be honest and approach individuals with compassion and understanding.
In summary, Aggressive behavior may be due to:
Physical conditions
Sensory changes
A need that is not being fulfilled
Heightened sensitivity to emotions
The way to diffuse aggressive behavior is by:
Centering
Understanding there is a reason behind the behavior
Validating the person
Addressing the unfulfilled need
It is also important to remember that an aggressive behavior is not a personal attack on the caregiver or other individuals around them, but most probably is the only way they can express themselves to let us know something is wrong.
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