When Dementia Residents Fight

17 Nov

Here’s a story ripped from the headlines. Names and location changed, to protect those who should have done better.

Imagine this. An old gentleman in a care center had been a professional footballer. At 88, Bill was still big, and weighty and somewhat aggressive. Another old gentleman arrived to live at the same place. Simon was a slender old man, rather scholarly-looking and dignified. Both were diagnosed with dementia of the Alzheimer’s type. They did not become friends.

In fact, staff noticed that the retired footballer, Bill, seemed to take something of a pleasure in bullying the other man. He would deliberately bump into Simon. Staff watched to prevent this from happening. A staff note said the men seemed to have a tendency to fight or quarrel, although in fact only one of them did that.

This, by the way, is commonly found in care situations and it comes about because staff are often neither practiced nor trained in unbiased reporting of incidents. Then one day, Bill apparently was just full of energy for combat and he chect-butted Simon, causing the smaller man to fall and hit his head against a chair. Ten days later, Simon died and the local district attorney considered but ultimately did not file murder a murder charge against Bill.

In my observation of aggressive residents, there should often have been a question from the care facility of the original dementia diagnosis. Consider the background — aggression in sports is not unusual. Head injury not unusual. Daily aggressive social behavior is unusual. The care facilitiy should have insisted on having the diagnosis re-examined, with suitable psychiatric investigation into Bill long before this incident.

In fact, in my opinion, with that retrospective wisdom so clear to us all, the facility was courting disaster in keeping this resident once he was known to be aggressive. I would have notified the family and the state that he was not able tyo benefit from a socially-based care policy and posed a possible danger to fellow residents.

At the very least, staff should have been continually watchful so that Bill could not bully others. My guess is that Bill had sports charisma and staff did not feel able to challenge his presence there.

Let me list two other resident “fights”. The quotes are because actually it is always a one-resident fight. An old woman strangled her room-mate asnd put a plastic bag over her head. Whatever else this may be, it is certainly NOT normal dementia behaviior. It is the behavior of serious mental illness and made her a totally unsuitable candidate for ordinary care residency.

Anita, a cheerful bright eyed woman of 82, was walking down the corridor with Andrei, the retired professor of alcohol studies, approaching on the other side. Andrei, known to be unpredictable, subjects to rages of unknown origin and likely to hit anyone who approached his comfort zone, punched and kicked her. The incident report described them as “getting into a fight” even though the fight was caused by only one of them.

My point is that when residents fight, usually only one of them is the initiator and the aggressor. Often staff know and almost excuse the violent resident. It is the same kind of scapegoat thinking that accuses raped girls of “asking for it.”

I wish the art of forensic investigation into violent incidents was taken more seriously. I wish staff could be impartial and I wish care facilities would take this particular responsibility much more seriously.

If they won’t, the law eventually will.



Source by Frena Gray-Davidson

Leave a Reply

Your email address will not be published. Required fields are marked *