I saw this for the first time in the nursing home I worked for. Some of the patients would lash out. Most did so verbally but a few were physical. One hit a caretaker with a cane and another with a fire extinguisher. Our elders can and sometimes do abuse people.
Why would an elder lash out? Some do this knowingly and without having any mental problems. Most of them, however, have some form of dementia. They have all the knowledge they gained in their lifetime and none of the restraints. There isn’t anything in the brain saying “this isn’t the right thing to do.”
The cause of these outbursts can be anything from a delusion to disliking what you brought for dinner. If a major change in life is needed it can get really bad. In short, anything can be a cause. We have to be on our guard at all times.
Validation: This is considered a theory but I’ve seen it work. Find something in the commentary that can be considered valid and focus on it. For instance, the patient may need to move from home to a care facility. That will upset them. Instead of focusing on the reasons this move is good, start with validating the patient’s feelings. “I can understand; you don’t want to move. This is your house.”
Redirection: Validation can only go so far. It’s pretty hard to find somewhere positive to continue on with in validating an emotion. Next is redirection. If it’s a dementia patient it is often easier than when it is with others. After you validate how they feel, ask questions like “this is such a great house; when did you buy it?” Find positive things to say about the house and get the patient talking about these positive things.
Firm but Gentle: A dementia patient is a lot like a young child. It takes a firm but gentle person to handle the finesse of validation and redirection. It takes a lot of self restraint. It isn’t easy.
Medication: There are patients and there are times when medication is the only way of resolving the crisis enough to prevent a patient from abusing a caregiver. Talk to the patient’s doctor at the first sign of abuse to make sure this option is safe and available.
The Game Changer: If this is an in home caregiving situation, there is one act of abuse that changes things utterly: physical abuse. Once a dementia patient has resorted to physical violence it is my experience that it only gets worse. The family and/or professional in home caregivers don’t have the resources a memory care facility has. While it isn’t always considered necessary, our family members have been told that if they do strike someone they will not be able to stay in home.
Caregiver abuse does happen. The verbal and emotional abuse is hard to take; I’ve had a good deal of that with our elder. The techniques mentioned above do work; I’ve used them as have the professional caregivers. It is up to us to make sure no one is abused, and that includes us.