Combative behavior is a common description for behaviors exhibited by some people with Alzheimer’s disease. Para professionals, professionals and family commonly use words like; combative, difficult, un-cooperative and disrespectful to describe behavior that they feel is inappropriate. With that in mind let’s think about this scenario from the perspective of a person with Alzheimer’s disease:
You are at home one day and you are told you can no longer live there safely and now your familiar people, places and things must change. You get to your new home and it is smaller and more confined then your “home”. You do your best to adjust to all these new situations. There has been a diagnosis of Alzheimer’s disease given to you. Used as the reason for such a big change in your life, this causes you to feel anger about having Alzheimer’s disease and you feel vulnerable. These new situations require the ability for new learning. New learning is difficult now because of the Alzheimer’s disease. One day you get another illness besides Alzheimer’s disease. This new onset of symptoms not related to Alzheimer’s disease causes concern.
The call to 911 is made and this activates the emergency response system. The police arrive first followed by the ambulance because the decision has been made that you are going to the hospital.
They transport you to the hospital and you find yourself surrounded by people in uniforms. Some are in medical uniforms and some are wearing black thick belts with walkie talkies going off. You are trying to process who these people in uniform are and you are feeling sick. You feel threatened by all the sounds, smells and talking that doesn’t make sense to you. Everyone is speaking too fast and too soft. All your senses are on high alert and you don’t always agree with the people that are now in your personal space.
The sicknesses you have leave you feeling drained. The people come in and say that you can’t go home. “What do you mean I can’t go home?” (Remembering that you have Alzheimer’s and are thinking of your “home” not the new home and you feel angry). You now are supposed to be getting medical treatment. You don’t like where you are and the medical personnel know this and feel that your treatment can be managed at a Short-Term Rehabilitation facility. The hospital sets up two choices for your family to pick and gives them 12-hour notice of the move. A medical discharge plan is handed over and there is a special note that states that you are not always compliant and at times you are “COMBATIVE”. The hospital feels that you are well enough to leave there but you can’t go “home”.
So now you are off to another new environment. More new learning and coping that your Alzheimer’s disease keeps you from having. You are curt and nasty, so say everyone who tells you about your “new, new” home and how great it is going to be. You are angry and you voice your discontent. This doesn’t seem to be heard, not at least in the way you are processing. The answers that are coming, are coming very fast. This only increases your vulnerability as you perceive the situation using a brain that has Alzheimer’s disease. Before you know it here comes the uniformed people.
Why are they here again? Did you do something wrong? You hope they are going to take me “home”. You are wheeled out of the facility and now you take an extremely bumpy van ride on a stretcher to “God” knows where. I really hope it is “home”. You pull up in front of a very large building and you know that this is not “home”.
The uniformed people get you out with the loud noises and loud talking and in you go to the new, new home. Bah humbug. The admission nurse and social worker see your paperwork and see those word, “COMBATIVE” stamped like a scarlet letter. Before you have even had a chance to impress the new people, the new place and new things, you have a been summed up. You are COMBATIVE. All of the changes that have occurred in your life thus far have caused you some distress. That distress makes you feel like you are not safe because you do not completely understand what is happening. So, you can either fight or flee. Flight is hard when you are sick and when you come from a generation that is known for fight. The place you are looks like a prison.
Imprisonment calls for behavior that saves your life.
Why can’t it be seen as you are being self-preserving? And what if you are trying to protect you and be self-preserving? Can’t we as the caregivers, para-professionals, professionals and family empathize and say we understand that you feel that no one understands you? If self-preserving was the label seen by those para professionals, professionals and family members, who only saw COMBATIVE, they may be more understanding that you feel you need a life preserver. You need to feel safe and you don’t. Those who are labeled “COMBATIVE are approached, spoken to and interacted with as a potentially violent person; which can cause such behavior by simple unspoken triggers. Taking a posture of helper to those who are self-preserving offers that person the much-needed life preserver.
Quality of life is a life goal and presumed outcome that is written in stone. The person who has Alzheimer’s disease needs those who interact with them to realize that the memory loss is not selective. Saying to a person with Alzheimer’s disease that they should remember the information because you want them to does not work. The thoughts and memories will fade, unfortunately.
What doesn’t fade is the feeling that can be; joyous because you are right and things are going well or sad and scary because you do not know what is going on and no one seems to have the time to calm you over and over.
Choosing carefully the words that are spoken is our advice for the para-professionals, professionals and family that use words that are not flattering for the person they describe. Why not choose words that when conveyed they sound like you are helping someone? HV Aging at home is there to help. Boots on the ground in the facilities. We can be the quality of life preserver!!!!!!