3 Reasons You’re Triggering Aggressive Reactions in People Living with Dementia (And What to Do Instead)
Teepa Snow's Positive Approach to Dementia Care
Radically Transforming the Experience of Dementia. Until there’s a Cure, there’s Care
By Valerie Feurich, PAC Team Member
Have you experienced challenging reactions when you try to assist your person living with dementia? Have you been hit before and don’t know why?
You’re trying your best to help, but your well-intended actions often hit resistance. Understandably, this can leave you feeling confused and unsure what to do. We understand. Having worked with thousands of caregivers worldwide, we know how frustrating this can be.
It is true that aggressive reactions are very common in dementia care. However, what is not commonly recognized is that these reactions are often triggered by the caregivers themselves.
Are we blaming you? No, we’re not. If you were never taught why these aggressive reactions are occurring, you can’t be expected to know how to avoid them. And without that insight, you are left confused on what you can do to get a better care outcome. That is neither fair nor right.
The Snow ApproachTM methods, created by Teepa Snow over her 40+ year career in dementia care, help caregivers like you prevent or overcome challenging situations.
The 3-Step Snow Approach helps caregivers like you:
By considering these changes to the brain and their effects, you as a caregiver are better able to understand reactions, change your approach, and to achieve significantly improved care interactions. By using the Snow Approach, you’ll be able to not just survive, but thrive as a care partner.
So, what does the Snow Approach recommend you do to reduce aggressive reactions?
Here are three tips to help you bring more harmony into your care relationship:
1. Make Sure the Person Understands What You Plan to Do
What happens to the brain?
When a person is living with dementia, their brain experiences chemical as well as physical changes. These changes, over time, cause the person to need more time to process language. In addition, it causes a decline in the person’s ability to comprehend words or express themselves through language.
How does this affect the person?
As the dementia progresses, at some point the person in your care will struggle to understand your words. Similarly, their ability to use words to express their wants and needs becomes less and less, leaving them with fewer options to communicate with you. This can lead to them feeling frustrated and helpless, and feeling like the only way to let you know that they don’t like what you’re doing is to verbally or physically lash out.
What should you do differently?
As a care partner, respect them when a person tells you no. Throughout this journey, pay very close attention to their sounds and body language.
More often than not, people living with dementia will give you lots of cues that they’re wanting you to stop before they resort to the last option they have left – defending themselves with words and actions.
If it’s not through language, signs like stiffening of the body or sounds like Oh oh oh are an indication that they either didn’t understand what you’re about to do or don’t want you to proceed.
Slow down to give the person time to process what you’re trying to communicate. Take it step-by-step so as not to overwhelm, and most importantly, don’t rush.
To help the person understand what you’re trying to do, add visual cues to your spoken words. The ideal sequence to remember for your interaction is visual, verbal, and then touch.
Take this as an example:
Instead of shoving a washcloth into the person’s face, slow down and take it step by step.
First, give a visual cue, such as holding a washcloth near your face. Next, call their name to get their attention. A simple phrase like Oh! Hey Greg! may be enough for them to turn towards you.
Now motion using the washcloth on your own face, then point at their face to help them understand you’re looking to help them get clean. You might pair this action with a simple phrase like Looks like you’ve got a bit on your cheek, let’s get you a washcloth.
You may also try letting them use the washcloth on their own, but if they need a little help, instead of you doing it to them, try supporting them through the use of Teepa Snow’s Hand-under-Hand? technique.
See Teepa use Hand-under-Hand:
Watch Teepa using cues to communicate in this brief video:
2. Get Their Permission First | Use Empathy
What happens to the brain?
As a dementia affects a person’s brain, their sense of wanting control over oneself does not change.
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How does this affect the person?
Just as you and I would want a chance to agree to being touched by someone else before they do it, a person living with dementia will not like someone else to just touch them without permission.
What should you do differently?
It is critical that you get permission first and repeatedly throughout the process. After all, how would you feel if someone just shoved a washcloth in your face without giving prior notice? Chances are, you’d try to fend them off as well.
So, let’s continue with the example from #1.
You just motioned with the washcloth near your own face, and pointed at them to help them understand you’re looking to use it on their face. You also paired this action with a simple phrase like Looks like you’ve got a bit on your cheek, let’s get you a washcloth.
Now, look at their reaction. Are they signaling that they understand what you’re looking to do, and that they’re okay with it? If yes, you may proceed to touch. But if they look confused and unsure what you want, ignoring their reaction and diving right in is likely to trigger a reaction.
Give yourself a chance to understand what they’re thinking or feeling before you get yourself in trouble.
Will this take longer? Maybe a little bit. But how much time does it take you when they react aggressively? How much more time will you spend going forward as the person no longer trusts you, and is more likely to become reactive from the get-go?
Watch Teepa demonstrate how getting permission improves the care experience for all:
3. Pause and Rethink or Step Away If needed
What happens to the brain?
The amygdalae, the primitive part of the brain that is responsible for humans’ involuntary reactions to ensure our survival (such as impulsively running away from sudden danger), remains unharmed when dementia affects the brain.
How does this affect the person?
The more you push something onto a person that they don’t want, the more you’ll trigger the amygdalae’s fright, flight, or fight response. This explains why the harder you push, the more the person is likely to fight back (especially if you don’t leave them physical and visual space for flight - to get away from you).
What should you do differently?
Again, try to put yourself in their shoes. If you feel you’ve signaled no but the person proceeds to do things to you nonetheless, would you be tempted to fight back?
If you sense a person does not understand what you’re trying to explain, pause and think if there may be another way to help you two communicate. Is there an object you can show to support your message? Can you demonstrate what you plan to do?
If the person does not signal permission for what you want to do, pause and rethink your approach or step away for a little while. Trying to push through your agenda at this point would likely not end well for either party.
We know what you’re likely thinking now: That’s all well and good, but I need to get my tasks done. Well, we understand. That said, proceeding without the person’s permission not only greatly increases your risk of getting hit, but there’s also a fine line between forced care and abuse that you don’t want to cross.
Consider trying to find a compromise.
In this example, Teepa would like for Greg to take a shower:
Did you notice that Teepa is respectful, but does not give up right away?
You may need to negotiate and be willing to have less than everything you want; they aren’t getting everything they want either.
Watch PAC Mentor Amanda Bulgarelli use the Snow Approach to get Teepa to change her soiled shirt:
Conclusion:
Caring for a person living with dementia is not an easy job. Without knowing what happens to the brain and how this affects the person, it is nearly impossible for you to know how to best approach a situation.
But if you make sure the person understands what you plan to do and you make sure to get their permission first, you’re already off to a better start. Try to put yourself in the person’s shoes as much as possible, and pause and rethink or step away if you sense resistance.
Now, will this blog post equip you to handle any and all situations that come your way? Unfortunately – no. For that, you’ll need to do more than reading. To make that happen, you’ll have to actively use and practice the Snow Approach techniques. Just as you likely could not ride a bike the first time you sat on it, effective care techniques take a little while to learn.
That said, we can help you speed up the process and save a lot of time. PAC’s Champion Courses are two-hour long practical care skills courses that you can attend virtually from home or work. For only $49, you get to learn and practice care skills with Teepa’s PAC Mentor team (webcam required).
Start your journey towards a positive care future today with a PAC Champion Course.
Now – it’s your turn. Are you experiencing a difficult care situation? Have you been able to use the Snow Approach and got a better care result because of it? Let us know by commenting below.