What advice can be provided to help prevent and minimise aggressive behaviour?

What significance can be placed on the family dynamics?
• If Mary Jo wants to let her mother know about her concerns, how should
she deal with the fact that she has promised not to talk to other family
• What might account for Mary Jo’s response to seeing her grandmother’s
• How prevalent is aggressive behaviour between people with dementia and
their carers?
• What advice can be provided to help prevent and minimise aggressive
In the kitchen
Mary Jo informed her grandmother (Matilda) that Alex was asleep in his
Mary Jo and Matilda did have a cuppa, with Mary Jo listening to what
Matilda said and allowing her to tell the story as she had experienced it.
Mary Jo also learnt that Matilda had put off approaching her granddaughter,
as she was still embarrassed that Alex had hit her and twisted her arm. It
was so out of character for him but it really had scared her, and she still
felt a bit on edge because it might happen again. She thought that it
related to his wanting a cigarette and her saying no because she didn’t
want to bother at the time. She was not able to distract him from the idea.
Her grandmother continued, ‘He got up to look for his smokes and spotted
them and then went to light one. But in his agitation, he tried to put the
match in his pyjama pocket when it was still alight. I was trying to stop him
from burning himself—thank God they were good cotton and not synthetic—
and God knows what he thought but he hit out at me and grabbed my arm.
Then when he saw me crying he was all ‘lovey dovey’ and not aware of
what had just happened!’
Mary Jo thought about the number of smokers who are admitted to hospital
but don’t get to smoke while they are there. She quietly wondered how
much crankiness and worse could be attributed to nicotine withdrawal.
Prompting questions, set 2
• How might you as a health professional respond to this story?
• Why is Alex’s wife feeling guilty and embarrassed?
• What problem-solving techniques could be employed to assist with the
issue of unsafe smoking?
• If one of the options selected were for Alex to undertake a quit smoking
program what would be required?
Further disclosure
Mary Jo and Matilda got into the flow of interacting and maintaining the
routine that had been pretty well established between Matilda and her
husband. Mary Jo was pleased to be able to prepare the meal her
grandmother had planned and observed her grandparents holding hands
while watching the TV together. Although Mary Jo offered, Matilda did not
accept any assistance with toileting or caring for Alex. Mary Jo was
page 2
mpressed with her grandmother’s ability to help Alex maintain the skills he
did have; she seemed to wind into her conversation with him the
suggestions and cues about what needed to be done or focused on. There
wasn’t that babying approach that Mary Jo had so often seen and
sometimes knew she resorted to at the hospital just to get the task done.
Later that evening Mary Jo and Matilda were able to spend time together
At this time Matilda revealed that their GP had suggested that she needed
to start thinking about putting Alex into residential care. This was her worst
fear as they had in fact made part of their marriage vows to care for each
other in their latter years. She did not deny that he had hit her but felt that
with more help and information she could do better.
The doctor had given Alex a definite diagnosis of dementia, and probably
Alzheimer’s disease. Matilda wanted to know whether the type of dementia
made any difference to what she should do. The doctor was also reluctant
to discuss how long this might go on for. Matilda understood that no one
had a crystal ball but felt that it would help her if she knew some of what
was in store and had some

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