Easing dementia caregiver burden, addressing interpersonal violence
Caring for aggressive patients with dementia can lead to exhaustion, fear, and burnout. These strategies can help improve the welfare of both caregivers and patients.
PRACTICE RECOMMENDATIONS
› Screen caregivers and family members of patients with dementia for signs of interpersonal violence. C
› Counsel caregivers early on that behavior changes in patients with dementia are likely and may be unpredictable. C
› Discuss safety strategies for the caregiver, including when it is appropriate to alter routines such as bedtimes and meals. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
At the time of this publication, the patient’s irritability and paranoia had subsided and he had made no further threats to his family. He has allowed a home health aide into the house and has agreed to have his roof repaired. His wife still lives with him and assists him with activities of daily living.
Interprofessional teams are key
Caregiver burnout increases the risk of patient neglect or abuse, as individuals who have been the targets of aggressive behavior are more likely to leave demented patients unattended.8,16,23 Although tools are available to screen caregivers for depression and burnout, an important step forward would be to develop an interprofessional team to aid in identifying and closely following high-risk patient–caregiver groups. This continual and varied assessment of psychosocial stressors could help prevent the development of violent interactions. These teams would allow integration with the primary health care system by frequent and effective shared communication of knowledge, development of goals, and shared decision-making.38 Setting expectations, providing support, and discussing safety strategies can improve the health and welfare of caregivers and patients with dementia alike.
CORRESPONDENCE
Abu Baker Sheikh, MD, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131; absheikh@salud.unm.edu.
