How to handle a dementia patient gone wild

This hasn't happened, but in my dealings with my dad (Alzheimer's) this could and I just wanted to brainstorm how to deal with it.

One of the issues with dementia type patients is that they can suddenly get violent with no warning. So let's say that an 80 something year old man is in a dining hall with dozens of other people at one of these larger retirement facilities. You are there having a meal with one of your parents. All of a sudden, this man gets violent. He has never done it before, so it is a total surprise to everyone. He picks up a standard table knife and starts stabbing people. Security is on their way, but in the meantime, he is hurting people, mostly elderly people who really can't move fast or defend themselves.

Now, this man is not evil or bad. This violent behavior is just part of the disease and can happen unexpectantly.

Just want to get some ideas of the best way to handle this.

Grab a chair and use that to run interference, pushing the guy into a defensive status, forcing him either to the ground or to back up into a wall...

Grab a tablecloth and toss it over him, then grab him in a bear hug from behind, pinning his arms to his sides...

At that age, he's not likely to have significant strength. He's also likely to be relatively frail, with bone breakage all too easily done. A broken hip in a fall often leads to death within a year. Obviously, you want to avoid any unnecessary injury, to others or even to him.

In that given situation distraction and bear hugs work pretty good. The trick is when you begin the bear hug you start hunting for the wrists. Once you have the wrists you pull them back towards you like the person is in a straight jacket. This technique does take practice to keep you both from being hurt.

I have done this procedure, not with Alzheimer's patients but with younger and stronger people with developmental disabilities. Do not attempt this unless you are trained, both of you can get hurt very easily. With no training at all, the chair idea is viable. Keep the person in a defensive position and try to back them into a corner away from others.

If you're not trained in restraint techniques don't try to physically restrain someone. The best you can do is buy time until properly trained personnel arrive.

In Arizona specifically, whoever is paying for the persons care dictates what procedures you can use. As a regular person you can use what ever means necessary to defend yourself. If you're working under the Department of Developmental Disabilities you are restricted to approved intervention techniques. If you can't handle the person you're supposed to call 911, the police come in under a completely different set of rules. It can turn ugly.

Different states have different intervention rules. I'd recommend checking your own state to be sure.

Hope this helps,

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Originally Posted by exactlymypoint

This hasn't happened, but in my dealings with my dad (Alzheimer's) this could and I just wanted to brainstorm how to deal with it.

One of the issues with dementia type patients is that they can suddenly get violent with no warning. .

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You are talking about a theoretical possibility but one which isn't too likely to turn real given that your dad was not a violent fellow when he was still well.

Sometimes dementia patients become passive instead.

Try to not worry yourself too much with imaginary scenarios. You'll intuitively do the right thing at the time that something happens.

Stun gun? It WILL work.

I gotta disagree, Hoppy. I mean, they can be very passive or child-like, but dementia can so confuse even the tamest of folk to the point where violence happens. I've dealt with more dementiatic patients than I can recall, and the good news is, they are usually easily distracted so you can get that bear hug on. The table cloth might be a good idea, but he/she would probably be slashing and stabbing and you may not be able to see where that knife is if you've covered it. Pretty easy to get the drop on them if you have a partner, but the old rope-a-dope can usually work by making a big flashy movement with your off hand, then make the grab with your good one. Probably the best way to go if you don't have able help would be the chair technique mentioned above. You don't have to make the "apprehension," just keep him busy until PD shows. This will also wear him down.

on-topic, but not really: A very memorable call of mine was to do a medical standby at the scene of a shooting/barricaded gunman. The guy was a WW2 vet having a flashback and started shooting up his house with his prize luger he brought home. Noone hit, but scared the crap out of his family because by all accounts he was always a kind and peaceful guy, even when confused. He just went back that day. PD was very compassionate and was able to talk him down.

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Originally Posted by Cupcake

I gotta disagree, Hoppy. I mean, they can be very passive or child-like, but dementia can so confuse even the tamest of folk to the point where violence happens. I've dealt with more dementiatic patients than I can recall, and the good news is, they are usually easily distracted so you can get that bear hug on.

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What I am saying is, play the hand as it comes and not as your imagination might create it.

Exactly has a tough situation for any child, and needs to be as nice to himself as he possibly can be. That includes, not worrying himself to death over things he has no control over.

Should something happen, he will do the right thing as he sees it at the moment. In the meantime, there is at least as good a chance that dad will stay passive as go off the deep end.

Endless worry about "what ifs" accomplishes very little in life. And believe me, I know. And I've learned the lesson that life is too short to worry about imaginary problems the hard way.

Hopyard: Point well taken, and you are of course correct that there is a very good chance that dad will stay on the easy side of things. I also agree that fretting over every possible "what if" will usually just steal joy from your life, but IMO some things are still worth giving a few moments of thought. :bier:

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Originally Posted by Rivers

At that age, he's not likely to have significant strength. He's also likely to be relatively frail, with bone breakage all too easily done. A broken hip in a fall often leads to death within a year. Obviously, you want to avoid any unnecessary injury, to others or even to him.

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not necessarily, I worked in a "long term care facility" for a couple of years and they can be very deceptive...

also my personal experience with my wife's grandfather would say that I hope you don't believe this for all octogenarians at 83 he was stronger than I have ever been - as a young and physically fit Army Sergeant he was out lifting me at every turn (my BN commander liked for me to play offensive tackle on the football team cause at 220 # I could lift guys my own weight and chuck 'em - making a hole for him to run thru)

also very good friend's dad stopped farming when he fell off a tractor at 94 and broke his hip... he was raising hogs and crops - not light work by any means... they had him up and walking in a couple of months - he lived to be 100

Exactly, I could be reading this wrong, and please clear it up if I am, but the way I was reading this particular scenario is that the guy doing the attacking is NOT your father which could change things quite a bit. Others have stated things like restraint etc...

I disagree. The only time I might even consider it is if it was one of my own and then it MIGHT be worth it. But when someone I don't know is going around stabbing folks (with my own folks there too)...dementia or not, I'm going to stop the threat whether I'm armed or not.

Now, it may well be that I get lucky and I'm able to stop him/her quick without any need for permanent damage, but that's not my goal. Armed or not I'm going for damage, severe shock to the core nervous system and or breakage of key joints(No legs to stand on means no legs to fight on) because it's the only thing that gaurantees any kind of success(if you can call it success). It doesn't matter if it's a person that's not in their right mind. You can't feel sorry for them and deal with the threat at the same time or you've already lost. You can't feel bad about it. You can't feel about it at all. That is effectively what other folks are advocating. They're feeling about it, hence the comments about restraining them. Feeling about it on the scene gets you dead. Feel about it later. Deal with the issue that presents itself in your face, a knife wielding dementia patient is killing people and you or yours are next. If you can't get the flock out of dodge...do what you gotta do.

Some may respond that I couldn't possibly feel that way, because I must not have been in that situation...but they would be wrong. Been there done that unfortunately. Mine unfortunately wasn't a frail 80 year old, but rather a not so frail, 200lb 45 year old with a pension for turning violent when not severely medicated. I was severly overpowered and outmatched. I reached for the first thing I could grab and use as a weapon and began attacking knees, elbows, hands in hopes to stop the fight. I caused damage...without repentence. I believe it was and still is the only viably safe option. Some 15 years later and the person I'm talking about is able to get by on meds now compliments to modern medicine and the incident is all but forgotten for him.

None of us can really say for sure what we're going to do until the issue presents itself. Use your instincts. If you train yourself the way you want to respond now, hopefully you're instincts will follow that path IF the time ever comes.

Thanks guys for all the input so far.

The thing I love about this forum is it gives me the opportunity to think through things before they happen. I don't have a lot of experience in this area and I am able to draw upon people who do.

This scenario is just a hypothetical. Very much different than a BG doing the stabbing. In this case, it is a demented person who probably truly does not know what he is doing. No evil intent, so the stopping the action is more what alternatives are there to lethal force.

I presented where it was NOT my dad. But it could very well have been. I think the action would be the same. I really liked the idea of a chair to hold him at bay. I never would have thought of that. Distraction was good, too.

I truly hope I would never be in the above situation, but as I get older, my friends have parents and/or family that are in these types of environments and things happen. To have ideas just in case is just good preparation.

A friend of mine lived right beside his wife's parents. They knew that his Father-in-law was having problems but did not know how severe. One day the FIL came over and told his son-in-law, "That woman that lives in that house there, I am going to kill her". He was talking about his wife and did not even realize that who she was or that he also lived there. They knew then that something had to be done. My mother has dementia and we are trying to make a decision on what to do right now.

Your post on the scenario has some validity but I expect is vastly overstated in severity but does get the thought process going. Do not confuse dementia suffers with druggies. Except in rare cases the dementia patient is not a young strapping powerful person jacked up on drugs feeling no pain full of adrenelin. They are older, weaker and usually be physically restrained by the average person.

Best of luck to you and I fully understand your situation.

A short while back we had an elderly male family member in the hospital. He was in his 80's and his entire life he was a very kind person. Never knew him to offend, hurt or lay a hand on anyone.

As I understand it, elderly people with some level of dementia, tend to get "Sundowners syndrome" when hospitalized (well actually when they're taken out of their familiar home surroundings).

With Sundowners they tend to become combative, irritable, confused, restless, etc. especially during the night (darkness.....hence the name).

As I previously mentioned our family member was always a model of cooperation, kindness, etc.......at least he was until I witnessed my first Sundowners episode.

I saw him continually try to crawl out over the bed rails. Pull on every IV line, electrical wire, or catheter within reach. A nurse was standing nearby his bed and all of a sudden he reached up and snatched her clipboard from her hands. Later on, as another nurse was leaving his room, with her back turned he made an obvious inappropriate hand gesture at her !

Whenever the nurses, aides, or family members were attempting to straighten out his sheets, gown, or IV's I would hover over his chest area an remain on alert if he decided to punch one of them. He never did, but I was ready to deflect his blow or take the punch myself.

This was really a personality change.....sort of a Dr Jekyl and Mr Hyde deal. He was sort of glazed over during this time, and his attention span was very short in listening to anyone about anything.

Today, he has no recollection of his behavior, and would deny he did any of that. However subsequent hospitalization would see the Sundowners reoccur.

I'm surely not an expert in geriatrics, but the reason I mention this is because I personally witnessed quite a personality change in someone who I knew to be very peaceful, though he really became combative unexpectantly.

Exactlymypoint- IMHO I think your scenario is possible, thanks for bringing this up.

Good info posted, check into Project Lifesaver in your area in case he ever goes "walking".

Never underestimate the strength of someone having an episode. Just like anyone else, when frightened or otherwise stimulated their brains call for loads of adrenaline.

Depending on the situation you may be in for more than you bargained for. For example, I worked with one person that when they became combative for attention's sake, I could restrain them with one arm and call it in with the other. In that case the person wasn't really that strong and did not present much of a challenge. When that same person really did have an uncontrollable episode, it was all I could do to hold him on the ground, sometimes it took 2 of us (he only weighed 118 Lbs.) Big difference in strength and degree of aggression.

As far as defending yourself or your loved ones the way you would against a BG, be careful. In your eyes you may only see a threat, the courts and local PD may see it otherwise.

Technically you may have the right to, but in reality it may not work out that way. Yes, by all means stop the attack, but be careful how you do it. It could come back to haunt you in a meaningful ($$$) way. You may also find yourself up on charges. Not only that, you could make life more difficult for your loved ones too.

This is only my opinion, but it's based on 18 years of experience. Laws will vary from state to state and sometimes from city to city. So be careful what you do and how you do it. Dealing with mental disability is one of the most challenging things I've done in my life, not easy to understand, accept or endure.

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