Specialized unit aims to curb aggression in dementia patients

Peter Grace, a 69-year-old retired engineer with dementia, heard a resident in the next room where he lived cry out for help and mistakenly thought the personal support worker assisting the man was hurting him.

"He grabbed her by the collar and I knew he wasn't doing anything with malice," Grace's wife, Lucie Bechamp, recalled.

Bechamp said the incident was out of character, but she added her husband did hate when others "invaded his personal space" and he shouted at others when they bumped his wheelchair.

Grace was referred to the Perley and Rideau Veterans' Health Centre's specialized behavioural support unit, which is designed for people with dementia who yell, pace, grab or hit others.

The number of residents abusing other residents in Ottawa's long-term care homes has risen 24 per cent in the last six years, according to a CBC analysis of Ontario Ministry of Health and Long-Term Care data.

But a year ago, an option like the Perley centre's unit didn't exist in Ottawa.

The unit, the only one of its kind in the city, opened in April and is already full with 20 residents. A similar unit at the Peter D. Clarke Long-Term Centre closed two years ago.

Not surprisingly, there's now a waiting list to get in.

Watching for triggers

The unit's workers identify the stimuli or situations that make patients act out and find ways to sooth them to avoid the outbursts.

"Noise or over-stimulation is something that can trigger an aggressive response in some people with dementia," said Dr. Ben Robert, the Perley and Rideau centre's medical director — one of two doctors who treats residents at the unit.

"People with dementia are unable to explain what's bothering them, so it's all about reading signals because it's very much a puzzle that needs to be figured out."

Several large "electronic ears" are mounted on the unit's walls. When noise levels are good, the lit-up ears stay green. When noise increases, they turn red — signalling that the loudness may prompt aggression in some patients.

Staff are also trained on something called the gentle persuasion approach, which involves taking a patient's arm and diverting them away from a stressful situation.

"We're using gentle re-direction techniques that respect the dignity of the resident, and knowing that person is still in there somewhere," said Kerry Tubman, the Perley and Rideau centre's manager of resident care.

Nancy Lesiuk, a nurse at the Royal Ottawa Mental Health Centre and the head of the behaviour support program for the Champlain Local Health Integration Network — which oversees nursing care at the unit — said they try to get to know what patients like and dislike.

Activities 'bring them back to where they were'

Doing so, she said, helps "bring them back to where they were, so their responsive behaviours will de-escalate."

Recreational therapists at the centre work with residents on activities from their past, because long-term memory is stronger than short-term memory for dementia patients.

One male resident sands a piece of lumber. Another types on a keyboard. One woman pets a life-like robotic cat that purrs and meows. Another changes a doll's diapers, stimulating memories of her time with her own child.

Staff knew Grace was an avid gardener, so they took him to the outdoor garden.

"He loved the soil on his hands and I could tell by the peacefulness in his face that he was happy," Bechamp said.

Staff also downloaded rugby games for Grace, a native of New Zealand, and his mood greatly improved.

"They're angels; that's all I can say about the staff here. They are absolute angels," Bechamp said.

Returning to long-term care homes

Behaviours are tracked and residents are allowed to return to their long-term-care residence when the disruptions disappear. They're sent back with a care plan that identifies the triggers and how to control them so they don't relapse.

So far, two residents are ready to return to their long-term-care homes and staff are encouraged.

"To me, I think the joy of seeing someone smile when they are listening to their music instead of hanging their head low and drooling is a lot happier for me," Lesiuk said. "For me it just brings tears to my eyes and it's a happy tear."

After six months, Bechamp has noticed a big difference in her husband.

"More calm, more happy, and I haven't seen him get agitated or be rude to staff," she said. "Whatever they're doing is working because they know what types of words work best for him."

They also don't forget about the spouses, Bechamp said.

"Peter was very bright and I try not to cry," she said, wiping tears from her cheek. "I have my bad days and sometimes I leave here and cry and they give me a hug and it makes me feel good. There should be more units like this and I don't want Peter to leave."