Grappling with the concept of “aggressive behavior” among people with dementia

Date added: November 17, 2022
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‘Aggressive behavior among dementia patients’ is seen as a major concern in nursing homes because of its stressful impact on caregivers. Geriatric-medicine literature defines ‘aggressive behavior’ as hitting, kicking, and screaming. Caregivers are advised to ‘manage’ this ‘behavior’ through a variety of strategies: identifying and removing environmental triggers, behavior modification, reassurance and distraction, and if these fail anti-psychotic drugs and mechanical restraints. This advice both reflects and contributes to dementia discourse, which frames dementia as a disease leading to loss of self-hood and agency. Researchers in critical disability studies and critical gerontology offer alternative ways of framing ‘aggressive behavior’; for example, viewing actions as (a) a way that people without speech communicate differently, (b) embodied, rather than cognitive, expressions of agency, and (c) viewing screaming as a language unique to each person with dementia. This presentation will critique the concept of ‘aggressive behavior’ by taking the standpoint of people with dementia. The critique will be illustrated by stories from the presenter’s participatory observation of a nursing home, and audience members will be asked to consider these stories through the lens of critical disability studies. Efforts are underway in Canada to reform institutional, hospital-like, nursing-homes and develop alternative forms of care and supportive housing for people with dementia. Key to this effort is how people with dementia are represented and treated by clinicians and caregivers. This presentation contributes to this effort by advocating a new way of looking at what is now called ‘aggressive behavior’ among a group of disabled people. Keywords Agency, aggressive behavior, cognitive impairments, dementia, long-term care