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 | You and Yours - Transcript BBC Radio 4 |
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| TX: 25.11.05 - Dementia: Challenging Behaviour PRESENTER: CAROLYN ATKINSON |
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| THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY. ATKINSON Bruises, near strangulation, physical and verbal attacks - the one predictable fact about having dementia is that it's totally unpredictable. It affects different people in different ways but an area that is often not talked about is when people with the condition become violent and aggressive, usually to their nearest and dearest. It's an area that many of you have asked us to cover. This challenging behaviour is a major source of stress for carers of people with dementia, who often see their own health suffer. And for the person with dementia it's one of the main reasons why they're admitted to hospital or into care. Well Dr Graham Stokes, is consultant clinical psychologist at South Staffordshire Healthcare NHS Trust, specialising in dementia and older people, and he's written numerous books on challenging behaviour and dementia and he's also head of mental health at BUPA. Dr Stokes, first of all, when we say challenging behaviour in people with dementia what do we actually mean? STOKES That's any behaviour that a family or professional carer finds difficulty coping with. Typically that will be when they say they've started to do things they've never done before, so that would be wandering, aggression, noise, out on the street searching for young children, even though they're aged, it's all that they never used to do. ATKINSON And violence and hitting people and attacking people again out of character? STOKES Out of character behaviour, resisting care, unpredictable violence. ATKINSON Okay, well we'll talk more in a moment on how to deal with this aggression but first I went to Nottingham to visit Tina and Jim Radburn who've been married for 32 years. Tina is now 56, she was diagnosed with Alzheimer's Disease when she was just 50 years old. After Tina became increasingly violent and trashed their house Jim reluctantly moved her into a home about six months ago. He says people do not realise how traumatic life can become. JIM RADBURN People who don't know about dementia really would be shocked to find what's going off in people's homes. Aggression - verbal, physical, mental. You can't get away from it, you've just got to keep on going and keep on going. ATKINSON People still go oh well it can't be that bad. JIM RADBURN We're not talking about feeling bad, we're talking about worlds being destroyed. She was a lovely character, she could have a good laugh with you and she certainly liked to go to the football match with me every so often and have a joke and generally enjoy herself. There's sparks of that here but not a lot. ACTUALITY - JIM AND TINA TINA RADBURN I don't like - [indistinct words]. JIM RADBURN You never used to like that did you. Let me just take you for a walk up the corridor. Yes it's [indistinct word], give us a kiss. Give us a kiss, oh it's lovely. TINA RADBURN I just [indistinct word]. JIM RADBURN Eh what's the matter? Eh? Come on then. Give us a cuddle. Ah. She's crying now, she don't know why she's crying but she is. Come on love let's just a little walkies up and down the corridor. ATKINSON I've met you at a nursing home here in Nottingham and the reason that Tina's at the nursing home is because? JIM RADBURN Of behavioural problems. Because not only Tina couldn't cope with her problems but I couldn't cope on a daily basis, it was wearing me out. Ended up in hospital at one stage before the major incident where Tina literally ripped the house up. Just pure breakdown in the end, physically and mentally exhausted. I couldn't dress myself because I was physically exhausted, I was crying because I was mentally exhausted. I wasn't bleeding, I hadn't got a broken leg, the bleeding is inside you, it's not outside where they can see it. Sweetheart what's the matter eh? We're talking on radio. She's looking at us now wondering what is actually happening, she knows she's with her husband, with Jim, and she's calm. But if I go away she's in a world of her own and she really is lost. Sit down sweetheart, sit down. We're just talking for five minutes and then we're going to go for walkies. I've got this photo album here which shows, as I'm looking through now, the night time after four hours. ATKINSON It does look like you've been burgled. JIM RADBURN Yes. The large dining room chairs were turned upside down and that is my little room where my computer was smashed and is on the floor. That is a one inch thick ashtray which was just shattered by Tina slamming it down. ATKINSON And this is the bit that people don't talk about because we've had a lot of people e-mailing us and saying we mustn't present a sanitised view of it. JIM RADBURN The idea that you have of little old ladies sitting in the chair being looked after is nothing, it is nothing compared with what reality is. She did during the bad incident come in with a knife in her hand, which I took off her very easily, not aggressively, just she had it in her hand. But if I'd have got my back to her who knows. ATKINSON You though aren't angry with her, you still love her. JIM RADBURN No, no definitely, I love my wife very much. It's not my wife that I married, this is a new person. But the person is my wife. ATKINSON How do you see your future and Tina's future? JIM RADBURN Unpredictable. I'd love her to come home but she's in the best place for her at the moment. It can only - only get worse. ACTUALITY TINA RADBURN Dinner. JIM RADBURN Dinner, yes, let's go and get your din dins then. TINA RADBURN I thought I'd let you know. JIM RADBURN You'd let me know that dinner's ready. TINA RADBURN Yeah. JIM RADBURN Yeah, come on then. We'll go and get it. My life and Tina's life is revolving round Tina, getting the best thing for her at this moment in time but also trying to live my life but I really haven't got one at the moment. Everything revolves around Tina. ATKINSON Jim and Tina Radburn from Nottingham. Well Dr Graham Stokes, consultant clinical psychologist at South Staffordshire Healthcare NHS Trust, is still here. Dr Stokes, your reaction to that because it's very much ruining two people's lives there isn't it. STOKES Well Carolyn that's the point - two people's lives. I mean traditionally it would always be seen one person's life and that would be the carer because it would often be said that the person with dementia has disappeared and there's just a shell and this is just a symptom of disease. It's the case that Jim talked about - his hurt not being physical but his bleeding heart. With Tina you can't see her churning stomach, her pounding heartbeat, her racing pulse - she's frightened, she's in a world she doesn't understand. And as a consequence she can act in ways that are most unlike her. But it doesn't mean to say she's disappeared, she's encountering a world of emotional pain that you can hardly relate to. ATKINSON But would you argue that all her aggression does have a meaning to her, it's just very, very difficult to interpret it and obviously to the person on the other end it's very, very difficult. STOKES I would say that most of that aggression will have meaning. ATKINSON So what sorts of things could you interpret it as meaning? STOKES Well it could be the case that she's frightened, she's frustrated, she's just generally in a fearful state. In essence what dementia does it sets up intellectual disability, the diseases that destroy the brain destroy the capacity to understand, to remember, to communicate. That person with that intellectual disability has to survive. ATKINSON And somebody described it rather like sometimes you can wake up in a strange place, as it were, and you for a moment wonder where you are, it's actually like being that the entire time. STOKES Yes, I mean when that happens to us normally when we first wake up in the morning that penny drops within a matter of moments. We have to say to ourselves what it would be for us like if we did not have that penny drop, how would we be, would we just be lying in bed restful and relaxing albeit not knowing, or would we start to have the panic well up inside us. For a dementing person that panic does well up and it'll happen anywhere. ATKINSON And things like - they're can be triggers like, for example, seeing one's face in the mirror or something on television, they think they're in part of what's going on on the screen. STOKES Yes I don't think we can ever truly say what a person is experiencing when they're dementing but I suspect it's a world most unlike our own, it's a world of unremitting not knowing, increasing mystery, perpetual insecurity. They misunderstand much things, they misunderstand why somebody might come up to them and say let's get those clothes off you, I mean who is this person who's saying that. ATKINSON Can anything be done to help the person who's displaying that behaviour and consequently to help the carer as well? STOKES Yes this way of working which we can refer to as a person centred understanding and it goes back now nearly 15 years. There's a wonderful question to always ask in dementia care and that is why. Why is somebody doing what ever it is they're doing? And the answer is not because they have dementia. To say that Tina is the way she is because she has dementia, it would be untrue because that would mean that all people with dementia would be aggressive - trashing their homes - and they do not. Ask why, find the reason and then try to address that reason. ATKINSON We've had a lot of e-mails about this. Sophila McKee, who's looking after her mother-in-law, she says her mother-in-law's developed a fear of going outside the environment she knows, things like going to the hairdresser, or even going to stay with another member of the family, she becomes upset, tearful, the more they try to reason the more upset she gets. What would you say the best way of dealing with that type of issue would be? STOKES Yes, again the reason why she's doing that is not because she's dementing, the reason why she's doing that is she's insecure. Every step forward for a person who's dementing is a step into the unknown. So rather than taking her to places it's bringing that to her. If she stays in where it is familiar then the likelihood is she'll become less agitated and fearful. ATKINSON Now Jane Perry e-mailed saying her mother is in a nursing home, she's tried to hit her on numerous occasions, push her down a flight of stairs but whenever a nurse comes into the room the violence goes, the aggression goes. STOKES That's like kicking the proverbial cat. It tends to be the case itself and the familiarity does breed a degree of contempt. We have a deep seated respect for authority figures, how to behave in public, how to respect others, that may well be the reason why when she's in the company of nurses she's quite peaceful and compliant but in the presence of her own daughter she hurts her daughter. ATKINSON Okay Dr Graham Stokes thank you very much. Well next week is the final week of our dementia series. We hope to be talking to the health minister Liam Byrne. If you have a point or a question that you would like put to him then please do let us know. Back to the You and Yours homepage The BBC is not responsible for external websites |
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