A Plea for Further Research on Self-Injurious Behavior

COPING WITH SELF-INJURIOUS 

BEHAVIOR IN LATE STAGE 

ALZHEIMER'S PATIENTS

Evelyn Smith

My mother & namesake

Three years ago, I received a phone call at work that Mother had so scratched the cornea of her left eye that she was waiting for me to summon transport to return her to her nursing home from the emergency room of a nearby hospital.  After this, Mother, who rather enjoyed her outing, wore gloves at all times, or else if an attendant couldn’t find a clean pair of gloves,  she wore socks over her hands. A couple of months ago, again I received a similar phone call early in the morning that Mother had severely bitten her right index finger, presumably trying to remove  a sock from her hand.    


Both these incidents are examples of self-injurious behavior, or SIB, a comparatively common self-destructive behavior that late-stage dementia patients sometimes exhibit both in the United States and elsewhere--if a case study of aggressive behavior of dementia patients in Japanese nursing homes (Shreiner, 2009) as well as the numerous patients outfitted with socks or gloves on their hands on Mother’s unit devoted to the care of late stage dementia patients at a local nursing home is any indication.  


While most references to SIB observe that dementia patients occasionally injury themselves through repetitive behavior,  such as scratching or picking at  the skin, discussion of these incidents seldom is more specific since researchers ordinarily confine references to incidents in early or mid-stage dementia. Nevertheless, articles note that this type of repetitious movements if not checked cause self-harm--presumably in advanced Alzheimer’s (Mendez, 2008).   


Typically, articles on SIB assign the same “cures” at all stages of dementia (Mandel, 2013).  A reasonable response to late-stage Alzheimer’s SIB, however, might be to look no more deeply than to a medical or physical problem that might not be any more complicated than prolonged discomfort in a patient who no longer can speak (Kahn, n. d. para. 11 & 14).  Occasionally, an author will admit that "physical aggression . . .  is not uncommon in  late-stage Alzheimer's" (Scott, 2013, para. 1-2), but then only suggest that the caretaker continue to follow a familiar routine and record any SIB incidents, so the nursing staff can analyze why they occurred (Scott, 2013, para. 3).  


However, some “cures” for each incidence come across as more logical responses than others, for instance, changing the environment—in this case,  keeping gardening gloves that are harder to remove than regular cotton gloves or socks on the patient’s hands and trimming the fingernails as short as possible—and more closely supervising all activity (Kahn, n. d., para. 19-20).   Such incidents cannot be “cured” by medication, so individualized interventions must manage them (Desai, 2001, para. 1 & 5). 


Moreover, trying to determine a logical reason for self harm might not help improve the response to future SIB behavior (Kennard, 2009, para. 4).  Nevertheless, continuing to document instances of SIB even in the very late stages of Alzheimer's could help caretakers better attend to patients' needs and ease the fears of concerned family members.

References

Desai, A. K. & Grossberg, G. T. (2001).  Recognition and manangement of behavioral disturbances in dementia.  Primary Care Companion to the Journal of Clinical Psychiatry, 2(3), 93-109.  Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181170/

Kahn, D. A. (n. d.).  Agitation in older persons with dementia.  Challenging Behaviors for the Caregiver.  Retrieved from http://www.zarcrom.com/users/alzheimers/c-02a.html

Kennard, C. (2009, July 7).  Problem behaviors in mid-to-late stage Alzheimer’s.  Health Central.  Retrieved from http://www.healthcentral.com/alzheimers/c/57548/79950/stage-Alzheimer

Mandel, D. (2013).  How to cope with the boredom of Alzheimer’s.  Alzheimer’s site.  Bella Online.  Retrieved from http://www.bellaonline.com/ArticlesP/art29328.asp
                        

Mendez, M. F., Shapira, J. S. (2008).  The spectrum of recurrent thoughts and behaviors in Frontotemporal Dementia.  CNS Spectrums, 13(3): 202-208.  Retrieved from
http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1460

Schreiner, A. S., Yamamato, E., & Shiotani, H. (2000, May).  Agitated behavior in elderly nursing home residents with dementia in Japan.  Series B. Psychological Sciences & Social Sciences. Journals of Gerontology, 55(3), 180-186.  Abstract retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11833979

Scott, P. S. (2013).  How to cope with the physical aggression of Alzheimer’s.  Caring.com.  Retrieved from http://www.caring.com/articles/alzheimers-hostile-aggression

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