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Tips for Dealing with Aggression

“No one knows for sure why Alzheimer’s patients become aggressive. Aggression may be a symptom of Alzheimer’s disease itself. It may also be a reaction to actions of others or to the environment around the person with Alzheimer’s disease..”

Dementia affects each person differently. Alzheimer's disease and related dementias can cause a person to act in different and unpredictable ways. Some people with Alzheimer's disease become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear.

These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and the caregiver. It is important to understand that the person is not acting that way on purpose.

Understand the Triggers of Alzheimer’s Aggression

Alzheimer’s aggression can flare up without warning. There may not be an obvious cause. However, often there are triggers that caregivers can look for. By knowing the triggers, you may be able to lower the frustration level of the person with Alzheimer’s disease. This can reduce the number of aggressive outbursts.

Here are some common triggers of Alzheimer’s aggression:

  1. Discomfort caused by lack of sleep, side effects from medication, or pain that the person is not able to describe
  2. The surrounding environment, such as loud noises, busyness around the person, or clutter.
  3. Confusion caused by being asked too many questions at once, trying to understand complex instructions, or feeling the stress of caregivers

For Anxiety or Agitation

A person with Alzheimer's may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places or focused on specific details. He or she may also become over-reliant on a certain caregiver for attention and direction.

How to respond:

  • Listen to the frustration. Find out what may be causing the anxiety, and try to understand.
  • Provide reassurance. Use calming phrases. Let the individual know you're there for him or her.
  • Involve the person in activities. Try using art, music or other activities to help the person relax.
  • Modify the environment. Decrease noise and distractions, or move to another place.
  • Find outlets for the person's energy. He or she may be looking for something to do. Take a walk, or go for a car ride.

For Confusion

The person with Alzheimer's may not recognize familiar people, places or things. He or she may forget relationships, call family members by other names or become confused about where home is. The person may also forget the purpose of common items, such as a pen or fork. These situations are extremely difficult for caregivers and require much patience and understanding.

How to respond:

    Stay calm. Although being called by a different name or not being recognized may be painful, try not to make your hurt apparent.
    • Respond with a brief explanation. Don't overwhelm the person with lengthy statements and reasons. Instead, clarify with a simple explanation.
    • Show photos and other reminders. Use photographs and other thought-provoking items to remind the person of important relationships and places.
    • Offer corrections as suggestions. Avoid explanations that sound like scolding. Try "I thought it was a fork," or "I think he is your grandson Peter."
    • Try not to take it personally. Remember, Alzheimer's causes your loved one to forget, but your support and understanding will continue to be appreciated.

For Suspicion

Memory loss and confusion may cause the person with Alzheimer's to perceive things in new, unusual ways. Individuals may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior. Sometimes the person may also misinterpret what he or she sees and hears.

How to respond:

  • Don't take offense. Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
  • Don't argue or try to convince. Allow the individual to express ideas. Acknowledge his or her opinions.
  • Offer a simple answer. Share your thoughts with the individual, but keep it simple. Don't overwhelm the person with lengthy explanations or reasons.
  • Switch the focus to another activity. Engage the individual in an activity, or ask for help with a chore.
  • Duplicate any lost items. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.

 

 

 

 

Tips to Reduce Alzheimer’s Aggression

Once you understand the triggers for Alzheimer’s aggression, you can take steps to prevent it. Try these suggestions:

  1. Anticipate situations in which the person with Alzheimer’s may be uncomfortable, overstimulated, or confused.
  2. Avoid asking too many questions at once, giving overly complicated instructions, and speaking negatively. That way, you are less likely to confuse and agitate the person you are caring for.
  3. Limit the amount of loud noises, frenetic movement, and clutter.
  4. Don’t contradict. Those with Alzheimer’s disease see a different reality than you do. Rather than challenge that reality, sit and listen. Ask questions about it.
  5. Focus on the past. Alzheimer’s affects short-term memory. It’s often easier and less stressful for someone with Alzheimer’s disease to recall and talk about distant memories than it is for them to remember what they watched on TV the night before.
  6. Use memory cues. As the disease progresses, remembering to do and how to do everyday tasks like brushing your teeth or getting dressed becomes more difficult. Reminder notes placed in key locations can help prevent frustration.

Aggressive behaviors may be verbal (shouting, name-calling) or physical (hitting, pushing). These behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation. Whatever the case, it is important to try to understand what is causing the person to become angry or upset.

How to respond:

  • Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
  • Focus on feelings, not facts. Try not to concentrate on specific details; rather, consider the person's emotions. Look for the feelings behind the words.
  • Don't get angry or upset. Be positive and reassuring. Speak slowly in a soft tone.
  • Limit distractions. Examine the person's surroundings, and adapt them to avoid other similar situations.
  • Try a relaxing activity. Use music, massage or exercise to help soothe the person.
  • Shift the focus to another activity. The immediate situation or activity may have unintentionally caused the aggressive response. Try something different.

 

It’s not easy to care for a person with Alzheimer’s disease. The burden of round-the-clock care takes an emotional toll. Add to it the frustration and sadness of watching a loved one deteriorate. It’s not surprising that caregivers may feel isolated and depressed. Left unrelieved, these feelings can lead to abusive behavior toward the person with Alzheimer’s disease, from insults to physical injury.

If you are a caregiver, do yourself and the person you care for a favor. Seek help for yourself if you notice signs of depression, anxiety, sleeplessness, exhaustion, or irritability. Taking care of yourself will help you take better care of others.

For Repetition

A person with Alzheimer's may do or say something over and over again – like repeating a word, question or activity. In most cases, he or she is probably looking for comfort, security and familiarity. The person may also pace or undo what has just been finished. These actions are rarely harmful to the person with Alzheimer's but can be stressful for the caregiver.

How to respond:

  • Look for a reason behind the repetition. Try to find out if there is a specific cause for the behavior.
  • Focus on the emotion, not the behavior. Rather than reacting to what the person is doing, think about how he or she is feeling.
  • Turn the action or behavior into an activity. If the person is rubbing his or her hand across the table, provide a cloth and ask for help with dusting.
  • Stay calm, and be patient. Reassure the person with a calm voice and gentle touch.
  • Provide an answer. Give the person the answer that he or she is looking for, even if you have to repeat it several times.
  • Engage the person in an activity. The individual may simply be bored and need something to do. Provide structure and engage the person in a pleasant activity.
  • Use memory aids. If the person asks the same questions over and over again, offer reminders by using notes, clocks, calendars or photographs, if these items are still meaningful to the individual.
  • Accept the behavior, and work with it. If it isn't harmful, let it be. Find ways to work with it.

Nine Quick Tips: Responding to behaviors

  1. Remain flexible, patient and calm.
  2. Respond to the emotion, not the behavior.
  3. Don't argue or try to convince.
  4. Use memory aids.
  5. Acknowledge requests, and respond to them.
  6. Look for the reasons behind each behavior.
  7. Consult a physician to identify any causes related to medications or illness.
  8. Explore various solutions.
  9. Don't take the behavior personally.