Aggressive Behaviour Associated With Dementia

by Alzheimer's SocietyDealing with aggressive behaviour

If you are close to someone with dementia, there may be times when you are faced with aggressive behaviour. This can be very distressing. This factsheet aims to aid understanding about what may cause this type of behaviour and offers some ways to deal with it. This should make sure it happens less often, and mean that you are better able to manage when it does.What do we mean by 'aggressive behaviour' in people with dementia?People with dementia may sometimes behave aggressively in one or more of the following ways:

• being verbally abusive or threatening
• being physically threatening, such as kicking or pinching
• lashing out violently at people or property
• overreacting to a situation, or becoming very agitated as a result of what seems to be a very minor setback or criticism.

What causes aggressive behaviour?There are many reasons why a person with dementia may act aggressively, including:

• feeling frightened or humiliated
• feeling frustrated at being unable to understand others or make themselves understood
• the physical effects of dementia, which may have eroded their judgement and self-control
• loss of inhibitions and decreased awareness of rules about appropriate behaviour learned in early childhood.

Dealing with aggressive behaviour is not easy, and there are no simple answers. However, it is possible to make it less of a problem through a gradual process of identifying what triggers the aggression, and finding some effective ways to deal with it. It is important to remember that all behaviour is a form of communication. If we can establish quickly what the person is trying to communicate, it may prevent them from feeling frustrated and acting aggressively.Key tip: don't take it personallyAny form of aggression can be upsetting, but the most important thing to remember is that the person is not being aggressive deliberately. The behaviour may appear to be targeted at you, but that is probably just because you are there. The fact that the person is aggressive towards you doesn't mean that their feelings towards you have changed − just that their reactions have become different as the structure of their brain has changed.Although the emotion at the root of the aggressive behaviour may persist, the person with dementia will probably quickly forget individual incidents.Below is a step-by-step plan to manage and get to the root of aggressive behaviour.Step 1: Find ways to react to aggressive situationsIn the long term, prevention is the best solution for aggressive behaviour (see Step 3), both for you and for the person with dementia. If an aggressive situation does arise, don't blame yourself. Instead, concentrate on handling the situation as calmly and effectively as possible, using the following tips.At the time:

• Before you react, take a deep breath, step back to give the person space, and count to ten. You may need to leave the room until you have both calmed down.Try to stay calm and don't enter into an argument. A heated response will probably make the situation worse.
• Reassure the person, and acknowledge that you can see they are upset.
• Try to distract their attention.
• Try not to show any anxiety, as this may increase the person's agitation − although if you feel threatened, this is easier said than done. You might be able to plan some strategies in advance that you could use in such situations.
• If the person is physically violent, give them plenty of space. Unless it is absolutely necessary, avoid closing in or trying to restrain someone as this can make matters worse.
• Ask yourself if whatever you are trying to do for the person really needs to be done at that moment. If you are able to give them a little space, come back in five or ten minutes and try again gently − you maybe able to avoid a confrontation.
• If you need to, call for help.

After the incident:

• Resist any temptation to punish the person by, for example, withdrawing a treat or ignoring them. The person may no longer be able to learn from experience, and could forget the incident very quickly. However, they may feel a general sense of unease for some time. Try to behave normally, and be as reassuring as possible.
• If aggressive incidents are frequent or worrying, discuss them with a professional, such as a psychiatrist specialising in older people or a community psychiatric nurse. They may be able to offer support and suggest other ways of handling the situation.
• It is best not to address aggressive behaviour with drugs, as these can suppress the behaviour without addressing its cause, and may add to the person's confusion. However, if there seems to be no other option, the doctor should prescribe the minimum dose, and review the treatment very regularly.

Step 2: Work out what triggers the aggressive behaviourOnce the heat of the moment has passed, take some time to think about what happened, and why. Think back to other times when the person has become aggressive, and what events seemed to lead to their outbursts. Making a note after each incident may help you remember. Can you identify any common triggers? This could give you a clue as to what is troubling the person. Use the list below to give you some ideas.People with dementia may become aggressive if:

• they feel frustrated, under pressure or humiliated because they are no longer able to cope with the everyday demands of life. It can take a person with dementia longer to process information and respond to situations than it used to, and this can be very distressing
• they feel that their independence or privacy is threatened. Being forced to accept help with intimate functions such as washing, dressing or going to the toilet can be understandably stressful, as most of us have had privacy in these areas of life since childhood
• they feel they are being judged or criticised because they have forgotten something or have made a mistake in completing an everyday task
• they feel bewildered or anxious because there is too much noise, there are too many people around, or there has been a change in a familiar routine
• they feel nervous or threatened because they don't recognise certain places or people. They may be convinced that they are in the wrong place, or that a relative is a stranger who has broken into their home
• they are frightened by a sudden noise, sharp voices, abrupt movements or a person approaching them from behind without warning
• they are in physical discomfort or pain, they are bored, or even simply thirsty.

Step 3: Tackle the triggersUsing what you have learned in Step 2, try to find ways to avoid or minimise the situations that trigger the person's aggressive behaviour. Some of the solutions may be straightforward − for example, making sure the person always has plenty to drink. Others may require rather more thought.Tips for preventing aggressive behaviour:

• If the person with dementia does not seem to be coping well, reduce any demands and make sure they have an unrushed and stress-free routine.
• Try to remember that the person may not understand what you are trying to do and why. Wherever possible, explain things calmly and in simple sentences, allowing the person more time to respond than they would have needed before the dementia.
• Find tactful ways to offer help without seeming to take over. Guide or prompt the person, and break tasks down into easily manageable steps, so that they can do as much as possible for themselves.
• Try not to criticise, and do your best to hide any irritation that you feel. Avoid situations where the person is set up to fail. Praise any achievements, and focus on the things that the person can still do, rather than what is no longer possible.
• Watch out for warning signs, such as anxious or agitated behaviour or restlessness, and take action immediately to help the person feel more calm and reassured.
• Find activities to stimulate the person's interest, and make sure that they take enough physical exercise.
• Make sure the person has regular health checks, and consult the GP immediately if they seem to be ill or in discomfort.

If there seems to be no pattern to the behaviour and you are finding it difficult to cope, don't suffer in silence − seek professional advice.Step 4: Take time to deal with your own feelingsEven if you manage not to take it personally, an incident of aggressive behaviour may well leave you feeling quite shaky, and over time this kind of behaviour can leave you feeling exhausted and distressed. Find ways to help yourself recover, both immediately after an incident and in the longer term, and tap into sources of support.Try not to bottle up your feelings or resentments − find ways to talk things through. If you do lose your temper, don't feel guilty − remember, you are under great stress − but do discuss things with a friend, professional or another carer who may be able to suggest ways of handling such situations more calmly.Try these suggestions:

• Chat things through or just have a cup of tea with a friend, relative or neighbour.
• Take some time to unwind on your own.
• Talk to the GP, community psychiatric nurse or other professional.
• If you are a caregiver, join a carers' group to share experiences and offer mutual support.
• Phone a helpline, join an online discussion forum or see a counsellor.

Source: http://alzheimers.org.uk/site/scripts/documents_info.php?documentID=96