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Tips for Handling Aggressive Behavior in Dementia

Some people with Alzheimer’s or dementia may enter a combative stage of dementia. This is a normal part of the disease and can happen even if your aging loved one's typical personality has been kind and non-violent throughout their lives. It’s caused by the damage that’s happening in their brain.

Because they’re not able to clearly communicate their needs, people with dementia may lash out when they’re afraid, frustrated, angry, or in pain or discomfort.

These aggressive outbursts can be scary and difficult for caregivers to handle. Older adults could scream, curse, bite, grab, hit, kick, push or throw things. Since you’re feeling attacked, your instincts might prompt you to argue and fight back – but that only makes the situation worse.

We share 10 tips for dealing with aggressive behavior in dementia while it’s happening. We also explain a few ways to learn from the situation to find ways to prevent or reduce future outbursts. 10 TIPS FOR DEALING WITH AGRESSIVE BEHAVIOR IN DEMENTIA 1. Be prepared with realistic expectations. Reminding yourself that challenging behavior and aggressive outbursts are normal symptoms of dementia helps you respond in a calm and supportive way. Knowing that these episodes are a common part of the disease reduces your shock and surprise when it does happen and may also make it a little easier to not take the behavior personally. 2. Try to identify the immediate cause or trigger. Think about what happened just before the aggressive outburst started. Something like fear, frustration or pain might have triggered it. For example, your older adult might start yelling at empty areas of the room and telling people to get out. Looking around, you might notice that the room is starting to get darker because it’s early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner. After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help your loved one calm down. And, in the future you’ll know to turn on the lights before the room gets too dim. 3. Rule out pain as the cause of the behavior. Pain and physical discomfort can trigger aggressive behavior in someone with dementia. Many older adults with dementia aren’t able to clearly communicate when something is bothering them. Instead, being in pain or discomfort could cause them to act out. Check to see if they need pain medication for existing conditions like arthritis or gout, if their seat is comfortable, or if they need to use the toilet. 4. Use a gentle tone and reassuring touch. When your older adult gets upset, take a deep breath and stay as calm as possible. If you’re upset, that unintentionally continues escalating the tense emotions in the situation. Staying calm and breathing slowly helps to reduce everyone’s anger and agitation. Speak slowly and keep your voice soft, reassuring, and positive. If appropriate, use a gentle and calming touch on the arm or shoulder to provide comfort and reassurance. 5. Validate their feelings. If your older adult is being aggressive and there isn’t an obvious cause, it could be because they’re having strong negative feelings like frustration, sadness or loneliness and don’t know how to properly express themselves. Try to look for clues to their emotions in their behavior and speak in a calm and comforting way. Reassure them that it’s ok to feel that way and that you’re there to help.

6. Calm the environment. A noisy or busy environment could also trigger aggressive dementia behavior. If your aging loved one starts behaving aggressively, take notice of the environment to see if you can quickly calm the room. Turn down music volume, turn off the TV, and ask other people to leave the room. 7. Play their favorite music. Music has an amazing effect on mood. Sometimes, singing an old favorite song, humming a soothing tune, softly playing relaxing classical music, or playing their favorite sing-a-long tunes can quickly calm someone down. 8. Shift focus to a different activity. If the current or previous activity caused agitation or frustration, it could have provoked an aggressive response. After giving your older adult a minute to vent their feelings, try to shift their attention to a different activity – something they typically enjoy. 9. Remove yourself from the room. In some cases, nothing works to calm the person. If that happens, it may be best to leave the room to give them some space and to give yourself time to calm down and regain balance. They may be able to calm themselves or might even forget that they’re angry. Before leaving, check to see that the environment is safe and that they’re not likely to hurt themselves while you’re gone. 10. Make sure you and your older adult are safe and call for help in emergencies. If your older adult can’t calm down and is becoming a danger to you or to themselves, you’ll need help from others. If the situation isn’t extreme and there’s a nearby family member or friend that your older adult usually responds well to, call and ask them to come over to help immediately. In an emergency, call 911 and emphasize to the operator that the person has dementia, which is causing them to act aggressively. This helps first responders know that the person isn’t behaving criminally and needs help to safely calm down.

When first responders arrive, make sure you again clearly state that this behavior is caused by dementia or even “a brain injury” (in case they’re not familiar with dementia). That knowledge helps first responders treat them more appropriately. 3 THINGS TO DO AFTER DEALING WITH AGGRESSIVE BEHAVIOR IN DEMENTIA 1. Learn from what happened. After giving yourself a chance to calm down and destress from the episode of aggressive dementia behavior, take a step back to see what you can learn from the situation. Analyzing the situation also helps you take it a little less personally and makes it easier to think about what you could do differently next time to try to avoid an aggressive reaction. Think about possible triggers, which responses helped calm things down, and which responses seemed to make the situation worse. It often helps to take notes on your observations to see if you can spot patterns or figure out new ways to try to prevent a similar outburst in the future or cool things down if it does happen. 2. Find sources of support. It’s essential for your well-being to talk with people who understand and can help you cope with these tough situations and deal with the conflicting emotions. Share your experiences with members of a caregiver support group, a counselor or therapist, or with supportive friends or family members. Getting your feelings out is an important outlet for stress. Plus, you might get additional tips and ideas for managing aggressive dementia behavior from others who have dealt with it. 3. Consider medication. When non-drug techniques aren’t working and challenging behaviors become too much to safely handle, it might be time to work with their doctor to carefully experiment with behavioral medications. When used appropriately, medication can curb dangerous aggression and improve quality of life for both your older adult and yourself.

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