 If you are caring for someone with dementia, you may find that at times
they behave aggressively. This can be very distressing. By understanding
what causes this type of behaviour and learning some ways to deal with
it, you can make sure it happens less often, and feel better able to
manage when it does.
What do we mean by ‘aggressive behaviour’ in people
with dementia?
People with dementia can behave aggressively in one or more of the
following ways:
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Being verbally abusive or threatening.
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Being physically threatening, such as kicking
or pinching.
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Lashing out violently at people or property.
This may take the form of 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:
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If they feel frightened or humiliated
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If they feel frustrated because they are unable
to understand others or make themselves understood
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If the dementia has eroded their judgment and
self-control
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If they are no longer restrained by inhibitions
learned in early childhood, and have forgotten how to behave appropriately.
Dealing with aggressive behaviour is not easy, and there are no simple
answers. You can help 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.
Step 1: Try not to take it personally
Any form of aggression can be upsetting, but it’s important
to remember that the person is not being aggressive deliberately. Their
behaviour may appear to be targeted at you, but that is probably just
because you are there. Although the emotion at the root of their aggressive
behaviour – such as frustration – may persist, they will
probably forget any individual incidents much more quickly than you
do.
Try to remember that for many people aggression is simply a normal
part of the way that dementia progresses in many people. The fact that
the person you are caring for 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.
Step 2: Find ways to react to aggressive situations
In the long term, prevention is the best solution for aggressive behaviour
(see Steps 3 and 4), 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…
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Before you react, take a deep breath and count
to ten. Try to stay calm, and don’t enter into an argument.
A heated response will probably make the situation worse.
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Reassure the person and try to distract their
attention.
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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.
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If the person is physically violent, give them
plenty of space. Unless it is absolutely necessary, closing in on
them or trying to restrain them can make matters worse.
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You may need to leave the room until you have
both calmed down.
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If you need to, call for help.
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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 as normally and be as reassuring as possible.
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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.
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Try to avoid treating 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 3: Work out what triggers the aggressive behaviour
Think back to times when the person has become aggressive and to what
events have led to their outbursts. Can you identify any common triggers?
These could give you a clue as to what is troubling them. You won’t
be able to do this until the situation has been and gone, but once the
heat of the moment has passed you may be able to think about what happened,
and why. 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 longer for someone with dementia to process
information and respond to situations, and this can be very distressing
for them.
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… if they feel that their independence or
privacy are threatened. Being forced to accept help with intimate
functions such as washing, dressing or going to the toilet can be
understandably stressful. Most of us have had privacy in these areas
of life since childhood.
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… if they feel that they are being judged
or criticised because they have forgotten something or have made a
mistake in completing an everyday task.
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… if they feel bewildered or anxious because
there is too much noise, too many people around, or a change in a
familiar routine.
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… if they feel anxious 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.
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… if they feel frightened because of a sudden
noise, sharp voices, abrupt movements or a person approaching them
without warning from behind.
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… if they are in physical discomfort or
pain, or if they are bored or thirsty.
Step 4: Tackle the triggers
Using what you have learned in Step 3, 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.
Some carers have found the following useful:
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If the person with dementia does not seem to be
coping well, reduce any demands on them and make sure they have an
unrushed and stress-free routine.
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Wherever possible, explain things calmly and in
simple sentences, allowing more time for them to respond than they
would have needed before the dementia.
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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.
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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 on those that are no longer possible.
-
Watch out for warning signs, such as anxious or
agitated behaviour or restlessness, and take action immediately to
help them feel more calm and reassured.
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Find activities to stimulate the person’s
interest, and make sure that they take enough physical exercise.
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Make sure that the person has regular health checks,
and consult the GP immediately if they seem to be ill or in discomfort.
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If there seems to be no pattern to their behaviour
and you are finding it very difficult to manage, don't suffer in silence
– seek professional advice.
Step 5: Take time to deal with your own feelings
Even 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, a professional or another carer who may be able
to suggest ways of handling such situations more calmly.
Some carers find the following solutions help:
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Chat things through or just have a cup of tea
with a friend, relative or neighbour.
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Take some time to unwind on your own.
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Talk to the GP, community psychiatric nurse or
other professionals.
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Join a carers’ group to share experiences
and offer mutual support.
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Phone a helpline, join an online discussion forum
or see a counsellor. Try logging on to Talking Point, the Alzheimer’s
Society’s online discussion board at
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