Aggression and Anger

Aggressive behaviors may be verbal or physical. They can occur suddenly, with no apparent reason, or result from a frustrating situation. While aggression can be hard to cope with, understanding that the person with Alzheimer’s or dementia is not acting this way on purpose can often help.

Causes

Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. If the person with Alzheimer’s is aggressive, consider what might be contributing to the change in behavior.

Physical discomfort

• Is the person able to let you know that he or she is experiencing physical pain? It is not uncommon for persons with Alzheimer’s or other dementias to have urinary tract or other infections. Due to their loss of cognitive function, they are unable to articulate or identify the cause of physical discomfort and, therefore, may express it through physical aggression.
• Is the person tired because of inadequate rest or sleep?
• Is the person hungry or thirsty?
• Are medications causing side effects? Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions?

Treating Behavioral Symptoms

Anyone experiencing behavioral symptoms should receive a thorough medical checkup, especially when symptoms appear suddenly. Treatment depends on a careful diagnosis, determining possible causes and the types of behavior the person is experiencing.

Environmental factors

• Is the person overstimulated by loud noises, an overactive environment or physical clutter? Large crowds or being surrounded by unfamiliar people — even within one’s own home — can be over-stimulating for a person with dementia.
• Does the person feel lost?
• Most people function better during a certain time of day; typically mornings are best. Consider the time of day when making appointments or scheduling activities. Choose a time when you know the person is most alert and best able to process new information or surroundings.

Poor communication

• Are your instructions simple and easy to understand?
• Are you asking too many questions or making too many statements at once?
• Is the person picking up on your own stress or irritability?

How to respond

• Try to identify the immediate cause. Think about what happened right before the reaction that may have triggered the behavior.
• Rule out pain as the cause of the behavior. Pain can trigger aggressive behavior for a person with dementia.
• Focus on feelings, not the facts. Rather than focusing on specific details, consider the person’s emotions. Look for the feelings behind the words or actions.
• Don’t get upset. Be positive and reassuring. Speak slowly in a soft tone.
• Limit distractions. Examine the person’s surroundings, and adapt them to avoid 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.
• Take a break. If the person is in a safe environment and you are able, walk away and take a moment for yourself.
• Ensure safety. Make sure you and the person are safe. If the person is unable to calm down, seek assistance from others. Always call 911 in emergency situations. If you do call 911, make sure to tell responders the person has dementia, which causes them to act aggressively.
• Share your experience with others. Join a caregiver support group or an online support community to share response strategies have worked for you and gain new ideas from other caregivers.