Aggression—a destructive or hostile action or behavior directed toward
oneself, other people or objects—is one of the most frightening behaviors
displayed by some individuals with dementia.
Typically, aggressive behavior in a
person with dementia involves swearing, screaming, throwing objects, slamming
doors, resisting care, biting or attempting to hit other people. Less commonly, it may be sexual in nature.
Not surprisingly, aggressive behavior
can cause considerable distress for caregivers, family members and nursing home
staff and is often cited as a reason why a loved one is placed in residential
care.
Aggravating Factors
Many things can trigger aggressive
behavior in a person with dementia. For example, aggression may be a sign of an
underlying problem that the patient cannot communicate. Pain, physical illness,
dehydration, depression, anxiety, a lack of sleep, frustration, a change in the
person’s drug regimen or even constipation may cause the patient to act
out. That’s why it’s important to get a
doctor to evaluate the person and rule out possible physical causes for
aggressive behavior.
At times, seemingly innocuous
actions of another person may be a trigger. An individual with dementia may
strike out while a caregiver is helping him bathe or a doctor is performing an
evaluation, for example, because he feels that his personal space has been
invaded. The aggressive behavior is merely an attempt to defend it.
In some instances, aggressive
behavior may occur when the person doesn’t understand why she or he is asked to
do something. The person with dementia may misinterpret certain actions or be
mistrustful of someone and react aggressively toward that person.
Identify and Adapt
You may be able to identify a
pattern in the person’s aggressive behavior and take steps to prevent it by
keeping a detailed written account of the events that surround the acts of
aggression. The account should describe what happened immediately prior
to the outburst, what the behavior
entailed and the outcome of the situation. The account should also note how
often aggressive behavior occurs, whether anyone else is present when the
behavior happens and what, if anything, reduces the behavior.
Information gleaned from the written
account can be useful in helping you make adaptations that will help avoid
triggering the aggressive behavior. For example, if your notes reveal that the
person typically is aggressive when he is unable to find items such as clothes
or dishes, try labeling drawers and cabinets.
If a person becomes combative when trying to make choices about eating
or dressing, limit the options you present. If outbursts occur when a person
receives instructions on how to do something, avoid general directives and
instead give instructions that contain only one step. For example, say “put
this shirt on” rather than “dress yourself.”
If the person exhibiting the aggressive behavior lives in a nursing home,
take a look at the
surroundings to identify potential triggers. The facility may be
overcrowded, or the person may be over or under stimulated; in some cases, a
roommate may be inadvertently triggering the behavior. Addressing those issues may help avert future
outbursts.
Additional Strategies
Some caregivers find that maintaining a regular daily routine helps prevent
outbursts. Playing music the person enjoys during problem times such as while
bathing may also be useful. In addition,
a regular, gentle exercise program may help reduce aggression on days the
patient is physically acting out.
The Medication Option
If repeated use of behavioral modification does not help control the
behavior, medication may be appropriate in some situations. While no drugs are specifically approved to
treat aggression in dementia, research shows that a number of medications may
be helpful. These include antidepressants, antipsychotics and anti-anxiety
drugs. The doctor will make treatment decisions based on a number of factors,
including the cause of the dementia, symptoms, the presence of other health
conditions and the person’s caregiving arrangements.
What To do When Aggression Occurs
Despite efforts to prevent and treat aggression, episodes may occur from
time to time. Knowing what to do can help defuse the situation.
If a person with dementia becomes aggressive, try your best to stay calm
and stop whatever it is you are trying to get the person to do. Give the person
enough space so that he or she doesn’t feel threatened. Don’t argue with the person, make degrading
comments or punish the person physically or psychologically. Remember, because of the person’s illness, he
or she likely will not recall the event or be able to learn from it.
Talk to the person in a calm non
threatening voice using easyto-understand language. If a television or radio is
on, turn down the volume or turn it off. Try to ignore the aggression or
distract the person by switching to another subject.
If this doesn’t work, try to calm the person by working through the reasons
for the aggression. For example, if the
person is suspicious that someone has stolen his or her wallet, spend a few
minutes looking for it with the person. Some caregivers find it helpful
to distract the person with a calming activity like sitting in a rocking
chair.
Get Support
Most caregivers are not trained professionals, but learning good caregiving
techniques can be worthwhile. In addition, getting support and learning how
other people cope with similar situations is invaluable. Contact the
Alzheimer’s Association to find out if there are caregiver training programs or
caregiver support groups in your area.
(Source: John Hopkins Memory
2013-Guide to Alzheimer’s Disease & Dementia)
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