What to do when someone with Alzheimer's gets violent?

According to the Alzheimer's Association, behavioral symptoms like aggression can affect up to 90% of individuals with dementia at some point. Knowing what to do when someone with Alzheimer's gets violent is crucial for ensuring the safety and well-being of both the person with dementia and their caregivers.

Quick Summary

When aggression occurs in an Alzheimer's patient, prioritize safety by calmly creating distance and removing triggers. Understand the root cause, validate their emotions without arguing, and use redirection. Learn when to seek professional help and establish a long-term management plan for patient and caregiver safety.

Key Points

• Prioritize Safety First: When aggression occurs, immediately create distance, move to a safe space, and remove any potential hazards from the environment.

• Stay Calm and Reassuring: Your calm demeanor can help de-escalate the situation. Speak softly, use simple language, and validate their feelings rather than arguing with them.

• Identify and Address Triggers: Look for underlying causes like pain, hunger, overstimulation, or fear. Maintaining a consistent daily routine can minimize common triggers.

• Use Redirection and Distraction: Gently shift the person's focus to a calming or enjoyable activity, such as listening to music, looking at photos, or having a familiar snack.

• Seek Professional Medical Advice: Consult a doctor to rule out or treat any medical conditions, pain, or medication side effects that may be causing the aggressive behavior.

• Plan for Emergencies: Know when to call emergency services (911) and have a plan in place. Always inform first responders that the individual has dementia.

• Prioritize Caregiver Self-Care: Caregiving is stressful. Take advantage of respite care and support groups to manage your own well-being and prevent burnout.

Immediate Steps During a Violent Episode

When a person with Alzheimer's becomes violent, the first priority is to ensure the safety of everyone involved. These moments can be frightening, but a calm, measured response is the most effective approach. Reacting with frustration or anger can escalate the situation and make it worse for everyone.

Ensure Your Safety First

Before you can help your loved one, you must protect yourself. Create a safe distance from the person, especially if they are hitting, kicking, or throwing objects. If possible, move to another room or stand behind a piece of furniture that can act as a barrier. Removing yourself from immediate danger allows you to think clearly and respond appropriately. Also, remove any objects that could be used to cause harm, such as sharp utensils, from the area.

Calm Yourself and the Environment

Your own anxiety and fear can be perceived by the person with Alzheimer's, adding to their distress. Take a few deep breaths and lower your voice. Speak slowly, clearly, and in a soft, reassuring tone. Reduce sensory overload by turning off loud music, the television, or dimming bright lights. A quiet, calm environment can often help de-escalate a tense situation.

Use De-escalation Techniques

1. Create Distance: Give the person space and avoid cornering them. Maintain a non-threatening body posture by standing to the side and keeping your hands visible.
2. Reassure, Don't Argue: Validate their feelings even if their perception is incorrect. For example, if they say someone is stealing from them, say, "I can see you're upset. Let's look for it together," rather than arguing. Arguing will only increase their frustration.
3. Redirect Attention: Shift their focus from the source of their agitation to a calming activity or object. This could be a favorite photo album, a snack, or some soft music. Engaging them with something pleasant can break the cycle of aggression.
4. Use Simple Communication: Avoid complex sentences or detailed explanations. Use simple, direct statements and rely on non-verbal cues like a gentle touch (if safe to do so) to convey comfort.

Understanding the Triggers for Aggression

Aggression is not a choice; it is often a symptom of the disease caused by fear, confusion, or an inability to communicate. Identifying and addressing the underlying cause is key to long-term management.

Common Triggers

• Unmet Physical Needs: Undiagnosed pain, hunger, thirst, constipation, or being too hot or cold can cause immense frustration. A person who cannot articulate their needs may lash out.
• Environmental Factors: A cluttered, noisy, or chaotic environment can be overwhelming. Sudden changes, bright lights, or confusing reflections can also trigger a violent response.
• Fear and Confusion: Being disoriented, unable to recognize a loved one, or being in an unfamiliar place can cause fear, which manifests as aggression.
• Communication Breakdown: The inability to express oneself can lead to frustration. If a caregiver is rushing or correcting them, it can feel demeaning and lead to a reactive outburst.
• Changes in Routine: A predictable schedule provides comfort and security. Any unexpected change, from mealtimes to different caregivers, can be upsetting.

Preventing Future Violent Episodes

Proactive strategies can significantly reduce the frequency and intensity of aggressive outbursts. By creating a stable, supportive environment, caregivers can minimize triggers and improve quality of life.

Create a Calm and Safe Environment

• Reduce clutter and create open, easy-to-navigate spaces.
• Improve lighting to reduce shadows and disorientation.
• Use calming colors and familiar, comforting objects in the living space.
• Secure or remove potential hazards, such as kitchen knives and tools.
• Table: De-escalation vs. Escalation Techniques

Technique	De-escalation	Escalation
Tone of Voice	Calm, soft, reassuring	Loud, harsh, demanding
Body Language	Relaxed, open, non-threatening	Tense, clenching fists, invading space
Communication	Simple, validating emotions	Arguing, correcting, using logic
Action	Redirecting to a pleasant activity	Forcing compliance, physical contact
Goal	Calm the person and situation	Win an argument, prove a point

Improve Communication Strategies

Learn to listen for the emotion behind the words or actions. Focus on validating their feelings rather than the facts of a situation. Use patience and positive reinforcement, celebrating small successes to build confidence and trust.

Use Engaging, Relaxing Activities

Boredom and restlessness are common triggers. Plan engaging activities tailored to the person's interests and abilities. These might include:

• Listening to favorite music
• Going for a gentle walk
• Folding laundry or a simple household task
• Looking through old photo albums
• Pet therapy, if appropriate

When to Get Professional Help

Sometimes, even the best strategies are not enough. It's important to recognize when professional intervention is necessary.

Consulting Healthcare Professionals

Your loved one's doctor should always be informed of any changes in behavior. A thorough medical evaluation can rule out underlying issues like infections, pain, or medication side effects. The doctor may adjust medications or recommend a behavioral specialist.

When to Call Emergency Services (911)

Call 911 immediately if the person is an immediate threat to themselves or others and you cannot safely de-escalate the situation. It is crucial to inform the dispatcher that the person has Alzheimer's or dementia. This information will help first responders approach the situation with the appropriate training and patience.

Caregiver Self-Care and Support

Caring for someone with aggressive behavior is exhausting and emotionally taxing. It's essential to prioritize your own well-being to avoid burnout.

Respite Care

Take regular breaks from your caregiving duties. Respite care, provided by family, friends, or a professional service, can give you the time you need to rest and recharge. This prevents caregiver fatigue, which can contribute to stress and potential frustration with your loved one.

Finding Support Groups

Joining a support group with other caregivers of Alzheimer's patients can provide a valuable outlet for sharing experiences and learning coping strategies. The Alzheimer's Association offers a wide range of online and in-person support options.

Learn more about managing behavioral symptoms from the Alzheimer's Association.

Conclusion: A Compassionate and Prepared Approach

Dealing with a loved one with Alzheimer's who becomes violent is one of the most challenging aspects of caregiving. However, by staying calm, prioritizing safety, understanding the triggers, and implementing proactive strategies, caregivers can manage these behaviors more effectively. Remember that aggression stems from a place of fear or confusion, not malice. Seeking professional help and utilizing a strong support network are vital tools for both the caregiver and the patient. By fostering a calm, predictable, and understanding environment, you can help your loved one feel safer and more secure, improving everyone's quality of life.

Frequently Asked Questions

What is the very first thing I should do if my loved one with Alzheimer's becomes violent?

Your first priority is safety. Create distance between yourself and the person. If they are throwing things or hitting, move to another room or put a barrier between you. Remain calm and speak in a low, soothing tone.

Why does a person with Alzheimer's become violent or aggressive?

Aggressive behavior is often a response to fear, frustration, confusion, or discomfort due to their condition. They may be unable to communicate needs like pain, hunger, or overstimulation from their environment.

How can I calm down a person with Alzheimer's during an outburst?

Use a calm, reassuring voice, and avoid arguing or correcting them. Try to redirect their attention to something pleasant, like a favorite song or a familiar object. Reducing noise and visual clutter in the environment can also help.

Should I physically restrain a person with Alzheimer's who is violent?

Physical restraints should be an absolute last resort, as they can cause injury and increase fear and agitation. Create space, maintain a calm presence, and only use physical intervention if there is an immediate threat of serious harm.

How can I prevent aggressive behavior from happening in the first place?

Prevention involves maintaining a predictable daily routine, creating a calm and safe environment, improving communication with simple words, and offering engaging activities to prevent boredom and restlessness.

When is it necessary to call 911 for a violent Alzheimer's patient?

Call 911 if the person poses an immediate and unmanageable threat to their own safety or the safety of others. Inform the dispatcher that the person has dementia so responders can approach the situation with appropriate knowledge.

What role do medications play in managing violence in Alzheimer's patients?

Medications can sometimes help manage severe behavioral symptoms. This should be discussed with a doctor, who can perform a medical evaluation to rule out other causes and determine if medication is an appropriate part of a treatment plan.

Can I use reasoning to help my loved one understand that their behavior is wrong?

No, reasoning is often ineffective with advanced Alzheimer's. The part of the brain that handles logic is impaired. Focus on validating their emotions and redirecting their attention, rather than trying to correct or win an argument.