What to do with an aggressive person with dementia?

According to the Alzheimer's Association, up to 90% of individuals with dementia will experience behavioral and psychological symptoms, including agitation and aggression, at some point in their journey. Knowing what to do with an aggressive person with dementia? is a crucial skill for family and professional caregivers alike.

Quick Summary

Managing aggression in a person with dementia requires a calm and patient approach, focusing on identifying underlying triggers rather than confronting the behavior directly. By ensuring safety, validating feelings, and using redirection techniques, caregivers can de-escalate outbursts and improve the quality of care.

Key Points

• Prioritize Safety First: Always ensure the immediate safety of yourself and the individual during an aggressive episode by creating space and removing hazards.

• Become a Detective for Triggers: Understand that aggression is a symptom, not a choice. Investigate for underlying causes like pain, hunger, confusion, or environmental stress.

• Master De-escalation Techniques: Stay calm, use a soft voice, and validate the person's feelings (not their statements) to diffuse tension without arguing.

• Embrace Redirection and Distraction: Gently shift the individual's focus to a different activity, a favorite object, or calming music to interrupt the aggressive behavior pattern.

• Establish and Maintain Routine: A predictable daily schedule and a calm environment provide security and help reduce anxiety that can lead to aggressive outbursts.

• Involve Healthcare Professionals: Consult with a doctor or behavioral specialist if aggression persists to rule out medical issues and create a personalized management plan.

Understanding the Root Causes of Aggression

Aggressive behavior in someone with dementia is not intentional malice; it is a symptom of the disease, often stemming from an unmet need, confusion, or fear. To effectively address the behavior, it's essential to become a detective and figure out what might be causing the distress.

Common Triggers for Aggression

Recognizing potential triggers is the first step toward prevention. A change in behavior can be a sign that something is wrong. Common causes include:

• Physical discomfort: Pain from arthritis, infection, or a full bladder may be impossible for the person to communicate. Other discomforts like hunger, thirst, or being too hot or cold can also trigger frustration.
• Environmental factors: A noisy, chaotic, or overly stimulating environment can be overwhelming. Clutter, strange lighting, or a feeling of being rushed can also contribute.
• Changes in routine: People with dementia rely on routine for security. A sudden change in schedule, caregiver, or environment can cause immense anxiety.
• Communication breakdowns: The inability to express oneself can be incredibly frustrating. A person may become aggressive when they can't make sense of what you are saying or if they feel misunderstood.
• Fear and confusion: Losing one's memory and cognitive abilities is a frightening experience. They may mistake a familiar person for a stranger or believe they are in a different time or place.

Immediate De-escalation Techniques

When an aggressive episode is happening, your immediate response is critical. The goal is to ensure safety and diffuse the situation without escalating it further.

Strategies for an Active Episode

1. Stay Calm and Reassuring: Your tone of voice and body language are paramount. Speak slowly and softly. Maintain a non-threatening posture by standing to the side rather than directly in front.
2. Ensure Personal Space: Give the individual plenty of room. Moving too close can feel like an invasion of privacy and increase anxiety.
3. Validate Feelings, Not Facts: Instead of arguing or correcting them, acknowledge their emotions. If they say they are scared, respond with, "I see you are scared. I am here to help keep you safe." This validates their feelings and builds trust.
4. Redirect Attention: Shift their focus to something pleasant or distracting. This could involve offering a favorite snack, playing a familiar song, or suggesting a simple, calming activity like folding towels.
5. Remove Triggers: If you can identify the immediate cause, remove it. If the television is too loud, turn it off. If they are overstimulated by a group of people, move them to a quieter room.

Table: Responding to Triggers with Empathy vs. Confrontation

Trigger	Empathetic Response (Recommended)	Confrontational Response (Avoid)
Physical Pain	"I wonder if your tummy hurts? Let's get you a glass of water."	"You can't be in pain, you were fine a minute ago."
Environmental Noise	"It seems a bit loud in here. Let's go to the quiet room."	"Stop shouting, the TV isn't even that loud."
Confusion about Time	"You want to go home? I understand. We're safe here."	"This is your home. Stop trying to leave."
Feeling of Helplessness	"Let's do this together. You can hold this for me."	"Just let me do it. You'll only get frustrated."

Long-Term Management and Prevention

After a distressing event has passed, it's crucial to take steps to prevent future aggressive outbursts. This involves careful planning and establishing consistent routines.

Creating a Calming Environment and Routine

• Simplify the Environment: Minimize clutter and noise. Use calming colors and soft lighting. Natural light is often soothing. Secure any potential hazards like sharp objects or medications.
• Establish a Predictable Routine: A consistent daily schedule provides a sense of security. Try to schedule potentially stressful activities, like bathing, at the same time each day.
• Incorporate Calming Activities: Music therapy, aromatherapy, and sensory activities (like soft blankets or fidget toys) can be very effective. Physical activity, such as a gentle walk, can also reduce agitation.

Working with Healthcare Professionals

It is vital to consult with a doctor if aggressive behaviors worsen or new patterns emerge. A medical evaluation can rule out underlying issues like infections or medication side effects. The doctor may also suggest medications to help manage severe symptoms.

• Consider a Behavioral Specialist: A specialist can help identify specific triggers and create a personalized care plan. They can also offer coping strategies and communication techniques tailored to the individual.
• Explore Support Resources: Caregivers should not feel isolated. Support groups, like those from the Alzheimer's Association, offer valuable insights and emotional support from other caregivers.

Protecting Yourself and Others

Your safety is paramount. In an emergency, it is crucial to protect yourself and seek help immediately.

Steps for Emergency Situations

• Leave the Room if Necessary: If you feel threatened or the person is becoming physically violent, step back and leave the room to a safe space. This allows both of you to calm down.
• Create Safe Zones: Ensure you have a space to retreat to, such as a room with a lockable door. Keep a phone handy with emergency contacts programmed in.
• Know When to Call for Help: If the situation becomes an immediate threat, do not hesitate to call 911. Be sure to inform emergency responders that the person has dementia, as this will help them approach the situation appropriately.

Conclusion

Caring for an aggressive person with dementia is one of the most challenging aspects of caregiving, but it is manageable. By understanding that the behavior is a symptom, focusing on identifying triggers, and employing empathetic de-escalation techniques, caregivers can navigate these difficult moments with confidence and compassion. Utilizing a consistent routine, creating a calming environment, and seeking professional help are all part of a comprehensive strategy. Most importantly, remember to prioritize your own safety and well-being, because a supported caregiver provides the best care.

Frequently Asked Questions

What is the very first thing I should do when a person with dementia becomes aggressive?

The first step is to ensure safety. Step back to give them space and remove any potential hazards from the immediate area. Your calmness can help de-escalate the situation.

Should I argue with a person with dementia to prove them wrong?

No, you should never argue or confront a person with dementia. Instead, focus on validating their underlying feelings. For example, if they are scared, acknowledge their fear and offer reassurance, even if their fear is based on a mistaken belief.

What are some common environmental triggers for aggression in dementia patients?

Common triggers include loud noises, bright or glaring lights, excessive clutter, and a rushed or chaotic environment. Consistency and a calm atmosphere are key to prevention.

Can pain cause aggression in someone with dementia?

Yes, physical discomfort or pain is a very common trigger for aggression, as the person may not be able to communicate it verbally. Always check for signs of pain, infection, or other physical issues.

When should I seek professional medical help for aggressive behavior?

If the aggressive behavior is new, escalating, or poses a safety risk, it is time to consult a doctor. This is especially true if non-pharmacological interventions are not working.

How can I protect myself as a caregiver during a physical outburst?

Remove yourself from the immediate situation to a safe place. Have a charged phone with emergency contacts readily available. If there is an immediate threat, call 911 and inform them of the person's dementia.

Does music therapy help with aggression in dementia?

Yes, music therapy can be highly effective. Playing familiar, soothing music or engaging in musical activities can have a calming effect, reduce agitation, and redirect focus away from aggressive impulses.