How to Respond to Anger and Aggression in Dementia

Caregiver Tips for Dealing With Aggression

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While some people living with Alzheimer's or other types of dementia remain pleasant and easy-going throughout their lives, others develop intense feelings of anger and aggression. When someone with dementia lashes out at you for seemingly no reason, it's normal to feel surprised, discouraged, hurt, irritated, and even angry at them. Learning what causes anger in dementia and how best to respond can help you cope.

What Behaviors Develop From Anger in Dementia?

When persons with dementia become angry, they may raise their voice, throw things, display combative behavior such as hitting, kicking, or pushing, yell and scream at you or even try to physically attack you. Their language may become very colorful, even if they've never uttered a foul word before.

Sometimes, there are warning signs such as a loud voice, a scowl, or a swinging of the arm at empty space. But other times, it can be difficult to see the anger coming. It may seem to rise out of the blue. This "no-warning" anger can be the hardest to cope with because of its unpredictability.

In What Stage Do Anger and Aggression Often Develop?

Challenging behaviors such as anger and aggression are the most likely to develop in the middle stages of dementia.

What Causes Anger in Dementia?

  • Dementia affects emotions. If you're a caregiver for someone who has dementia, it can be helpful to remind yourself that their emotions are being affected by the disease. Dementia affects the brain, and the brain is responsible for more than just our memory and thought process. The brain also controls our emotions and behaviors. So, depending on where the damage in the brain is, emotions may be affected as well. Catastrophic reactions, where a sudden and disproportionate reaction to a seemingly normal situation occurs, are often triggered by care. This "over-reaction" in emotions can cause anger and aggression.
  • Dementia produces misunderstandings. Because dementia affects communication, the ability to understand what someone else is saying or doing is reduced. As a caregiver, you may mean only to be helpful, but the person with dementia might not understand why you're trying to help her or feel that you're trying to boss her around.
  • Dementia affects recognition of loved ones. People with dementia might not recognize their family members or friends, and this can cause fear, anxiety, and aggressive behavior. For example, a wife with dementia may try to attack her husband because she is afraid of the "strange man" in their house.
  • Dementia can cause paranoia, delusions, and hallucinations. Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle. Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.
  • Dementia can cause caregivers to feel overloaded. If you as a caregiver are more frustrated, impatient, and angry, even if these feelings aren't verbalized, there's a good chance that the person with dementia will reflect these feelings back to you in their own behaviors. Both your verbal and non-verbal communications can be picked up by the individual with dementia, and sometimes, like a mirror, projected back at you. Monitoring yourself for caregiver burnout and overload is important—not just for your own quality of life, but also for your loved one.

    Responding to Anger in Dementia

    • Give space. Remember to give a little space to the person living with dementia. When you invade someone's personal space and they don't understand why, you can expect resistance or combativeness with care.
    • Don't argueYou might be tempted to try to prove your point, but arguing with someone who has dementia is almost never effective. In fact, you normally will just make someone even more angry if you argue with them, and you won't "win."
    • Give time. If you're trying to help someone brush her teeth and she becomes angry with you, make sure she's safe to leave alone and give her a little time. Trying the same task 20 minutes later can sometimes produce a completely different result.
    • Use distraction. Sometimes, music can be a wonderful distraction. Try playing her favorite big band collection and singing with her for a few minutes before helping her get dressed. Or, turn on his Michael Jordan highlights while giving him a haircut.
    • Approach with one person. Rather than having two or three people go to help you give someone a shower, use one person if at all possible. More than one person approaching someone with dementia can raise anxieties and trigger aggression.
    • Try to determine the cause. When looking at causes of anger and aggression, don't forget to consider that pain, fatigue, hunger, or too much stimulation could contribute. Physical factors and environmental factors could affect behaviors and have to be carefully evaluated. Look for patterns on timing (for example, does he typically get angry in the evening hours?), as well as what happened before the anger developed (was it really loud and busy?).
    • Use a different caregiver if possible. If you're working in a nursing home or assisted living where there are other staff members present, try switching with a different caregiver if the person for whom you're caring becomes angry with you. While it's more typical that routines (such as a consistent caregiver) are beneficial, it's also possible that a different face can sometimes bring a different result.
    • Ask the doctor. Sometimes, dementia can provoke so much aggression and anger that those around the person just aren't safe, whether that's the caregivers or other residents. If aggression and anger are putting the individual and those around him in danger, it's time to call the doctor. Medications should never be the first choice in responding to challenging behaviors, but there are times that they may be needed. The physician can evaluate this.

    Sources:

    Alzheimer's Association. Aggression and Anger. http://www.alz.org/care/alzheimers-dementia-aggression-anger.asp

    Alzheimer Society Canada. Shifting focus: A guide to understanding dementia behavior. http://www.alzheimer.ca/on/~/media/Files/on/Shifting-focus/Shifting_Focus_Full_Guide.pdf

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