Behavior Changes with Dementia: Aggression

Nov 22, 2019 | Living with Dementia

This article is part of a 3-part series on the behavior changes that come with dementia. You can find the rest of the series below.

Behavior Changes with Dementia: Sexually Inappropriate Behaviors
Behavior Changes with Dementia: Hallucinations

It can be upsetting when someone with dementia suddenly lashes out at you. If you are on the receiving end of aggressive behavior, as stressful as it might be, remember that the behavior typically is not about you, and the person with dementia is not behaving as they are on purpose.

What Aggression Looks Like

Aggressive behavior occurs in two ways:

Verbal – such as yelling, using profanity, or making threats
Physical – such as pushing or shoving, hitting, pinching, hair-pulling, or biting

Aggression is forceful behavior, either verbal or physical, intended to dominate, master, or harm another person.

Aggression in Dementia Causes

Aggression can be linked to a person’s personality before their diagnosis of dementia, but often it is not.

Aggression may be unprovoked, but when it comes from a person with dementia, it can be caused by many factors, for example, confusion, discomfort, environmental factors, and misunderstandings through poor communication.

Evaluating Aggressive Behavior

Aggressive behavior is often unintended and typically is a reaction, so as a caregiver, a close friend or family member, your best tool when aggression is displayed is to assess the environment and conditions through the eyes of the person with dementia.

Physical discomfort

Is the person in physical pain? Perhaps they cannot tell you verbally that they are in discomfort. Underlying and hidden areas of discomfort or pain can be urinary tract or other infections, or stomach aches or irritation caused by certain foods.

Is the person tired? Have they been sleeping soundly at night?

Is the person hungry or thirsty? Have they been eating a well-balanced diet, and eating routine scheduled meals?

Is the person on medication, and is the aggressive behavior caused by side-effects? If the person receives more than one prescribed medication, is the combination incompatible and can it cause side-effects that lead to aggressive behavior?

Environmental factors

Is the person with dementia confused by noise, light, or perhaps clutter in their living environment? Changes to the environment, including a change in staff, can be confusing and may provoke the person with dementia to lash out, especially if they are unable to articulate their confusion.

Does the aggression normally occur at a given time of day? For example, if it is mealtime, evaluate what has changed at mealtime. Could it be a change of staff, or new patients dining in the area, or a change such as remodeling or redecorating?

If the person is more aggressive early in the morning, did they receive enough sleep? Has the morning wake up and care routine changed?

Communication

You don’t want to add to the confusion that the person with dementia feels. First, don’t blame yourself. Sometimes we just need to take a step back and evaluate our own communication.

When a person with dementia lashes out to you after you’ve given instructions, consider:

Were your instructions clear and concise (easy to understand)?

Are you taking the time to ensure the person in your care has time to think about your instructions, or do they feel rushed by too many directives at once?

Are you feeling stressed, and could the person in your care be picking up on your stress level?

How to Deal with Aggression in Dementia

As a caregiver to a person with dementia, you never know when you’ll be on the receiving end of aggressive behavior. This could be your redeeming mantra to work or live by:

“Have the courage to act instead of react.” – Oliver Wendell Holmes, Sr.

How to respond to aggressive behavior:

Focus on the facts

Evaluate the cause of the aggressive behavior.

Do not react

Act in a manner that does not promote aggression. Try to understand. Be positive and reassuring and use a calm and soft voice. Even though you’ve experienced what might feel like an attack, you can be in the lead when your actions come from your heart and brain, not from your own negative reactions.

Try redirection

Try to steer the person away from what they were focused on when they displayed aggression. This could shift the person to a sense of calm or forget what irritated them.

Take a break

If the environment is safe, try walking away and take time for yourself. Give yourself a chance to think, breathe, and restore your calm.

Seek Medical Help

When a person with dementia suddenly lashes out with aggression, the caregiver must rule out irritations such as physical discomfort, environmental factors, and poor communication. The next step, which is a very important step, is to seek medical attention.

What you cannot see with your own eyes can be a hidden condition, such as an internal infection. The person with dementia may not be able to verbalize when they feel sick or are in discomfort or pain.

Your Safety

Safety is everything. Make sure you and the person in your care are safe. If the person with dementia does not calm down, seek assistance. In emergency situations, especially when help is not available, call 911. Be prepared to tell the responder that the person has dementia and what may have caused them to act aggressively.