B4

People with dementia may react in what appears tobe an aggressive manner if they feel frightened orhumiliated, or frustrated because they are unable tounderstand or make themselves understood. Theymay also become aggressive if their sense of judgmentand self-control have been eroded by the dementia sothat they are no longer restrained by normalinhibitions and cannot remember how they shouldbehave. Sometimes their aggressive behaviour mayseem like an over-reaction and they may shout orscream or become very agitated as a result of a veryminor setback or criticism.

Although any form of aggression is very upsetting, itis important to remember it is not deliberate and thatthe person cannot help themselves. They are likely toforget the incident very quickly.

Triggers for aggression

If you look carefully at the situations in which theperson becomes aggressive and the events leading upto them, you may be able to identify what triggers thereaction and gain some understanding of what maybe troubling them. If there seems to be no pattern totheir behaviour and it is very difficult to manage, seekprofessional advice.

Possible reasons for aggressive behaviour includesituations in which the person:

• feels frustrated, pressurised or humiliatedbecause they are no longer able to cope witheveryday activities

• feels their independence and privacy arethreatened because they are forced to accept helpwith intimate functions such as washing, dressingor going to the toilet

• feels they are being judged or criticised perhapsbecause they have forgotten something or madea mistake

• feels bewildered or frightened because there is toomuch noise or too many people or there has been achange in routine and they cannot cope.

In addition, aggression may occur in situations inwhich the person:

• feels anxious or threatened because they nolonger recognise certain places or people. Theymay be convinced they are in the wrong place orthat a relative is a stranger who has broken intotheir home

• feels frightened because of a sudden noise, sharpvoices, abrupt movements or someone approachingthem without warning from behind.

• feels discomfort, pain, boredom or thirst.

Preventative measures

If you can find out what may be upsetting theperson with dementia you may be able to reassurethem or you may be able to find ways of handlingsituations that will be less distressing. Ask foradvice from professionals or other carers. Ifappropriate you might:

• reduce demands made on the person if they do notseem to be coping, and ensure that there is anunrushed and stress-free routine

• explain things to the person, wherever possible,calmly and in simple sentences, allowing time forthem to respond

Common Problems Associatedwith Alzheimer’s Disease

Aggressive behaviourIf you are caring for someone with dementia you may find that theysometimes seem to behave in a very aggressive way. They may beverbally abusive or threatening, for example, or kick or pinch or theymay lash out violently at people or property. If such behaviour occurs,you are likely to feel distressed and anxious about the best way to cope.Here are some suggestions.

Alzheimer National Helpline 1800 341 341

Alzheimers A4 Inserts Section B 15/05/2012 08:39 Page 7

Understanding Changes in Behaviour

B4

12945-Alzheimers Inserts - B4.indd 11 09/05/2014 16:25

B4

• find tactful ways of offering help without seemingto take over. Guide or prompt the person and breakdown tasks into small easily-manageable steps sothat they can do as much for themselves as possible

• try not to criticise the person or show any irritationyou may feel and avoid situations where they arebound to fail. Praise any achievements and focuson their remaining abilities rather than on whatthey can no longer do.

In addition:

• Watch out for warning signs such as anxious oragitated behaviour and offer more reassurance, if appropriate.

• Avoid sharp voices and sudden movement. Toomuch noise or too many people may also add totheir confusion.

• Avoid confrontation. You might be able to distractthe person's attention if they seem upset or leavethe room for a few moments.

• Find activities to stimulate the person's interestand make sure they have enough exercise.

• Make sure the person has regular health checksand consult the GP immediately if they seem to beill or in discomfort.

Coping measures

Preventative measures will not always work. Do notblame yourself if aggressive behaviour occurs.Concentrate instead on handling it as calmly andeffectively as possible.

At the time

• Try to remain calm and do not allow yourself to bedrawn into an argument, however upset you feel. Aheated response is likely to make the situation worse.

• Take a deep breath or count to ten before you react.Speak in a reassuring voice and attempt to distracttheir attention or leave the room if necessary.

• Try not to show any anxiety as this may increasethe person's agitation.

• If they are physically violent, give them plenty ofspace. Closing in or trying to restrain the person,unless absolutely necessary, can make mattersworse. You may need to leave them until they havecalmed down or call for help.

Afterwards

• Do not try to punish the person by withdrawing atreat, for example. They are unable to learn fromexperience in this way and will probably forget theincident very quickly. Try to behave as normallyand reassuringly as possible.

• If aggressive incidents are frequent or worrying,discuss them with a professional such apsychogeriatrician, community psychiatric nurse or public health nurse. They may be able to offersupport and suggest other ways of handling the situation.

• Generally, it is best to avoid treating aggressivebehaviour with drugs as these can add toconfusion. However, if it does seem that such drugsare unavoidable the doctor will want to prescribethe minimum effective dose and to review thetreatment regularly.

Your own feelings

It is important to remember that, although much ofthe aggression may be directed at you, it is notintentional but simply because you are there.However, any incident will probably leave you feelingquite shaky. A cup of tea with a neighbour, a phonecall to a friend or a little time spent quietly on yourown will help you recoup your resources.

Don't feel guilty if you do lose your temper. You areunder great stress. If aggressive incidents are frequentor worrying discuss them with a professional such asyour GP public health nurse. They may be able to offersupport and suggest other ways of handling thesituation. Don’t bottle up your feelings or resentments.Talking things over with a friend, a professional orwithin a carer’s support group may help.

Alzheimers A4 Inserts Section B 15/05/2012 08:39 Page 8

B4

12945-Alzheimers Inserts - B4.indd 12 09/05/2014 16:25