Dealing with Dementia and Aggression

Dealing with Dementia and Aggressive Behaviors

Managing aggressive behaviors in dementia

I parked the car in the driveway then helped my mom out of the car this morning to walk into our house on this beautiful and warm spring morning.  She made it partway out of the car, feet on the cement, then froze. She stood leaning heavily into the car and I encouraged her to walk with me inside.  Instead, she maintained her position and yelled “Leave me alone! LEAVE meeee…. ALONE!”  I clearly couldn’t leave her as she has lost the ability to stand and walk safely on her own due to her moderately severe stage of dementia. I tried the tactic that usually works in these situations, reframing the situation by encouraging her to take care of her robotic dog, Sushi.  I sat Sushi on the seat of her walker placed in front of her and said, “We have to get Sushi inside, she wants to go in.”  Unfortunately, my usual tactic of reframing situations into ways she needs to care for her dog did not work. She was adamant, “Leave me ALONE, Lisa! Go AWAY!

how to manage aggression and agitation in dementia patients

I stood by her and said nothing, gave her some time to let this tense moment pass, and stepped out of her line of vision as I knew my close presence contributed to her agitation. After a couple of minutes I changed up the situation, which often can pull her out of a bad mood, and brought the wheelchair close by in place of the walker. With a few gentle yet firm words, I said “sit right here” while maximizing visual cues by patting my hand where I wanted her to sit on the wheelchair. In order to let those words have the most effect, I didn’t clutter the air with more words. My mom began to move, and I safely assisted her into the wheelchair. 

I pulled up a chair and sat side by side with her in the driveway.  I did this to give her time and quiet space to de-escalate.  I thought the agitated moment had passed, only to find every simple question I asked was answered with a resounding, “NO!”  My questions were related to her needs… “Are you cold? Would you like to go inside?” using a calm and low tone of voice that usually works, but my words weren’t well received at that moment.  We sat quietly together, and to my surprise, she said quietly, “I’m agitated and would just like to be left alone for a while.”  Wow! A well-spoken full sentence that made perfect sense and reflected exactly how she felt! These days are full of partial sentences where I typically have to guess the meaning, so such a spot-on sentence like that is rare!  We sat quietly together for another 10 minutes and then my mom was ready to walk inside the house. 

Does dementia cause aggressive behavior?

When it comes to dementia, one of the most troubling aspects is addressing agitation.  It can occur from a trigger, or it may have no trigger at all and can seem out of the blue. Oftentimes people that had a pleasant demeanor throughout their lives can surprise loved ones with harsh verbal outbursts and sometimes physical aggression.

3 facts on dementia and aggressive behaviors

  1. 1/3 of persons with dementia have aggressive behaviors. 
    facts about aggression and agitation in dementia patients
  2. Agitation and aggression are the main reasons persons with dementia are placed into a facility to live.
  3. As the brain’s ability to control emotions deteriorates, small seemingly insignificant stressors can trigger aggression. 

    Look for the triggers causing aggressive behaviors

    If you’re dealing with someone with mean or aggressive episodes, it’s important to play detective and look for the triggers causing the behavior. They may be in pain, hungry, too hot/cold, bored, lonely, tired, a soiled brief, constipation, or stressed by a noisy environment. Other reasons include feeling confused or feeling the loss of freedom to do things they once did easily.  They may feel pressured to do something they don’t want to do, like take a bath.  Today, my mom had difficulty transitioning from one activity to the next (riding in the car to going into my house). The most common stressor is a change to their daily routine. One way to prevent these outbursts is to strive for consistency with their sleep routine, meal times, bathroom habits, caregivers, and environment.  Doing so gives them a sense of predictability over their life. 

    What to do when someone with dementia is agitated?

    In moments of agitation, you can help them by validating their feelings and reassuring them. For example, “You feel cold? Let me get you a blanket,” or “You’re wondering who’s going to take care of that mess? I will take care of it.” 

    6 ways to calm down an agitated dementia patient 

    1. Use a calm, reassuring, and low tone of voice, and simple words
    2. Be in their line of vision when you talk to them
    3. Give them plenty of time to respond to you
    4. Distract them with a different activity, such as going for a walk (indoors or out), going for a car ride, or having a favorite snack
    5. Be sure to alternate activity with downtime; too much of either can lead to restlessness. 
    6. Pay attention to the environment, and look for stressors of too much noise, commotion, or activity. Unexpected sounds or movements can startle people more often as dementia progresses. 

    Managing stress as a dementia caregiver

    When you’re feeling stressed as a caregiver, it can be tempting to respond to them in anger.  Remember that they’re agitated because they are having a hard time, they’re not trying to be difficult. Take some deep breaths, count to 10, and prioritize care for yourself to be the person you want to be. 

    Keep in mind that what works one day, may not work the next.  Also, think through the rough spots after they happen and try to learn from them.  For example, in retrospect, I veered from my usual routine of having my mom get out of the car in the garage and instead, had her get out of the car in the driveway.  Seeing how my mom responded today while getting out of the car in the driveway helps me make a different decision in how I have her get out of the car the next time.

    managing stress as a caregiver
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