Dementia sufferers experience many changes in behaviour as their condition worsens, and this may include aggressive behaviour. Dementia aggression can manifest in different ways, such as verbal abuse, damaging property or even physically abusing others.
This type of aggressive behaviour is known in the aged care industry as ‘responsive behaviour’. Responsive behaviour means that the behaviour is in direct response to the progression of dementia. When living with or caring for someone with dementia, it’s essential to be on the lookout for such behaviours, identify the causes and look for the best ways to deal with them.
What causes dementia aggression?
There are many reasons for behavioural changes in dementia patients as there are many unsettling changes going on in the dementia sufferer’s life. As dementia affects people in different ways, each individual will respond in different ways. Some behavioural changes come about due to changes taking place in the brain, while external environmental triggers may also play a role. For example, pain, anxiety, an inability to perform a task or communicate can all feel very frustrating, which may manifest in aggression. Let’s look more closely at these events.
Even the smallest problem with health or physical well-being can make a dementia patient feel agitated. For example:
- physical discomfort such as fever, aches, pain, itching
- poor sleep patterns
- adverse reactions to medication
- loss of control over behaviour due to physical changes in the brain
Change of environment
If the patient has recently moved into a new place of residence, such as a care facility, they may feel overwhelmed with confusion and anxiety, which may manifest in aggression.
Defensiveness and pride
Despite the fact that the dementia patient’s brain is changing, they are still aware of the changes, particularly in the early stages, and will often feel humiliated and overwhelmed. For example, the dementia patient may start to need help with everyday activities such as dressing or bathing, which they have completed themselves without help for most of their lives. This can have a devastating effect on a person’s pride, which can make them feel irritated and sometimes result in aggressive or defensive behaviour.
Similar to suffering from a perceived loss of dignity, the dementia sufferer may feel defeated, as if they have failed. They may no longer be able to operate autonomously, and this awareness may make them feel both depressed and irritated.
As time marches on, the world gets harder for the dementia sufferer. Things become more difficult to understand. It is harder to communicate and confusion sets in. It is a distressing time for all concerned.
Anxiety and fear
As the brain physically changes, the world becomes more frightening as the ability to recognise people and objects diminishes. Memory will fade and communication will become more difficult.
Coping with aggressive behaviour in dementia patients
Make sure you discuss the dementia sufferer’s aggressive behaviour with a doctor as there may be underlying factors that need to be addressed, such as physical or psychological illness.
To minimise the likelihood of aggressive behaviour, consider the following:
- minimise the amount of stress the patient is under
- try not to change the surroundings as this may confuse the patient
- avoid rushing and keep a consistent routine
- keep the patient as comfortable as possible
- be aware of any warning signs of aggression
- do not provoke or confront them
- ensure they are getting enough exercise and stimulation through participation in activities
When aggressive behaviour does occur
By diverting the dementia sufferer’s attention to something else, you may be able to diffuse the aggression quite quickly. Distracting them with physical activity can help them to ‘blow off steam’ and forget about what initially concerned them. A short walk with company, a visit to the garden or the library to look at the papers can often create enough diversion to enable the person to calm down.
Communication and assurance can go a long way. Remember, aggression in elderly dementia patients may stem from feelings of confusion, intimidation, fright, anxiety, or simply feeling unheard. Letting the person know that you can hear them by listening and engaging – and clarifying any confusing issues – will often give them the reassurance they desperately need.
In most cases, no one knows the dementia patient like their family. Family members have lived with them for decades and understand their idiosyncrasies and know where their emotions stem from. Communicate with the family to develop a better insight into the way the patient ‘ticks’. Family visits should be encouraged too. Although an advanced dementia sufferer may not recognise her family anymore, there is still nothing like the comfort of having people who know her and love her around.
Immediate strategies to help with aggressive behaviour in dementia
Sometimes, despite our best efforts, aggressive outbursts will occur. In these instances, keep the following tactics in mind:
- Stay calm and avoid exciting the patient
- If you feel unsafe, stay out of harm’s way. Trying to restrain the patient will only exacerbate the issue.
- Try to identify and address the underlying issue as soon as you can to put the patient at ease and defuse the aggression.
- Try the distraction tactic and suggest moving to another room together, going for a walk, having a cup of tea or some other activity.
Sage Institute of Aged Care – it’s more than a job, it’s a rewarding career.
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