If you have a relative with dementia - perhaps you are their carer - you may be aware that at some point you might find yourself dealing with aggressive behaviour from them. This is a prospect that many people fear, but there are ways to cope with such challenging behaviours.
Why people with dementia can develop aggressive behaviours?
Both physical and verbal aggression can be a symptom of dementia, or they can be a sign that something is not right in your relative’s life so they are acting out their distress. It can be very upsetting for the people around somebody with dementia to see them behave in such a state, and it is often a prompt that leads them to seek out dementia care support.
Aggression can take place in someone with dementia because they are confused or frightened and don’t understand where they are or who the people around them are. Similarly, if they feel they are not in control of their surroundings or their lives, this can also provoke aggression.
Another issue is that, as dementia progresses, a person’s inhibitions can reduce. As a result of this, they may be more likely to “act out”.
Other reasons for aggressive behaviours in dementia include:
Loneliness or a lack of mental stimulation, which can cause extreme boredom and distress
A poor relationship with a care professional or a failure to recognise family members, which can lead to a sense that nobody familiar is around
Deteriorating eyesight or hearing can lead to confusion
Feeling limited by others, such as not being allowed to go out alone or to take part in activities they used to enjoy
Hallucinations can be experienced, which can be frightening
Feeling exposed or humiliated when needing help to get dressed or use the toilet
What is aggression?
Aggression can be physical or verbal. Verbal aggression can include shouting, yelling, accusing, screaming or swearing at somebody. Physical aggression might include kicking, hitting, pushing, scratching or biting.
A person does not have to have been aggressive before they had dementia to develop these symptoms, though they might have been. If they have an underlying aggressive nature, then the lack of inhibitions associated with dementia can bring that out. However, somebody who has been peace-loving and not at all aggressive throughout their life can also develop aggression as a symptom of, or response to the challenges of, dementia.
The impact of aggressive dementia behaviour on family life
Aggression is a challenging behaviour that tests carers and family members. It can be frightening to be faced with somebody who is shouting or scratching you or screaming. It can also be embarrassing or awkward if this takes place in a public space or in front of others. You may wonder whether or not your relative is still safe to spend time with your children, and you might consider whether it is time to look at getting some carer support to help both you and your relative to cope better.
Nobody is to blame for a person with dementia developing challenging behaviours like aggression, but there are things that can be done.
How to prevent and manage aggressive behaviours
Aggression is often a reaction to a person’s circumstances rather than, strictly speaking, a symptom of dementia. It can indicate that a need is not being met and it may be that your relative cannot express what they need or want. Even if they do not understand what they need or want in that moment, the frustration of not getting it can bubble over.
For instance, they may be hungry but unable to recognise the signs of hunger, or they may have an infection and feel unwell without being able to communicate this.
Aggression might be a reaction to being misunderstood, feeling embarrassed or frustrated, feeling threatened, feeling like their voice is not being heard, or experiencing pain or other distress.
It may be difficult for your relative to assert their needs and wishes, so aggression can come to the surface, especially if dementia has caused lowered inhibitions so they do not have the self-control (to manage their anger or distress) that they used to have.
To PREVENT aggressive dementia behaviours
We all know that ‘prevention is better than a cure’, so aiming to prevent your relative from getting into a distressing situation will always be preferable to fixing things when they are already upset.
In order to help to avoid aggressive behaviours from arising, consider the following tips:
Help the person to feel in control. Ask their opinions, explain what is happening, and adhere to a person’s preferences about, for example, the food they eat or the temperature of their bath.
Try to have your relative’s life set up in the best way possible. Have skilled carers to help them, commit to providing the care you are able to as well, and make plans so that everything suits your relative’s needs and wants. This can include everything from having their favourite brand of coffee to letting them watch their favourite TV programme and respecting their wishes about when they go to bed.
Identify if there are any triggers prompting their aggression. Do bursts of aggression happen at a particular time of day, or when your relative is feeling under pressure? Maybe you didn’t know that they react badly to being bathed by certain people, but when you work this out, you can make sure that the carer that helps them in the bath is the best person for the job (e.g. men with dementia may prefer male carers).
Keep a diary to identify whether there are any particular events or circumstances that lead to higher levels of aggression. This might include details of who is caring for them, whether their home is busy or quiet, which elements of personal care they have experienced, whether the television is on, and so on.
Ask your relative’s GP to assess their health and look at their medications. Side effects from tablets or symptoms of hidden but painful illnesses can cause upset and may be easily resolved. Keep an eye out for symptoms like redness, swelling, a temperature, pulling or touching a body part, restlessness, a change in appetite and facial expressions that denote fear or pain.
To MANAGE aggressive dementia behaviours
While putting your efforts into preventing challenging behaviours in dementia can pay dividends, there may still be occasions when your relative or loved one does become aggressive. It is important that you and any of his or her carers handle this appropriately and manage this behaviour in a way that does no further damage and limits the impact of the aggression.
The following tips will help:
Try to see things from your relative’s point of view. What could be distressing them or upsetting them? Do what you can to remedy the situation.
Reassure them that nothing terrible is happening and move them from an overstimulating environment to a quiet, calm environment. Say that you understand why they are upset and acknowledge what has gone wrong for them.
Keep communicating with them, explaining what you are doing and why. This can help to reduce the tension and help them to understand that you are there to help.
Try to divert their attention from whatever is upsetting them. Perhaps a breath of fresh air or a change of scene would help, so consider stepping out into the garden or just moving into a different room. Music and dance can be especially effective to help people with dementia to relax and feel comfortable.
Sometimes, the situation can’t be immediately resolved but structures can be put in place that will help in time. For instance, if your relative finds it distressing to deal with a particular carer, you cannot remedy that during that shift but, in the future, you can recruit a carer who suits your relative’s personality better. Similarly, if today’s lunch meal caused a meltdown, you can make sure they are not served the same food again in future.
Learn from previous upset. What has helped your relative to calm down in the past?
If the aggression has come on very suddenly and is particularly out of character, a visit to a doctor could rule out whether your relative is experiencing some kind of pain or infection that is upsetting them that they cannot describe. It could be something as simple as needing antibiotics for an ear infection.
Try not to show your alarm or panic as this may contribute to your relative’s feelings of confusion or distress. Though you may be upset by what is going on, waiting until later to express your emotions can be a good approach if you can manage this.
Avoid confrontations. Aggression is distressing for both the person with dementia and their family members. Leave the room if you have to, but stay calm in front of your relative to avoid exacerbating their state of mind.
Don’t take it personally. This is not a planned attack against you – instead it is an expression of frustration or confusion or hurt.
Most importantly, stay safe yourself. Nobody expects you to tolerate violent behaviour and you should not feel guilty for protecting yourself in a difficult situation.
Check out our blog to find out more about how to discuss care with your older relatives.
Where to seek dementia care support
Carers take on a lot of responsibility and worry and it is only fair that they get support themselves. You can get informal support from family and friends, or ask your GP for some more structured help, such as counselling.
Also consider what you can do in terms of self-care, because simple steps now to look after yourself can help to prevent much higher levels of stress at a later stage.
Finally, look at the following organisations and see which could offer you support and help with your caring situation: