Some people with Alzheimer’s or dementia experience a combative stage of dementia.
This is a normal part of the disease and can happen even if your loved one's personality has been kind and non-violent throughout their lives. It’s caused by the damage that’s happening in their brain.
Because they’re not able to clearly communicate their needs, people with dementia may lash out when they’re afraid, frustrated, angry, or in pain or discomfort. These aggressive outbursts can be scary and difficult for caregivers to handle. They could scream, curse, bite, grab, hit, kick, push, or throw things.
Since you’re feeling attacked, your instincts might prompt you to argue and fight back – but that will only escalate the behavior makes the situation worse.
Here are some tips on how to deal with the aggressive behaviors while it's occurring and how to reduce future outbursts.
1. Be prepared.
Remind yourself that challenging behavior and aggressive outbursts are normal symptoms of dementia. Doing this will help you respond in a calm and supportive way. If you know that these outbursts are a common part of the disease it will reduce your shock and surprise when it does happen and may also make it a little easier to not take the behavior personally and react aggressively.
2. Try to identify the immediate cause or trigger
Think about what happened just before the aggressive outburst started. Something like fear, frustration, or pain might have triggered it.
For example, did your loved one start yelling at empty areas of the room and telling people to get out? Look at the surroundings, you may notice that the room is starting to get darker because it’s early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner. After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help your loved one calm down. And, in the future you’ll know to turn on the lights before the room gets too dim.
In another example, you could have unintentionally approached your loved one from behind and startled them. This action could make them feel attacked and so they lash out in what they perceive as self-defense.
3. Rule out pain as the cause of the behavior.
Pain and physical discomfort can trigger aggressive behavior in someone with dementia. Many people suffering with dementia aren’t able to clearly communicate when something is bothering them. Instead, being in pain or discomfort could cause them to act out. Check to see if they need pain medication for existing conditions like arthritis or gout, if their seat is comfortable, or if they need to use the toilet.
4. Use a gentle tone and reassuring touch.
When your older adult gets upset, take a deep breath and stay as calm as possible. If you’re upset, that unintentionally continues escalating the tense emotions in the situation. Staying calm and breathing slowly helps to reduce everyone’s anger and agitation. Speak slowly and keep your voice soft, reassuring, and positive.
If appropriate, use a gentle and calming touch on the arm or shoulder to provide comfort and reassurance.
5. Validate their feelings
If the aggressive behavior is occurring and there isn’t an obvious cause, it could be because they’re having strong negative feelings like frustration, sadness, or loneliness and don’t know how to properly express themselves.
Try to look for clues to their emotions in their behavior and speak in a calm and comforting way. Reassure them that it’s ok to feel that way and that you’re there to help.
6. Calm the environment
A noisy or busy environment could also trigger aggressive dementia behavior. If they starts behaving aggressively, take notice of the environment to see if you can quickly calm the room. Turn down music volume, turn off the TV, and ask other people to leave the room.
7. Play their favorite music
Music has an amazing effect on mood and can change the environment quickly. Sometimes, singing an old favorite song, humming a soothing tune, softly playing relaxing classical music, or playing their favorite sing-a-long tunes can quickly calm someone down.
8. Shift focus to a different activity
If the current or previous activity caused agitation or frustration, it could have provoked an aggressive response.
After giving them a moment to express their anger, try to shift their attention to a different activity – something they typically enjoy.
9. Remove yourself from the room
In some cases, nothing works to calm the person. If that happens, it may be best to leave the room to give them some space and to give yourself time to calm down and regain balance. They may be able to calm themselves or might even forget that they’re angry. Before leaving, check to see that the environment is safe and that they’re not likely to hurt themselves while you’re gone.
10. Consider medication
If you have tried all of the above and challenging behaviors become too much to safely handle, it might be time to work with their doctor to carefully experiment with behavioral medications. When used appropriately, medication can curb dangerous aggression and improve quality of life for your loved one and yourself.
11. Last resort - call for help in emergencies
If you have can’t calm the person down and is becoming a danger to you or to themselves, you’ll need help from others.
In an emergency, call 911 and emphasize to the operator that the person has dementia, which is causing them to act aggressively. This helps first responders know that the person isn’t behaving criminally and needs help to safely calm down.
If you are caring for your loved one at home, consider moving your loved one to a memory care community, such as Alcoeur Gardens, a specialized memory care community, as there are multiple staff members on duty at all times, there’s 24/7 supervision and care, and they’re trained to handle these types of difficult situations.