People with dementia can sometimes get aggressive and angry. They may shout, hit or act inappropriately. This behaviour can be very different from their usual character. They can be disinhibited, meaning, they use words that are rude and not appropriate. They may do things that embarrass others or forget how to act in public.

This type of behaviour may be happening to a loved one you are caring for. Here are some problems you may notice and strategies to help you deal with this caregiving challenge.

Aggressive Behaviour

Here are some common behaviour challenges:

• Shouting
• Looking at you in an angry way
• Using bad language
• Screaming at you or screaming for no reason
• Hitting
• Pushing
• Kicking
• Pinching
• Biting

Reasons for Aggressive Behaviour

Your loved one may be acting aggressive because they:

• Don’t understand what you want them to do.
• Don’t know why they need to do what you’re asking them to do.
• Don’t like being told to do something.
• Are trying to regain independence in their life.
• Feel afraid.
• Think they’ve already done what you’ve asked them to do.
• Feel frustrated because they forget how to do what you’re asking them to do.
• Can’t see very well and are confused.
• Are in pain and not able to tell you.
• Think you’re angry with them.

Tips for Aggressive Behaviour

Determine what makes your loved one angry:

• Keep a notebook and write down when they get angry. Answer questions like: What time of day did they get angry? Did something trigger the anger? How did you respond? Did this help? Did it make things worse?
• Use this information to try and prevent an outburst or to calm your loved one down.
• Know what triggers the anger. For example, a change of routine, being hungry or thirsty, a certain time of day, someone coming to visit.

How to approach:

• Slowly approach from the front so you don’t startle your loved one.
• Keep your voice calm and speak slowly.
• Don’t raise your voice even if your loved one does. Raising your voice will make things worse.
• If they don’t understand you, try saying it in a different way. Use simple words and short sentences.
• Only ask one question at a time to avoid confusing your loved one..
• Don’t rush.

The environment:

• Keep the noise level down. Turn off loud TVs or radios.
• Try not to have too many people around.
• Make sure the lighting is good.
• Remove things that could be used as a weapon.
• Put knives and scissors in a secure place.
• Make sure all exits are kept clear.
• Consider getting a personal alarm, so you can call for help. (see Other Community Services)

Get some extra help:

• Your loved one may respond better to someone else. For example, they may get angry when you want to bathe them. They may prefer another family member and accept extra help in the home.
• You may be together too much. Consider getting relief from an adult day program if one is available in your neighbourhood.
• Have someone else stay with them to get a much-needed break. The person you’re caring for may respond better to someone else for certain things.

Inappropriate Behaviour

You may experience some of these behaviours with the loved one you are caring for:

• Swearing
• Making rude remarks
• Saying rude things about other people
• Taking their clothes off
• Touching their private parts
• Touching themselves in a sexual way
• Touching other people in a sexual way
• Spitting, belching, passing wind or nose picking

Tips for Inappropriate Behaviour

• Keep a notebook and write down when they behave badly. Answer questions like: What time of day did they get angry? Did something trigger the behaviour? Where did it happen? How did you respond? Did this help? Did it make things worse?
• Don’t argue with your loved one.
• Distract them so they get busy with something else.
• Try different things and use what works best.
• Choose clothes that are more difficult to take off. Look for clothes that fasten at the back or that have fastenings that are difficult to see.
• Keep your loved one occupied.
• Protect other people.
• Make sure you supervise them when children are around.
• Keep them away from places where their behaviour upsets people.
• Explain to others that this is part of the disease.

Things to Remember

• Try not to be ashamed if your loved one is behaving badly. Remember this behaviour is a symptom of the disease.
• Remind yourself that they are not being unkind to you on purpose.
• Don’t be afraid to ask for help.
• Bad behaviour can be part of the disease process. Ask your physician if you are unsure.
• Your loved one doesn’t don’t understand that the behaviour is inappropriate.
• Don’t get angry with them.
• Don’t blame yourself.

When to Ask a Professional

• Call 911 if it’s an emergency. If you, someone else or the person you are caring for is at risk, call for help.
• If the person you are caring for becomes aggressive, tell the doctor. The doctor will assess them to ensure your loved one is not having a bad reaction to prescribed medication. Or there may be an underlying health reason why the person is behaving this way. The doctor may be able to prescribe medication to calm your loved one down.
• Ask for an Occupational Therapist (OT) to visit. The OT can help you find ways to reduce the outbursts and give you strategies to deal with angry outbursts. He or she can also link you to an adult day program, arrange for respite help in the home or give you information about support groups where you can meet other caregivers.