If you’re caring for someone with dementia or Alzheimer’s, watching them struggle with memory loss, confusion and personality changes can be so devastating. However, the verbal and physical aggression that sometimes comes with dementia can be one of the most frightening and distressing symptoms. While there is excellent dementia care available from trained experts, it is still important to be prepared from an emotional perspective to handle when this happens as best as possible.

Your loved one may get upset or angry for no clear reason, throw things, push, kick, hit, bite, curse or make strange noises. This type of aggression is usually seen in the later stages of dementia but is fairly common. While aggression can be hard to cope with, understanding why it’s likely happening and the best ways to deal with it can make it less distressing.

What Causes Aggression?

It’s important to recognize that aggression in dementia patients isn’t usually deliberate. It’s often caused by fear, discomfort, desperation or changes in the brain that can create extreme reactions. Your loved one may act aggressively if they are feeling:

• threatened or scared
• physical pain
• depressed or stressed
• unheard or misunderstood
• embarrassed or frustrated
• lonely or bored
• overstimulated or overwhelmed

How to Respond

Dealing with aggressive behaviour can be very traumatic. However, once you understand what’s causing this behaviour, you can respond in a way that will help stop or minimize it. If your loved one is being aggressive, try to:

• Identify Triggers: Efficient dementia care involves being considerate of anger and aggression triggers. While aggression can happen without warning, there can also be an obvious cause. Write distressing events down and look for any patterns. If your loved one gets angry during bath time or while using the bathroom, look into assistive products to encourage independence. If leaving the house causes upset, try breaking the process down step-by-step, so it starts to feels less overwhelming.
• Rule Out Pain: Being in pain and not being able to communicate this, can logically cause aggressive behaviour. Look for signs that your loved one is uncomfortable including inflammation, fever, appetite changes or rubbing or pulling at an area of the body. Speak to your doctor to identify a possible physical cause as soon as an aggressive incident occurs.
• Stay Calm: If the person you’re caring for behaves aggressively, stay calm, positive and reassuring. While easier said than done, an angry response will only make things worse. If they are in a safe environment, take a deep breath and give them space to calm down—you’ll need it too. Once the situation has deescalated, make eye contact, use a low, soothing voice and tell them you want to help. This will give them the reassurance they need.
• Don’t Punish: While it can be tempting to scold your loved one after they’ve been aggressive, they usually won’t understand what they’ve done wrong, or remember what exactly happened. Let things go, be patient and forgive.
• Shift Focus: After an aggressive incident, do something different together. Listen to music, try massage, yoga, reading or going for a walk to calm down. Make relaxing activities a regular part of your day and everyone will benefit from them.
• Share with Others: To manage aggression, along with the many distressing symptoms of dementia, you will need to reach out for help. Connect with your doctor, counsellor or a support group to share what response strategies are working for you and to get useful advice from others. Reaching out will also help prevent your loved one from feeling your stress.
• Stay Safe: If your loved one is not able to calm down, you are badly injured or feel scared, call 9-1-1. Just make sure you tell the responder that dementia caused them to act aggressively. If these behaviours get too challenging, be open to professional home or long-term care options.

Being on the receiving end of aggression can leave you feeling distressed, hurt and rejected. The good news is that you can do something about it. To curb aggressive behaviour, be prepared for some trial and error, aim to understand and avoid triggers and try your best to stay calm and reassuring.

At VHA Home HealthCare, we can offer the support you need for your loved one living with dementia. Contact us for more on how our professional dementia care services can help you.