Alzheimer’s Aggression

Unfortunately, Alzheimer’s aggression is an all too common phase of this terrible disease.  Generally, it occurs during the middle stage of Alzheimer’s when the person is forgetting more becoming frustrated and angry.

It is the number one reason caregivers put their loved ones into assisted living facilities/nursing homes.  Alzheimer’s suffers may develop delusions, become extremely irritated and aggressive toward their spouses/caregivers.  Once the incident is over the loved one who is suffering from Alzheimer’s won’t remember the aggressive incident at all.

There are behavioral strategies and new medication options that can help with the aggressive tendency’s.

One of the major challenges we face as caregivers is figuring out where the aggression is coming from.  Is the Alzheimer’s patient scared/frustrated with themselves, hungry/thirsty?  Is there something in their surroundings that is making them uncomfortable?  In simple terms, we need to do our best to figure out what the triggers are that cause their aggressive outbursts.

In dealing with these behaviors we need to keep in mind that our loved ones do not mean to be aggressive with us.  We cannot take their behaviors personally, which can be extremely difficult to do, yet we must.  The Alzheimer suffer is not to blame it is the disease that is cuasing their behavioral outburst.

Reacting/Responding to aggressive behaviors

• Do not take the aggressive behaviors/outburst personally. Recognize that these outbursts/behaviors are part of the disease not the person.
• Avoid confrontation whenever possible(Always). Don’t argue with them about who or what they are remembering or who they may want to talk to (living or dead).  They are in their world not yours.  They can’t remember.  It’s not that they wouldn’t love to remember and be present with us they can’t.  Go with it.  Get them to talk about whatever they want to talk about.  It makes them feel connected and safe.
• Modify their surroundings to work out challenges and barriers to their well-being, security and serenity.
• Respond to the person not the aggressive behavior or statement. Recognize the emotion that is being conveyed not the anger in which it is being delivered.
• Validate their responses.  Let them know that it is OK to feel frustrated, anxious or sad.
• Comforting touches can help relieve the frustration or fear.
• Keep a sense of humor.  Not necessarily outwardly as that may be misunderstood but internally for your own sanity.
• Place labels on rooms, items in rooms.  Tape unnecessary remotes to block out what isn’t needed.
• Plan ahead if you anticipate that a situation or event may trigger an outburst.  Plan for an alternative to the hustle and bustle.  Routines are best.
• Don’t ask to many questions at one time. Give limited, step by step directions.
• Their reality is not our reality. Instead of arguing about it go along with it, listen to them.
• Focus on the place they are most secure – the past.  It is often less confusing for them and something they remember better.
• Understand that the logical or expected resolution to a situation will not factor into the Alzheimer’s brain.  You need to adjust your way of thinking without losing your temper.
• Distraction from the situation may work. Give them physical space if they begin to become physically aggressive.  Ask for support.
• There is never punishment for these behaviors! Never!

Understanding the reasons that our loved one’s respond aggressively to us can assist us in finding possible solutions to their behaviors. As caregivers, we need to observe our loved ones to see if we can pick out possible triggers for their aggressive behaviors.

Explanations/reasons for aggressive behaviors.

• Communication with others or the result of not being able to communicate their needs with others.
• Boredom and needing more stimulation in their environment.
• Overstimulated and needing a more peaceful environment.
• Physical distress/pain, possible infections such as sinus, cut/wound or urinary tract infections.
• Environmental Factors. Are our loved ones feeling too hot or too cold
• Are our loved ones tired? Are they hungry? Do they need a meal or snack?
• Are the medications that they take creating a toxic reaction which escalates the aggression?
• Possibly undiagnosed vision or hearing issues making communication even more strained for our loved ones.

Triggers

• Moving from a home environment to an assisted living facility or a new home.
• Hygiene care can bring on aggressive behaviors.
• Hospitalization.
• Change in caregiver(s).
• Not liking/caring for a caregiver.
• An inability to do simple tasks for themselves.
• Decisions being made for them without their input when possible can trigger anger.
• An unrealistic belief that someone is trying to harm them.

Treatment

• First step is a thorough physical examination by your family doctor.  It is generally the progression of Alzheimer’s that is causing the aggressive outburst but a physical exam can rule out or confirm secondary conditions that may be influencing the aggression.
• Medications – Antidepressants, Anxiolytics, Antipsychotics.  Please understand that no drug has been found by the FDA to treat behavioral issues in dementia patients.  That is why it is imperative to work with your family doctor should medication become necessary.
• Behavior management techniques – The Alzheimer’s patient is dealing with an incredible level of stress, realized or not.

Our loved one’s stress can be managed by lessening environmental stress and modifying their routines and adjusting our approaches to those routines. Behaviors are triggered and can be lessened or eliminated by knowing the trigger(s) and avoiding it(them).

Make sure that the Alzheimer’s patients environment is stress-free. Our loved one’s physical environment needs to be easy and functional so as not to add unneeded confusion.  Their physical mobility provides them with a level of comfort and independence.

We need to validate their emotions, their confusion and inability to remember simple things, without being argumentative or deeming toward them.

Behavioral response to aggressive behaviors need to take into consideration if those aggressive behaviors are harmful to the person with dementia or to others. If the behaviors don’t directly affect our loved one or anyone else, then we do not need to respond to them.  However, if these aggressive behaviors impact the well-being of our loved one or someone else then we will need to deal with it.

• Relaxation periods or quiet environment periods.
• Recognize what causes the upset.  Is the aggression occurring at the same time of day, during similar events, with the same people
• Listening to their favorite music can help.
• Physical exercise can help to reduce the feelings of stress and anxiety

Remember that this aggressive stage of Alzheimer’s will pass.  The disease will continue but the aggressive stage will subside.  As a caregiver, you need to take care of yourself during the duration of this disease.  Seek out support from Alzheimer’s support groups friends and relatives.

Sources:

http://www.alz.org/care/alzheimers-dementia-aggression-anger.asp

https://www.google.com/search?q=aggression+in+alzheimer+patients&oq=aggression+in+alzheimer+patients&aqs=chrome..69i57j0l4.18770j0j4&sourceid=chrome&ie=UTF-8

https://www.alzheimers.org.uk/info/20064/symptoms/92/aggression/5

http://www.caregiverslibrary.org/caregivers-resources/grp-diseases/hsgrp-alzheimers-disease/dealing-with-aggressive-behavior-article.aspx

Alzheimer’s Association Statement Regarding Treatment of Behavioral and Psychiatric Symptoms