There are more than 4.5 million Americans diagnosed with Alzheimer's disease every year, and up to 50 percent of these individuals will suffer from one of the most challenging symptoms of this disease: aggression.
This is a side effect that family members and caregivers are not prepared for when they first receive an Alzheimer's diagnosis. It’s also one of the top reasons that families need to move their loved ones into a nursing home. Deciding to place a senior with aggressive Alzheimer's outbursts in a nursing home can be heart-wrenching, but when the situation becomes unmanageable, it’s the best course of action for both the senior and their family.
Why Do Seniors with Alzheimer’s Become Aggressive?
Symptoms of aggression are really the senior’s way of expressing their frustration or pain. Aggression can be caused by physical discomfort, environmental factors and poor communication. Because of the disease, the patient is unable to cope like most people and it usually occurs in an advanced stage. For example, the person may:
- Be in pain, depressed or stressed out
- Be tired or unable to sleep
- Have soiled underwear or diaper, or be constipated
- Experience a sudden change in a routine, subjected to a new person or unfamiliar place
- Have feelings of loss or missing their independence
- Experience too much noise
- Experience too much confusion or too many people around
- Be asked to do things they can no longer do--like bathing or remembering a person
- Feel lonely and not have enough contact with other people
- Experience medication interactions
Because people with Alzheimer's gradually lose the ability to communicate, it's critical to monitor their comfort and anticipate their needs. They might simply be tired, hungry, thirsty, cold or hot. It’s not uncommon for individuals with Alzheimer’s to have a urinary tract infection, particularly for women. They may also have uncorrected vision or hearing issues. If they’re on multiple medications, there could be unpleasant side effects. Seniors with dementia become frustrated when their basic needs go unmet and find that aggression is their only outlet.
Dementia can cause a senior to become easily confused and suspicious because of delusions or hallucinations. He or she may think that others are trying to harm him or her. In their mind, they are reacting appropriately to the situation.
Persons with Alzheimer’s are often overstimulated by loud noises, busy environment or even physical clutter. Be aware of situations where your loved one will be in a large crowd or just surrounded by unfamiliar people. Time of day can also be a factor. Mornings are typically best for scheduling appointments or activities.
Seniors with dementia may be confused by your instructions or unable to respond because you’re asking too many questions at once. They may also be picking up on your own irritability or feeling pressured to do something that feels too challenging. Being self-aware is important.
How To Prevent or Reduce Aggression in Persons with Alzheimer’s
The following coping methods can help lessen the chances of an aggressive episode or control aggressive outbursts when they do happen. Do not ignore their aggression.
When Alzheimer's patients are dealing with a fit of aggression, they don't want to be tricked or talked down to as if they were a child. Instead, use logic and reason to try to talk them through the situation. If you use logic to discuss what is going on, instead of reprimanding them for their behavior, Alzheimer's patients will typically be able to control their emotions and their impulses and calm down on their own.
Acknowledge Their Feelings
There will be times when Alzheimer's patients will feel so sad or frustrated that they simply need to have an outburst. Many times, dementia has caused so many changes to their brain that there is nothing they can do to control these outbursts. When a senior with Alzheimer's reacts in this way, acknowledge their feelings. Let them know it’s okay to feel this way and that you understand their feelings. The more you argue with them about why they are feeling a certain way, the more frustrated they will likely become.
Do not Ignore Aggression Reactions
While acknowledging a senior's feelings is a great idea, promoting poor behavior is not. While you can validate a person's feelings, and the reasons why they feel angry, you shouldn't make them feel as though aggression is acceptable. Do not give in to aggressive threats or behavior, it will only make the problem worse.
Look For Triggers
One of the best ways to prevent aggressive outbursts from happening is to learn what triggers them in the first place and do everything possible to avoid those triggers. For most individuals with Alzheimer's, aggressive outbursts don't just happen out of nowhere. They may react more adversely to certain situations than they would normally, but it doesn't mean that there isn't a reason for the outburst.
Some outbursts can be easy to avoid. If your loved one gets angry when the television is on during dinner, then don't turn the television on during dinner. Other triggers are more difficult to ignore. For example, they may have outbursts when it’s time to go to bed, perhaps because they don't like being left alone at night. While you can't avoid bedtime, you can start slowing down the process and completing it step by step. Go slow, talk them through the process, distract them as you head towards the bed and stay with them until they fall asleep. The more you can do to avoid upsetting them, the fewer issues there will be.
Stick to a Routine
One of the biggest triggers for aggression in Alzheimer's patients is uncertainty. When an individual with Alzheimer's doesn't know what is coming next, or faces surprises, they may react with aggression. Routines are great for Alzheimer's patients as they can help individuals with their memory. When they know what’s next in their routine, they’re less likely to get caught off guard and react poorly.
Use Signs and Labels
For many Alzheimer's patients, nothing is as frustrating as forgetting the name of something or where something is located. Help them out and prevent unnecessary outbursts by using labels and signs around the home. This includes signs on rooms, phone numbers next to the phone, labels on cupboards and name tags on visitors. The less seniors have to struggle to recall names and objects, the less frustrated they will get.
No one will handle aggressive outbursts perfectly every time that they happen. One of the best things that caregivers can do when these situations arise is to do their best. Afterward, think about your reaction and their behavior, while learning from mistakes. A great care provider will always look at how they handled an aggressive outburst and think "ok, what could I have done better?"
Consider Medication with Care
Medication is only appropriate if non-drug approaches fail after being applied consistently, and only for individuals with severe symptoms or who have the potential to harm themselves or others. The Alzheimer’s Association cautions, “When considering the use of medications, it is important to understand that no drugs are specifically approved by the U.S. Food and Drug Administration (FDA) to treat behavioral and psychiatric dementia symptoms.” Medications prescribed for behavioral issues are considered “off label,” a medical practice in which a physician may prescribe a drug for a different purpose than the ones for which it is approved. Therefore, the decision to use medications should only be made by a medical professional.
How to Protect a Senior with Aggression (and Yourself) from Harm
While your first instinct might be to restrain your loved one to keep them from harm, it’s not a good idea. You could frighten or anger them, making the situation worse. There is also the chance that one or both of you could be hurt. It’s best to stand out of range. If the situation becomes unmanageable, make sure you have a list of family and friends who you can call on short notice. Or, call 911, depending on the severity of the situation. If aggressive episodes have happened previously, remove any object that your loved one might use as a weapon.
How to Care for the Alzheimer’s Patient Caregiver
For the millions of senior adults living with Alzheimer's disease today, dealing with some of the devastating side effects of this disease can be truly overwhelming. For Alzheimer's patients and their families, understanding the signs and symptoms of this disease is one of the best ways to be ready to handle certain side effects when they occur.
It’s important to recognize that your role of caregiver does not include allowing yourself to be physically hurt. Aggression or violence can be frightening, exhausting, and create strong emotions within yourself. Remember that these problems are part of the disease and do not reflect on your skills as a caregiver. Reach out for support – whether that’s family, friend, healthcare provider, or a dementia-related support group. Talking with others can help you deal with your own emotions and discover new ways of helping your senior with Alzheimer’s successfully.