Changes in the behaviour of people living with dementia are sadly very common. This can include verbal abuse, verbal threats, hitting out, damaging property or physical violence towards someone else, often those closest to them such as a carer or loved one.
What causes these changes in behaviour?
Every person with dementia reacts to circumstances in their own way.
Sometimes the behaviour may be related to changes taking place in the brain. In other instances, there may be events triggering the behaviour.
Understanding the aggression
Try to understand why your parent or relative is behaving in a particular way because if you can determine the trigger, it may be easier to work out ways to prevent it happening again, or at least you may be better able to manage it. There are lots of causes to consider, which include:
- Fatigue and poor sleep
- Physical discomfort such as pain, fever, illness or constipation
- Loss of control over behaviours due to the physical changes in the brain
- Adverse side effects of medication
- Impaired vision or hearing causing the person to misinterpret sight and sounds
A person with dementia may feel humiliated because they are forced to accept help with intimate functions such as bathing.
They may feel their independence and privacy are being threatened.
Sense of failure
Because they are no longer able to cope with everyday demands a person with dementia may feel increasingly frustrated.
No longer understanding what is going on may lead to bewilderment, or the person may become distressed by an awareness of their declining abilities.
The person with dementia may become frightened because they no longer recognise certain places or people.
They may seek places that were familiar to them at an earlier time in their life or may be recalling an earlier life experience that is frightening or uncomfortable to remember.
Need for attention
A person with dementia may be trying to let someone know that they are bored, distressed, have an excess of energy or feel ill.
6 Tips for managing aggressive behavior in people with Dementia
1. Things they love
There are practical things you can do to manage aggressive behaviour and ward it off. If your parent enjoys music for example, then hearing their favourite music on in the background may help. ‘Singing for the brain’ is often cited as great therapy, and there are increasing numbers of singing groups they could perhaps join; or you could try music therapy.
2. Getting enough sleep
3. Keeping calm
Create a calm environment. This could include soft blankets or cushions and familiar photos or pictures that they find comforting. Soft music or nature sounds, and fragrances such as lavender, can also help.
4. Keeping active
Help your parent to try and keep physically active. This can help reduce agitation and aggression, as well as improve their sleep.
It can help to use up spare energy and act as a distraction. It also provides opportunities for social interaction with others and can provide you with a break.
5. Signs of pain or discomfort
These are often linked to aggression in people with dementia. However, they are often not recognised, even in formal care settings like care homes.
Signs to look out for include scratching or rubbing themselves; crying, holding their heads and curling up. You should talk to the doctor or medical team if you are concerned.
6. Therapies that may help
- stimulating the senses – for example, with hand massage, aromatherapy or familiar, repetitive actions such as folding clothes or sorting buttons
- animal-assisted therapy – who doesn’t love to have a cuddle with a dog or a cat;
- doll or toy therapy
- arts therapy – including dance, drama, singing, drawing or painting
- light therapy or bright light therapy – this involves a person sitting in front of a light box for a set amount of time each day
- cognitive stimulation – this involves activities and exercises that are designed to improve memory and communication skills. Activities are based on day-to-day interests, reminiscence and information relating to the current time and place
Preventable measures may not always work. Do not blame yourself if the person still becomes aggressive. Concentrate on handling the situation as calmly and effectively as possible.
When aggressive dementia behaviours occur:
- Stay calm. Speak in a calm, reassuring voice
- Address the underlying feeling if possible
- A simple suggestion such as having a drink together, going for a walk or looking at a magazine together may help. Distraction and avoidance are often the most useful approaches
- If you feel unsafe, stand out of reach. Closing in or trying to restrain the person, unless absolutely necessary, can make matters worse. You may need to leave them until they have calmed down
- If you have developed some strategies for managing aggressive behaviours try to make sure that they are used by any other people who are also caring for the person with dementia.
Aggressive behaviours can be very difficult for families and carers. The behaviours are symptoms of dementia and are not meant to deliberately upset you. Remember to look after yourself and take regular breaks from caring.
And, probably most important of all - looking after yourself
- Try to remain calm
- If you do become frustrated or lose your temper, don’t feel guilty. But do regard it as a sign that you need some extra support. Talk it over with your doctor, a friend or a counsellor
- Prepare a safe haven for yourself if aggressive behaviour is a problem. This can be a room which locks from the inside, preferably with a phone
- It is not always easy to forget these incidents. They may leave you feeling quite shaky
- Take regular breaks from caring.