Alzheimer’s Disease and Aggression

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

Dealing with aggression can be frightening. It's normal to feel scared and angry when a loved one has an emotional outburst that feels threatening.

If you think they might hurt you, themselves, or someone else, you can do a few things to help keep everyone safe:

  • Keep dangerous things like guns, knives, glass, and sharp or heavy objects out of the house or locked away.
  • Try to distract them by going for a walk, having a snack, playing music they like, or asking them to help you with something.
  • If you can’t calm them, give them space.
  • Don't hold the person back unless you must to keep everyone safe. Holding them back could hurt you or them, and could make them angrier.
  • If you must hold them back, get help from someone else, if possible.

Once your loved one is calm, check for bruises or cuts, and treat them if needed.

If this happens often, it’s a good idea to ask a doctor or counselor for guidance or tips, or get support from others. Your local Area Agency on Aging or Alzheimer's Association chapter for caregiver groups might be able to help.

Find Emotional Triggers

To help prevent outbursts, you might think about what happened right before your loved one became aggressive and look for possible causes. Ask yourself the following questions:

Did they get aggressive during or soon after they:

  • Were touched or might have felt like their personal space was invaded, as with bathing or changing clothes
  • Noticed your anger or frustration
  • Were criticized or told they were wrong
  • Felt hurried or rushed
  • Felt threatened
  • Weren’t allowed to do something or go somewhere
  • Had to do something they didn’t want to do
  • Seemed confused about what was happening
  • Thought something was happening that wasn’t (for example, accused you of things that aren’t true, such as having an affair or stealing things)

Could their surroundings or changes in routine be the reason for the aggression?

  • Were they in a noisy room?
  • Were they with a lot of people they don’t know?
  • Could alcohol, caffeine, or drug use be part of the problem?
  • Was there a change in their normal routine?
  • Could they be reacting to your stress or emotions, such as frustration or anger in your face or voice?
  • Were their clothes uncomfortable?
  • Was the room dark?

Might they be sick, in pain, or depressed?

  • Are they showing signs of depression, such as sleeping more or less than usual, eating more or less than usual, and having little interest in normal activities?
  • Could they be in pain?
  • Might they feel ill?
  • Could they be cold, hungry, thirsty, tired, or in need of the bathroom?

Continued

Try Different Ways to Keep Your Loved One Calm

Once you have an idea of what might be behind the aggression, make a plan and see if it helps. If your first plan doesn’t work, try another one. You might need to try several things, and no one plan is likely to always work.

If nothing seems to help, talk to a doctor or counselor for advice.

Tips for aggression triggered by contact with you or other people:

  • Speak as softly and as calmly as you can, even if you feel frustrated, angry, or sad. If you need to and it's safe, step away for a few minutes and take some deep breaths.
  • Try to comfort your loved one instead of telling them they're wrong, even if what they're saying isn’t true.
  • Be as patient and as understanding as possible.
  • Don’t point out what they're doing wrong -- that can make things worse.
  • Be clear about what you'd like them to do instead of telling them what not to do. For example, say "Let's sit in this chair," instead of "Stay out of the kitchen."

Tips for aggression that happens during things like bathing, dressing, toileting, or eating:

  • Break the activity into simple steps and give one or two directions at a time.
  • Go slowly and don't rush them.
  • Explain what you're going to do before you do it, especially before you touch them.
  • Give them simple choices.

Tips for aggression triggered by their surroundings or routine:

  • Change the routine. For example, if they get upset when you go out in public in the evening, try to do those activities in the morning instead.
  • If they get upset when they aren’t allowed to go places, try hanging fabric or sheets to hide doors or posting a “Do Not Enter” sign.
  • Limit or avoid alcohol and caffeine.
  • Turn off noises like the radio or TV when you talk with them.
  • Stay away from noisy places such as loud restaurants.

If the person is in pain or an activity causes pain:

  • Give them acetaminophen or another pain medicine a health care provider has approved for them. Follow the label instructions closely.
  • If you use acetaminophen, don’t give them more 3,000 milligrams a day. If your loved one has liver disease, ask a doctor first.
  • If an activity like bathing causes pain, give the medicine 2 hours beforehand so it has time to work.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Neil Lava, MD on August 04, 2018

Sources

SOURCES:

American Journal of Geriatric Psychiatry: “Nonpharmacologic interventions for inappropriate behaviors in dementia: A review, summary, and critique.”

The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences: “Predictors of aggressive behaviors: a longitudinal study in senior day care centers.”

Primary Care Companion to the Journal of Clinical Psychiatry: “Recognition and Management of Behavioral Disturbances in Dementia.”

The Journal of the American Medical Association: “Nonpharmacologic management of behavioral symptoms in dementia.”

The Journal of Clinical Psychiatry: “Causes of aggressive behavior in patients with dementia.”

Mace, N., and Rabins, P. The36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss, Johns Hopkins University Press, 2012.

International Review of Psychiatry: “Motor subtypes of delirium: past, present and future.”

Gerontologist: “Modeling causes of aggressive behavior in patients with dementia.”

Journal of the American Geriatrics Society: “Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial.”

Journal of Gerontological Nursing: “Assaultive behavior in Alzheimer's disease: identifying immediate antecedents during bathing.”

The Gerontologist: “Relatives of the impaired elderly: correlates of feelings of burden.”

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