Menu

Alzheimer’s Aggression: What You Can Do

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on November 17, 2020

Sometimes, people with Alzheimer’s disease lash out for no clear reason. They may get upset or angry easily. They may curse, hurl insults, or scream. They might even throw things or resist caregivers by pushing and hitting. This kind of aggression usually starts when people get to the later stages of the disease.

No one knows for sure why it happens. Aggression may be a symptom of Alzheimer’s disease itself. It could also be a reaction when a person feels confused or frustrated.

If your loved one becomes aggressive, it’s important to remember that they aren’t doing it on purpose. There are also things you can do to make them feel better and keep outbursts from happening.

Understand the Triggers

Alzheimer’s aggression can flare up without warning. There may not be an obvious cause. But many times, there are triggers you can spot before or during a problem. Common ones include:

  • Discomfort from lack of sleep, side effects from medication, or pain that they can’t describe
  • The environment around them, including loud noises, too much activity, or clutter
  • Confusion from being asked too many questions at once, trying to understand complex instructions, or feeling the stress of caregivers
  • Being touched or feeling like their personal space was invaded, as with bathing or changing clothes
  • Noticing your anger or frustration
  • Being criticized or told they were wrong
  • Feeling rushed
  • Not being allowed to do something or go somewhere
  • Having to do something they didn’t want to do
  • Feeling threatened
  • Confusion about what was happening
  • Thinking 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? For example:

  • 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 the way their body feels be to blame?

  • 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?

 

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.

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."

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.

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.
  • Use brighter lighting indoors, especially at night.

 

What To Do if You Think They Might Hurt Someone

Here are some things you can do 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. Ask someone nearby, like a neighbor, to be ready to help if needed.

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.

Tips to Ease Alzheimer’s Aggression

Once you understand the triggers for Alzheimer’s aggression, you can take steps to prevent it. A few things to try:

  1. Think ahead of time if a situation might make your loved one uncomfortable, overstimulated, or confused.
  2. Don’t ask too many questions at once, give instructions that are too complex, or criticize. That way, you’re less likely to confuse and upset the person you are caring for.
  3. Limit the amount of loud noises, activity, and clutter around them.
  4. Don’t argue. People with Alzheimer’s disease see a different reality than you do. Rather than challenge them about it, sit and listen. Ask questions about it.
  5. Focus on the past. Alzheimer’s affects short-term memory, so it’s often easier and less stressful for someone to recall and talk about distant memories than what they watched on TV the night before.
  6. Use memory cues. As the disease gets worse, remembering when and how to do everyday tasks like brushing teeth or getting dressed gets harder. Reminder notes around the house can help prevent frustration.

Take Care of Yourself, Too

It’s not easy to care for a person with Alzheimer’s disease, especially when they lash out at you. It’s completely normal to feel overwhelmed, isolated, or sad.

If you are a caregiver, do yourself and the person you care for a favor. Let someone know if you start to feel depressed, anxious, exhausted, or irritable. If you take good care of yourself, you can take better care of others.

WebMD Medical Reference

Sources

SOURCES:

Alzheimer’s Research Foundation.

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

The Journal of Clinical Psychiatry: “Causes of aggressive behavior in patients with dementia,” “Agitation as a possible expression of generalized anxiety disorder in demented elderly patients: toward a treatment approach.”

Mace, N., and Rabins, P. The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss, Johns Hopkins University Press, 2012.

Journal of Gerontological Nursing: “Assaultive behavior in Alzheimer's disease: identifying immediate antecedents during bathing,” “The serial trial intervention: an innovative approach to meeting needs of individuals with dementia.”

The Gerontologist: “Relatives of the impaired elderly: correlates of feelings of burden,” “Identifying pleasant activities for Alzheimer’s disease patients: the pleasant events schedule-AD,” “Modeling causes of aggressive behavior in patients with dementia.”

Journal of the American Geriatrics Society: “Agitated behavior as a prodromal symptom of physical illness: a case of influenza,” “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,” “Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument,” “Predictive value of nonspecific symptoms for acute illness in nursing home residents.”

American Journal of Alzheimer's Disease and Other Dementias: “Managing pain to prevent aggression in people with dementia: a nonpharmacologic intervention.”

Geriatric Nursing: “A pilot study of the relationship between discomfort and agitation in patients with dementia.”

Geriatrics & Gerontology International:Aggressive behavior in patients with dementia: correlates and management.”

American Journal of Geriatric Psychiatry: “Nonpharmacologic interventions for inappropriate behaviors in dementia: A review, summary, and critique,” “Psychosis of Alzheimer’s disease and related dementias. Diagnostic criteria for a distinct syndrome.”

Current Treatment Options in Neurology: “Nonpharmacological management of behavioral problems in dementia: the TREA model.”

International Journal of Geriatric Psychiatry: “Longitudinal predictors of non-aggressive agitated behaviors in the elderly,” “Current awareness in geriatric psychiatry.”

Primary Care Companion to the Journal of Clinical Psychiatry: “Recognition and management of behavioral disturbances in dementia.”

Geriatrics: “Nonspecific and atypical presentation of disease in the older patient,” “Preventing aggression in persons with dementia.”

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

Journal of Psychosomatic Research: “Delirium phenomenology: what can we learn from the symptoms of delirium?”

Hadjistavropoulos, T., and Hadjistavropoulos, H. Pain Management for Older Adults: A Self-Help Guide, IASP Press.

Clinical Nurse Specialist: “The effects of language used by caregivers on agitation in residents with dementia.”

Ontario health Technology Assessment Series: “Health Quality Ontario (2008). Caregiver- and patient-directed interventions for dementia: an evidence-based analysis.”

Alzheimer’s Disease and Associated Disorder: “Undiagnosed illness and neuropsychiatric behaviors in community residing older adults with dementia.”

Pain Management Nursing: “The assessment of discomfort in dementia protocol.”

American Journal of Psychiatry: “Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia.”

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

American Family Physician: “A practical guide to caring for caregivers.”

Journal of Emergency Nursing: “The older adult in the emergency department: aging and atypical illness presentation.”

© 2020 WebMD, LLC. All rights reserved.
Click to view privacy policy and trust info