How do you manage aggressive and challenging dementia behaviors?

July 19, 2017

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One of the most difficult aspects of being a caregiver is having to cope with aggressive or other challenging behaviors that the person you care for exhibits. Other examples of challenging actions includes hallucinations, verbal abuse, anger, running away, taking clothes off, swearing, agitation, lack of appreciation. One of the secrets is that as a caregiver your response is a key on managing them and can influence the future reoccurrence.

The first thing to do is understand why these behaviors are occurring. The answer lies in 3 areas for people with dementia. People react in this way because of fear, confusion, and pain. They feel helpless or afraid and react to protect themselves. The first thing to do as a caregiver when these difficult behaviors erupt is take a step back and try to understand what is happening that is triggering them.

Dementia directly impacts the brain. It causes people to act in uninhibited, unfiltered ways. It directly impacts our ability to think, find words, or control feelings or what we do. It causes confusion. Take a moment and imagine what that would be like for you. It also tends to exacerbate the personality traits the person had prior to the onset of the dementia.  If you were a mean person before your diagnosis, those men traits may come out in a more intensified way as your condition worsens.

As caregivers we have to remember that people suffering from dementia still need to be respected. They want their wishes to be considered. They also want to feel they have some control over their environment. What may be surprising is sometimes they even regret these negative behaviors. They might not be able to express those feelings but it is important for caregivers to be aware they are there.

Caregivers can do some things to help manage these incidents when they occur:

  • Try to identify the cause of this behavior. Why are they reacting this way? What are they afraid of? What are they feeling? Try to make sense out of the reaction of a loved one.
  • Respond in a calm and comforting manner. Don’t argue. That will trigger more aggression. Don’t force the issue to prove you are right and they are wrong. Nobody will win that battle. Remember your body language. Smile and appear relaxed. Use direct eye contact. Be aware of the tone of your voice and the messages you are sending both conscious and unconscious.
  • Take a moment and imagine not knowing where you are. People often become combative and want to leave a place because they don’t recognize where they are. Try to gently redirect the confused person. Play a favorite song, go for a walk, take out a photo album. Use pictures or other concrete, tangible cues to help them focus and understand where they are at and why they are there. Keep your responses simple and direct. Say something to acknowledge their feelings like “I know it is confusing”, or “we can’t go now because it is very late or it is pouring rain” or whatever makes sense for you. Think about a response that will help them feel safe, cared for, and gets to the root of their fear.
  • Pay attention to patterns of behavior. Do these episodes occur at a particular time    regularly?  Some people experience sundowner syndrome where they get more confused as it gets dark.  Did something happen to trigger these episodes? What happened before they got agitated?
  • Look at the environment. Is there too much noise or stimulation? Is it too hot or too cold? Are there certain people that seem to upset the person receiving the care? Is being in a new place problematical and perhaps confusing?
  • Validate their feelings. Be understanding about what they are trying to communicate even if it is difficult to perceive. Try to collaborate rather than confront the person you are taking care of. If you overtly challenge what is being said or express doubt about it that can trigger an angry episode.
  • Become a master of distraction.  Try to use distraction as a technique to manage negative episodes and outbursts. Think about their favorite foods, hobby, music, photographs, clothing, or television show. Sometimes talking about people they like can ease the tension. Pay attention to what works and have it on stand by when a new outburst occurs.

 

This is very hard but also very important: Try to separate the person from the disease.

Dementia damages the brain and so people experiencing it are unable to control their thoughts, actions, feelings, and behavior as a result. Try not to personalize the negative interactions. Set boundaries for yourself and the person receiving care regarding physical safety. You cannot permit violent behavior that might potentially harm you or the person you are caring for. If this happens consult a physician about how to manage this issue. Take a time out for yourself if you need it. You must take care of yourself as a caregiver. That may be the most important tip of all.

Written by Iris Waichler
Iris Waichler, MSW, LCSW is the author of Role Reversal How to Take Care of Yourself and Your Aging Parents. Role Reversal is the winner of 5 major book awards. Ms. Waichler has been a medical social worker and patient advocate for 40 years. She has done freelance writing, counseling, and workshops on patient advocacy and healthcare related issues for 17 years. Find out more at her website http://iriswaichler.wpengine.com

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51 Comments

  1. With firm but calm assurances.

    Reply
  2. It’s hard to deal with it and when you have a group of 4 strong headed ladies like o do at my facility where I work it’s hard, and especially when one it very territorial and demanding it’s hard

    Reply
  3. I don’t deal with this particular problem but the same symptom in a different illness. For everyone’s sake, we medicate aggression. No one is comfortable with it, especially him. No one likes being in that state of mind. Mild prescriptions work wonders . Stress kills just as much as anything else. Lower that stress level any way you can. For everyone’s sake.
    This is why we need to legalize marijuana. Cuz that works too.

    Reply
  4. as a team leader of 5 caregivers, one is an lvn .. we have come to learn A LOT .
    i am blessed to have my dad at his home .. with 3 people on shift at all times.
    when dad gets agitated, angry, aggressive, etc.
    first, we needed to learn his “cues” .. and take his lead, so to speak.
    deflection usually works ..
    we have found that giving him some wash clothes and hand towels keep his head and hands busy .. it tends to calm him for a while ..
    there are certain words we do not use ..
    ex: the word “remember “ triggers him .. because, he can’t.
    people with dementia also have “craft” Can’t Remember A F-ing Thing ..
    how incredibly frustrating must that be.
    don’t ask them questions .. YOU learn their needs, wants and desires, etc.
    always be prepared and try to anticipate what might be coming at you next.
    try and be consistent in everything .. appearance, scent and tones of voice. body language too .. and if you can get a schedule down that’s helpful too.
    baby toys work too ..
    rattles, tethers, things with color.
    sometimes cartoons or watching something from their era or listening to music of their era ..
    this has worked really well too .. frequency music .. 528 hz and 432 hz worked great !!
    you can you tube it
    breathing, love, and major major patience ..
    i hope some of you find this helpful ..
    thanx for reading my effort ..

    Reply
    • thank you Michelle Shields McGraw if you would like to know more of what we have learned .. i would be glad to share and listen to what you’re experiences have been and what you have learned

      Reply
  5. There is no easy answer for this one. Sad.

    Reply
  6. There comes a time when a nursing home is a better alternative.

    Reply
  7. Distract, confuse, derail the conversation

    Reply
  8. I have sympathy but others have decided that distance and boundaries are what is best and that he needs to be “punished” for his behaviors, here’s a funny for you, that is from 2 family member with their master’s in psychology!! Unbelievable!!

    Reply
  9. I used distraction on my dad who suffered from dementia.

    When he was targeting me I would try to get him to focus on something else.

    For example I would ask him where is his shoes.

    So instead of being verbally and physically aggressive towards me he would start searching for his shoes which I of course hid.

    Reply
  10. Humor or activities. If they let you, a hug.

    Reply
  11. Very informative article. Thank you.

    Reply
  12. whenever my mom becomes belligerent, i leave her alone until she calms down, then i come
    back after a few minutes and she’s already ok

    Reply
  13. With lots of tears and alcohol (both mine)…

    Reply
  14. Drugs! The right medication in the right dosage in the right combination helps greatly!

    Reply
  15. It is also difficult when grandchildren see their grandparent or great-grandparent act in an aggressive way. Some become scared. Even adults may start locking their bedroom door at night. Some are afraid something will be thrown at them at any time.

    Reply
  16. Step away and take a sanity break

    Reply
  17. My uncle became nice and sweet. He wasn’t that way throughout his life.

    Reply
  18. Yep, I’d just put on my Alzheimer boots and walk around in that muck myself, trying to see/ feel what Graminator did. It’s a bizarre world, for sure. Somehow we both came out on the other side…sadly of course, her journey ended shortly after we had no choice but to place her in a care center. But we made it for 10 years, 24/7 with little or no outside help and lived to tell the tale. Oh, and wine helps, the caregivers, anyway.

    Reply
  19. With humor! Recently on a sitcom I heard someone describe her grandmothers brain as “being mushy. Like a hacky sack.”
    I hope I don’t sound cruel, but that helped me gain perspective. It also cracked me up!

    Reply
    • Humor kept both of us from killing each other! I SO agree, Angela!!

      Reply
  20. My husband is a sweet guy with a great sense of humor .. he was in a Re Hab after several hospital stays for infections and other problems ..
    6 months total )I visited every day and family would come in too
    We came into his room one evening and he was seeing people on his bed and in his room that weren’t there.. we told the nurse and she said it’s probably a UTI .. I said no he had those before and this is different .. I wanted the doctor to see him .. so this went on for two days .. the doctors assistant saw him and didn’t think it was anything to worry about. Probably a UTI and the culture had not come back yet ..
    I insisted something else was wrong ..
    Got a call early the next morning and they were taking hubby to the ER .. they had over dosed him on morphine and he flat lined .. they gave him Narcan in the ER and that was the worse 9 hours .. he survived but it took a long time to overcome that set back .. (yes we reported it to the state )
    He is home now ..
    he has CHF , Diabetes, COPD , high blood pressure, and had open heart surgery with new valve, stroke , toe amputation , and gall bladder and vascular surgery so since 2007 we have been up close with what goes on in hospitals and nursing homes .. being over medicated is one of the big problems I have seen ..
    when the state investigated there were several other patients that were getting too much medication

    Reply
  21. I tell my mother that the witches, wild animals or people who have died, will not hurt her, because we are with her and God will protect her. Medicine helps with this but only so much. The same with aggressive behavior, it takes the edge off but not always. We ask her to hug instead of hit. This helps somewhat…

    Reply
  22. I’m not dealing with dementia but my twenty year old autistic daughter can be aggressive. She has been hitting me when I try to sleep lately. My husband will make her go to her room, he sleeps on the couch to try to keep her away from the bedroom, then I lock the door with my son and I in the room. She will bang on the door sometimes. She is on meds, they help but I’m still burned out badly.

    Reply
  23. As a private caregiver, I try to stay calm and agree with everything they say. It’s a hard game to play. I had one client who loved me for over 7 months. We cooked, went on day trips and out to dinner. Then I took on more hours because another care giver was hit and she started to get mean. Really mean! She called me the other girls name and couldn’t get past it. Then she hit me and pushed me out the door screaming at me. Family didn’t even care, they are wealthy ( semi famous guys mother) they just kept on getting other caregivers. Sad! She needed different care and meds.

    Reply
  24. treat them as you would like to be treated in that situation! be in that persons shoes, is the best advice.

    Reply
  25. Went through same thing with father and every time it happened he had a uti…….

    Reply
  26. Medication. Sedation /anti psychotics / anti anxieties.
    No one should have to live like that. Or with that. Sleep is the best medicine. Help them get to sleep. Then get some sleep yourself.

    Reply
    • Look after yourself. It will do you in otherwise.

      Reply
    • We put Mom on Risperdal–it’s is an antipsychotic that works wonders for aggression and hallucinations. Saved us!

      Reply
  27. It’s the hallucinations that are doing us in. My mom wouldn’t go into her room for 8 hours yesterday because she always sees a man in there. No matter how many times we tell her he’s not really there and that he can’t hurt her and I wouldn’t let some strange man in my house that we live in with children. She won’t be consoled.

    Reply
    • My gran would see boys coming in the window, they would steal her stuff and hide keys in her bed (she was bedridden). I would go through all her blankets and show her no keys, etc. and close the window. For a decade after she died I would have nightmares I was locked in a home with frail elderly all coming after me. It’s hard for them, hard for us, just hard all around.

      Reply
    • Debbie Pumphrey Robertson have you looked into “therapeutic fibbing?” Sometimes (probably most of the time) instead of getting them lined up with reality, it works to validate their reality and make some adjustments. Say ” he was in here because he’s an electrician working on the wall outlet. But he left about 5 minutes ago.” Something like that.

      Reply
    • We have asked him to leave and told her he did but she sees him everyday starting in the afternoon and lasting until the night.

      Reply
    • I think her medication needs to be adjusted because obviously the disease is progressing but we are two weeks out from the dr.

      Reply
    • Debbie Pumphrey Robertson yeah. Classic sun downing symptom. Hardest part of the day. Med adjustment might do wonders. Will be praying for you and your mom

      Reply
    • Debbie Pumphrey Robertson – call the Dr.!
      My Mom also had medicine induced hallucinations. You don’t need to deal with it for 2 more weeks without trying to do something about it.

      Reply
    • My MIL sees children and men in her room and all throughout the house. Sometimes she says she cant lay down in her bed because those kids are laying in her bed. There are no kids!

      Reply
    • Yeah. It’s entering into their world and making adjustments. You have to learn how to adapt to purple, their world.

      Reply
    • You almost need to tell her you see that man and told him to leave. It’s like you have to immerse yourself in the crazy that is AlzWorld…

      Reply
  28. When this happened with my Gran, we were blessed that there were three of us caring for her. When it got too much for one person we could switch off. Saved my sanity many times

    Reply

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