Let’s be clear: physically aggressive behavior arises in a sizable minority of dementia patients — a German study of nursing home patients published last year put the proportion at nearly 29 percent — but those most endangered are the people with dementia themselves and their caregivers.

But violent behavior presents a particularly knotty problem for families. They know their loved ones with dementia generally don’t intend to cause harm. Yet when confused, fearful, angry or in pain, they may kick, hit, bite, throw or shove.

A Montana woman named June recently told me that her husband, diagnosed with Alzheimer’s three years ago, was becoming more irritable and resistant — and sleeping with a loaded gun. At his doctor’s insistence, she and her sons removed his three firearms from the house, a blow to a longtime hunter. Yet Joe still carries a canister of pepper spray in his pocket when he leaves the house.

Aggressive behavior and fears that a person will harm himself or others are among the most common reasons caregivers consider placing a family member in an institution, an Alzheimer’s Foundation of America survey found last year. But facilities, concerned about safety for their staff and other residents, aren’t always willing to take on that challenge, either.

Read more in the New York Times.