Use calming techniques to de-escalate aggressive dementia behavior
Some people with Alzheimer’s disease or dementia may enter a combative stage of dementia.
This is a normal part of the disease that’s caused by the damage that’s happening in their brain.
It can happen even if your older adult’s typical personality has been kind and non-violent throughout their lives.
Because they’re not able to clearly communicate their needs, people with dementia may lash out when they’re afraid, frustrated, angry, or in pain or discomfort.
These aggressive outbursts can be scary and difficult for caregivers to handle. Older adults could scream, curse, bite, grab, hit, kick, push, or throw things.
Since you’re feeling attacked, your instincts might prompt you to argue and fight back – but that only makes the situation worse.
We share 10 tips for dealing with aggressive behavior in dementia while it’s happening. We also explain 4 ways to learn from the situation to find ways to prevent or reduce future outbursts.
10 tips for dealing with aggressive behavior in dementia
1. Be prepared with realistic expectations
Reminding yourself that challenging behavior and aggressive outbursts are normal symptoms of dementia helps you respond in a calm and supportive way.
Knowing that these episodes are a common part of the disease reduces your shock and surprise when it does happen and may also make it a little easier to not take the behavior personally.
2. Try to identify the immediate cause or trigger
Think about what happened just before the aggressive outburst started. Something like fear, frustration, or pain might have triggered it.
For example, your older adult might start yelling at empty areas of the room and telling people to get out. Looking around, you might notice that the room is starting to get darker because it’s early evening. The dim light causes shadowing in the corners of the room, making it seem like there are people in the corner.
After identifying that potential trigger, turn on the lights to get rid of the shadowy corners. That will hopefully help you older adult calm down. And, in the future you’ll know to turn on the lights before the room gets too dim.
In another example, you could have unintentionally approached your older adult from behind and startled them. In a sensitive moment, that could make them feel attacked and so they lash out in what they perceive as self-defense.
3. Rule out pain as the cause of the behavior
Pain and physical discomfort can trigger aggressive behavior in someone with dementia.
Many older adults with dementia aren’t able to clearly communicate when something is bothering them. Instead, being in pain or discomfort could cause them to act out.
Check to see if they need pain medication for existing conditions like arthritis or gout, if their seat is comfortable, or if they need to use the toilet.
4. Use a gentle tone and reassuring touch
When your older adult gets upset, take a deep breath and stay as calm as possible. If you’re upset, that unintentionally continues escalating the tense emotions in the situation.
Staying calm and breathing slowly helps to reduce everyone’s anger and agitation. Speak slowly and keep your voice soft, reassuring, and positive.
If appropriate, use a gentle and calming touch on the arm or shoulder to provide comfort and reassurance.
5. Validate their feelings
If your older adult is being aggressive and there isn’t an obvious cause, it could be because they’re having strong negative feelings like frustration, sadness, or loneliness and don’t know how to properly express themselves.
Try to look for clues to their emotions in their behavior and speak in a calm and comforting way. Reassure them that it’s ok to feel that way and that you’re there to help.
6. Calm the environment
A noisy or busy environment could also trigger aggressive dementia behavior.
If your older adult starts behaving aggressively, take notice of the environment to see if you can quickly calm the room. Turn down music volume, turn off the TV, and ask other people to leave the room.
7. Play their favorite music
Music has an amazing effect on mood.
Sometimes, singing an old favorite song, humming a soothing tune, softly playing relaxing classical music, or playing their favorite sing-a-long tunes can quickly calm someone down.
8. Shift focus to a different activity
If the current or previous activity caused agitation or frustration, it could have provoked an aggressive response.
After giving your older adult a minute to vent their feelings, try to shift their attention to a different activity – something they typically enjoy.
9. Remove yourself from the room
In some cases, nothing works to calm the person.
If that happens, it may be best to leave the room to give them some space and to give yourself time to calm down and regain balance. They may be able to calm themselves or might even forget that they’re angry.
Before leaving, check to see that the environment is safe and that they’re not likely to hurt themselves while you’re gone.
10. Make sure you and your older adult are safe and call for help in emergencies
If your older adult can’t calm down and is becoming a danger to you or to themselves, you’ll need help from others.
If the situation isn’t extreme and there’s a nearby family member or friend that your older adult usually responds well to, call and ask them to come over to help immediately.
In an emergency, call 911 and emphasize to the operator that the person has dementia, which is causing them to act aggressively. This helps first responders know that the person isn’t behaving criminally and needs help to safely calm down.
When first responders arrive, make sure you again clearly state that this behavior is caused by dementia or even “a brain injury” (in case they’re not familiar with dementia). That knowledge helps first responders treat them more appropriately.
If your older adult needs to be removed from the home, ask that they be taken to a hospital or psychiatric institution rather than to a police station.
Assuming that you don’t want to press charges, make it very clear that this behavior is caused by dementia (or “mental illness” – might be easier to understand) and not criminal behavior. That helps avoid formal charges or unwanted court proceedings.
4 things to do after dealing with aggressive behavior in dementia
1. Learn from what happened
After giving yourself a chance to calm down and de-stress from the episode of aggressive dementia behavior, take a step back to see what you can learn from the situation.
Analyzing the situation also helps you take it a little less personally and makes it easier to think about what you could do differently next time to try to avoid an aggressive reaction.
Think about possible triggers, which responses helped calm things down, and which responses seemed to make the situation worse.
It often helps to take notes on your observations to see if you can spot patterns or figure out new ways to try to prevent a similar outburst in the future or cool things down if it does happen.
2. Find sources of support
It’s essential for your well-being to talk with people who understand and can help you cope with these tough situations and deal with the conflicting emotions.
Share your experiences with members of a caregiver support group, a counselor or therapist, or with supportive friends or family members.
Getting your feelings out is an important outlet for stress. Plus, you might get additional tips and ideas for managing aggressive dementia behavior from others who have dealt with it.
3. Consider medication
When non-drug techniques aren’t working and challenging behaviors become too much to safely handle, it might be time to work with their doctor to carefully experiment with behavioral medications.
When used appropriately, medication can curb dangerous aggression and improve quality of life for both your older adult and yourself.
4. Consider moving your older adult to a memory care community
If the aggressive behavior in dementia continues to be dangerous and no interventions are working, it may be time to consider moving them to a memory care community.
A specialized care community can be helpful because there are multiple staff members on duty at all times, there’s 24/7 supervision and care, and they’re trained to handle these types of difficult situations.
Next Step Get 7 ways to reduce and prepare for aggressive dementia behaviors
Recommended for you:
- Dementia and Anger: 9 Calming Strategies
- How to Understand and Manage Dementia Behaviors: A Comprehensive Guide
- 7 Ways to Reduce Aggressive Dementia Behaviors
By DailyCaring Editorial Team
Desperate to save
My mom is being abused by her dementia with violence husband. He turns it on and off when police or potential aid comes. He refuses any help she manages to get and is paranoid /delusional/persistantly hostile & increasingly violent. His family is non cooperative getting my mom in home help to manage him. He is non cooperative. Dementia runs in their family , but she lives in a very small town and no one does anything! We are worried for her safety daily! She is in another state and he is triggered by company when we manage to visit to help . My mom is an abused slave and has no personal time nor help. Please advise. I called elder abuse to no avail. What can we do to protect her ( and him?) he could injure her or worse …
DailyCaring
We’re so sorry to hear that this has been happening. Since he refuses any home care help (and sounds like he’s refusing medical care as well), it sounds like the only safe option is to get one of them out of the house – either move your mom out or move her husband into assisted living (memory care).
DrC
My mom is being abused by her dementia with violence husband. He turns it on and off when police or potential aid comes. He refuses any help she manages to get and is paranoid /delusional/persistantly hostile & increasingly violent. His family is non cooperative getting my mom in home help to manage him. He is non cooperative. Dementia runs in their family , but she lives in a very small town and no one does anything! We are worried for her safety daily! She is in another state and he is triggered by company when we manage to visit to help . My mom is an abused slave and has no personal time nor help. Please advise. I called elder abuse to no avail. What can we do to protect her ( and him?) he could injure her or worse …
CB
The problem is changing a parent’s diaper. I have identified the source of their angry reaction, but I still have to change the diaper multiple times a day. How do you deal with that, and make it less scary or less humiliating for them? Just pulling the pants down is aggravating enough, and I am trying to convince mom to start wearing long skirts, but then I would have to lift that long skirt, which is upsetting as well. Then the issue of cleaning or trimming nails comes up, which is never easy. Other than that, she functions well. It is just very hard for her to be handled for any issue related to cleanliness or diaper changing.
DailyCaring
It’s great that you’ve found the trigger for her reaction and behavior. It’s possible that your mom feels attacked or that her privacy is being invaded since these are personal care tasks.
These videos from leading dementia educator Teepa Snow might be helpful:
– https://www.youtube.com/watch?v=VDxBCb2-k1g
– https://www.youtube.com/watch?v=iKT9YIVPREE
We’ve also got an article that describes a situation similar to the one you’re describing. That video is no longer available, but the written explanations may still be helpful – How to Reduce Resistance to Care in Dementia: An Expert Demonstrates https://dailycaring.com/how-to-reduce-resistance-to-care-in-dementia-an-expert-demonstrates-video/
Anonymous
Excellent tips . . .…
Thank you for sharing .
DailyCaring
You’re welcome! So glad this article is helpful.
Anonymous
I have a dementia client who die speak clearly and today he told me to get out of his house. When it was time for me to leave his wife was trying to open the door (she has to keep it lock) she asked him to move so I could leave once I passed him he pushed me and told me to leave. This is my 2nd day on the job. What advice can you give me.
DailyCaring
When someone has dementia, they often won’t be able to accurately communicate their thoughts and often aren’t able to make good decisions so try not to take this client’s words too personally.
They may need more time to get used to having you around and may feel temporarily uncomfortable since you’re still a stranger to them. Give it some time, be patient and kind, and hopefully he will start to become more comfortable with you soon.
We’ve got plenty of tips on how to manage various dementia behaviors here – https://dailycaring.com/tag/challenging-dementia-behaviors/
Tammy
My husband and I have been married 40 years. He has ssd’s been an alcholic since I met him. He has been known to be physically and extremely ment as lly abusive. I have tried to commit suicide so many times I can’t remember. That was 18 years ago as nd God helped me and I never had a thought since. Lately he seems to drink less and act worse. He has high blood pressure and in the past week, I have had thoughts of suicide because he says the worst things to me, that hurts more than a beating. I can’t stay here much longer, IM on SSDA and get 680 a month. I have no place to go and need help .my health is bad at times and an abuse shelter wouldn’t work cause sometimes I have to be alone. I need a place with my own room. I have an old shitzue that I cant leave behind. Please help me.
DailyCaring
So sorry to hear about your situation. It’s essential that you keep yourself safe. Though it’s not the ideal solution, it may be best for you to go to a shelter so you can be safe while you figure out your next steps.
Natalie
Thanks for the great tips..been thrown in the deep end re aggressive behaviour from man with dementia
DailyCaring
So sorry to hear that you’re dealing with aggressive behavior. We hope these suggestions will help the situation.
James Baer
This is a response to your article on dealing with aggression in dementia. I have my wife (88) in a locked Memory Care unit (3 yrs) as she has suffered from AD for 12 years.
Perhaps the WORST part of a MCU is the other residents. All residents are negatively affected by the one who screams, fights or otherwise is difficult. A MCU may be good for the caregiver, but can be terrible for the patient, particularly if the Staff is poor and the facility treats patients as prisoners.
What’s the answer? Unfortunately I don’t know. My wife wanders and so must be confined. In any other situation, I’d keep her at home and use a homecare service.
DailyCaring
So sorry to hear that this is happening! When some residents are aggressive, it certainly creates an unpleasant situation for the other residents, especially when the staff aren’t able to handle the outbursts well. Unfortunately, there isn’t a great solution since it’s important for your wife to be in a place that’s able to keep her safe by preventing her from leaving.
Perhaps repeatedly speaking with the administration could help improve the situation. Or, you could report this to the local ombudsman’s office to see if they can provide assistance or advice. More info on that here — Nursing Home Complaints? The Ombudsman Is on Your Side https://dailycaring.com/nursing-home-complaints-the-ombudsman-is-on-your-side/
Diane Boysen
I can see when there are bathroom situations that the Alzheimer’s person gets combative. I will ask “Do you want help”? She will say “yes”. Then, she still ends up hitting me over the head or in the arm or in the stomach when I am trying to help her get her pajama bottoms up, etc., I don’t always remember to be “on guard” and that’s when I get hit. What can I do to help her NOT be combative?
DailyCaring
It’s possible that in these situations, she has agreed to your help, but then gets startled by your specific actions. This might not make sense to us because we fully understand and remember what we’re agreeing to when we say that someone can help us in the bathroom. This might not be the case when someone has dementia.
For example, she may understand that she does need help and agrees that you can help her. However, she might not realize that as part of that help, you’ll be pulling up her pants. She might perceive that action as invading her personal space and lash out instinctively to protect herself. Or, her dementia brain might even misinterpret the action and think that you’re trying to take her pants off.
To reduce combativeness, it may help if you move slowly while helping her and signal the personal actions before you do them. That way, she has a chance to see the specific action and know that it will be happening. Depending on how advanced her dementia is, she may be able to absorb information better if you minimize talking and focus more on non-verbal communication. When you do speak, keep your sentences as brief and simple as possible.
For example, before pulling up her pants, try pointing to her lowered pants so she will notice them. Then, make the motion on your own body of pulling up a pair of pants from the floor up to your waist and point to her pants. You could point to yourself and point to her pants to indicate that you’ll be helping with her pants. Hopefully this will help her understand what you intend to do so she won’t be startled and combative. You could also describe what you’re doing with words too, but keep the sentences very brief and specific so it will be easier for her to process and understand the information.
As you experiment with this style of extra-clear and partly non-verbal communication, you should be able to find out what works best to get her to accept your help without becoming startled and combative.
Anonymous
Always remember to ask the person for permission to come in. Never enter there space without there permission , that will tell you if they trust you. That space is usually around 3 feet around the person. Reach out for there hand see if they are willing to accept yours. Always maintain soft speech, slow movements, and keep them engaged. If anger escalates back off. Try another team member and you leave..
DailyCaring
Excellent tips! Thank you for sharing 💜