May is Mental Health Month and I want to talk about the very difficult and emotive issue of dangerous behavior in people with Alzheimer's. Over the years many people have asked our advice about some aggressive or violent behavior a loved one is exhibiting, and what they should do about it.

Violent incidents or threats of violence occur for a number of reasons. As Alzheimer's disease progressively causes more and more brain damage and neuron cell death, it can lead to behavior totally out of character for that person. Alzheimer's is associated with impairments of judgement and this can result in the person affected being unable to work out the consequences of their acts. Alzheimer's disease also reduces the person's capacity to reason and they are unable to appreciate how their behavior affects others.

A number of studies have found that the presence of anosognosia, a lack of awareness or denial of a neurological defect or illness, is associated with a significant increase in the risk of dangerous behaviors. This can lead to threats and acts of violence because of misinterpretation of events, paranoid delusions, inappropriate reactions to individuals and to caregiving procedures such as dressing, washing, having a shower.

Caregiver perception of danger varies

To complicate the issue, the way in which we as caregivers, perceive dangerous behavior in someone with Alzheimer's does vary. The overt, very obviously dangerous situations are the same for us all, for instance, being violently assaulted, threatened with a gun caregivers, being driven by someone with Alzheimer's at dangerous speeds.

Some caregivers find being shouted at or pushed aside less worrying than others and this alone can have a major impact on care planning and placement. It can sometimes be the case that neither aggression nor violence is the problem, but agitation or anxiety is. This can lead to situations of grabbing and pulling where the caregiver is left bruised and upset. Given the fact that many caregivers are themselves frail and elderly, the situation may be quite dangerous for them. This isn't always the case and sometimes the ability to cope is more due to perception and past experience. For example:

The perceived (real or otherwise) threat to personal wellbeing.

Body size
Mobility

Gender

Previous experience, perhaps through jobs, sporting activities, socialization, and life experiences 
Confidence

Physical, social and emotional support

Preventing Escalation, Responding to Danger

We all want to make decisions that are in our loved one's best interests. It is sometimes a balancing act involving human rights and maintaining individualism under the banner of ‘doing good/doing no harm.' But when harmful or dangerous behavior is involved your primary consideration must be safety. You must get help, so my strong advice is not to deal with this alone.

The following agencies may be able to assist or advise: