coping with emotional changes

Understanding Aggression in Alzheimer’s

Christine Kennard Health Pro February 12, 2014
  • Some people with Alzheimer’s can exhibit aggressive and sometimes violent behavior. Understanding what may be happening to someone with the disease helps us cope better. We can plan strategies to help defuse situations and seek help from appropriate doctors and agencies .

     

    So, why do people with Alzheimer's sometimes become aggressive? Alzheimer’s is a degenerative disease that causes increasing amounts of damage in the brain. It kills off brain cells so the normal connections between brain cells and areas of the brain do not function properly. Because of this damage caregivers see dramatic and sometimes unexpected changes in behavior.

     

    Behavior does not occur in isolation and all of us interact with the people and events in our environment. For people with Alzheimer's disease it is no different. Professionals who study normal behavior know that we cannot always predict or understand people's motives. When there is brain damage and impairment the picture becomes even less clear. Brain damage is sometimes interwoven with the individual's personality prior to the disease, their old styles of coping, old habits then expressed in more immediate, simple and sometimes unsophisticated behaviors. So it is not straight forward.

     

    Alzheimer's disease reduces the person's capacity to reason so they are less able to appreciate how their behavior affects others. They have less control than before.

     

    To complicate the picture further the way we might perceive aggression and violence varies. This is important for health professionals who are assessing patients with a view to offering appropriate treatments. Some caregivers find being shouted at or pushed aside less worrying than others. It can sometimes be the case that neither aggression nor violence is the problem, but agitation or anxiety is.

     

    Our perception of their aggression is often linked to our feelings of confidence in our ability to deal with it. Past experiences, or lack of it, our own health (many caregivers are themselves frail and elderly) our body size and strength all contribute to our sense of being able to cope.

     

    Knowing this how will it help us deal with aggression from someone with mid to late stage Alzheimer’s? Alzheimer’s causes significant brain damage so the affected person will have problems with abstract thinking. Moreover, their capacity to reason, their memory loss and their judgement is also impaired. This means the way you defuse aggression or a potentially violent situation has to be different.

    • Try to stay calm
    • Talk in a calming way, do not raise the tone of your voice unless you need to briefly and stridently tell them to “stop” (shouting, banging, kicking etc)
    • Provide reassurance. Use brief sentences to tell them you will help, that it is OK, that they should not be frightened. Use whatever brief assurance you feel they respond to best. Touch can be soothing but sometimes it can be misinterpreted.
    • Many people respond very well if you can distract them or redirect them. For instance “Look at that bird. It is like the one we saw at the zoo” or maybe offer a chocolate, ask them if they want to sit down, go for a walk, make a sandwich, etc.
    • Offering an activity works well. You may have to wait until the initial burst of anger, anxiety subsides. An activity will occupy them and focus their attention away from what may have been bothering them.
    • Minimise distractions such as loud noises or potentially frightening shadows or movements. It makes the environment less confusing.

    These are general rules to help you cope with aggression. Seek urgent medical advice after any significant behavior changes in people with Alzheimer’s. Sometimes the causes of their aggression may be due to illnesses such as a urinary tract infection, or pain, or other ailments. The doctor can also advise you on treatment, any needs for medication or support services that may be available to help.  

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    You may also find this sharepost on apportioning blame for difficult behaviors in people with Alzheimer's helpful.