Aggression in Alzheimer's Disease

One of the most difficult, distressing and frightening situations for home caregivers or staff in care facilities, is aggression from someone who has Alzheimer's disease. As a nurse, both in psychiatry and general nursing, I was only hit a few times, but in every case it was by someone who had dementia. Aggression such as shouting, raising a hand to someone, pushing, biting and hitting, is not uncommon amongst people with Alzheimer's. It can happen suddenly and without warning, at other times there is a clear build-up of emotion and disturbance prior to the outburst.

In this Sharepost I have put together some information about aggression and Alzheimer's and I suggest some strategies to help you cope.

Why Does Aggression Occur?

Alzheimer's disease reduces the person's capacity to reason, to plan and to carry out that plan. People with Alzheimer's, especially in the middle and late stages of the disease , are unable to appreciate how their behavior affects others. Their judgment is impaired and they are unable to judge the consequences of their behavior. You have to remember that serious brain damage has resulted from the destruction of brain tissue. This loss of tissue and connectivity has a devastating effect and affects both personality and behavior. Here you can check out more information about the Alzheimer's brain.

Understanding Aggression

As Alzheimer's disease progresses, the skills about how to react or respond to situations or events, become increasingly disorganized or inappropriate. The person may misperceive their surroundings and attempt a course of behavior which they believe is appropriate. Sometimes this is an aggressive act. Sometimes there may seem to be definite reasons for aggression, at other times not. Sometimes the event is simply the result of the disease process.

It can however be useful to note down when aggression occurs. Patterns can sometimes be distinguished that are not always obvious without a record. A record can also help to forewarn other caregivers of potentially problematic issues and can more clearly focus treatment interventions. I used simple ABC charts to assess, ‘A' the lead up or location of the aggression, ‘B' a description of the actual behavior and ‘C' what happened after the aggression.

For example, during lunch Joe shouted and threw his plate across the table. As a consequence he upset others at the table so was moved away. We wondered whether it was the content of the meal, or whether Joe preferred his own company? But he threw his plate even when by himself. Joe was passed the point of communicating with us in the normal fashion, but some days no plate throwing occurred. It took some time but eventually we narrowed the cause of plate-throwing to gravy. Once gravy was withheld, the throwing stopped.

Here is some more information about ABC.

Tips on Coping with Aggression

Communication is key for coping with aggression and so is your approach. If something does not work, try something else. Flexibility is important. It is also true that as you find ways of diffusing aggression you become more confident and situations can be less frightening.