Caregivers to people with Alzheimer’s disease and other types of dementia often have the unsettling, frustrating challenge of trying to quiet an agitated and possibly aggressive elder who is unable to communicate the source of his or her distress. We know that the behavior is an expression of discomfort either of body or mind, yet we are left trying to comfort our loved ones with few clues as to the root problem. Even experienced clinicians are often baffled.

Pain is one common reason for aggression. When a person who can’t communicate or has lost the cognitive ability to pinpoint a source of pain and ask for help, what option is there? They will likely act out.

The National Institute on Aging suggests additional causes for the discomfort that can trigger agitation or aggression. Depression and stress lead the list, but too little rest, constipation, soiled underwear, a sudden change in routine or surroundings, too many people around, or being pushed by others to bathe or to remember things beyond their grasp can all cause this distressed behavior. Loneliness and interactions of medications are also possibilities.

Watch for patterns, get medical advice

• Be mindful of any patterns of behaviors relative to specific physical environments, times of day, medications administered and other routine occurrences than may provide insight into the cause of the person’s distress.

• Schedule and keep regular medical and dental health exams to proactively head off sources of physical discomfort, especially for those people who cannot articulate where pain may be coming from.

How to cope

• Try to calm the person early on by listening carefully to the person’s frustration if he or she can explain what the problem is. Do your best to understand even if the reason seems senseless to you. The last thing you want to do is brush off the worry or say “that’s silly” or some related putdown. You can say, "I'm sorry that you are upset" and assure him or her that you will stay with them and try to help.

• Provide reassurance by saying something like “we’re going to get to the bottom of this.” If fear is the issue, you can say, “You’re safe now. We’ll take care of you.”

• Modify the environment if possible by decreasing noise and confusion. This may involve taking the person to another room.  

• Try to distract the person by changing the subject and then redirect him or her to another activity like art, music or some routine task that helps the person feel useful. If this doesn’t work, don’t push it. Maybe you’re trying too hard to fix the problem.

• The person may be bored and need something to do so going for a walk or car ride could help.

• Humor can also be helpful to both the caregiver and care receiver.

The National Alzheimer’s Association suggests that the caregiver check his or her own behavior. These experts say you should not “…raise your voice, show alarm or offense, or corner, crowd, restrain, criticize, ignore or argue with the person. Take care not to make sudden movements out of the person's view.”