Aggression in Alzheimer's Disease

by Christine Kennard Health Professional

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.

A recent posting from the Alzheimer's Foundation of America gives many helpful words of advice about communication with 'problem behaviors'.

"There are helpful techniques you can utilize to communicate effectively with someone diagnosed with Alzheimer's disease. Try and stay calm, while also providing reassurance and support at all times. It is important the person understand you are not upset and you are there to help. You can also utilize distraction in order to allow the individual with Alzheimer's disease to focus on something less upsetting. You must be creative while remaining in a positive mood. Distraction works in combination with redirection, which allows the person to focus on some other activity or discussion. Activities work better because they really engage the person's focus and attention. If an individual is upset about taking a shower, redirect him or her to getting a drink or watching a TV and then possibly try the shower again at a later time".

It is also important that all distractions, such as loud noises or potentially frightening shadows or movements, are reduced as much as possible.

For more about this posting, check it out in the 'questions and answers' section.

Make the Environment Safe

Remove objects that can be used as weapons for self harm, or to harm others, if that is appropriate. Do not clutter his or her room if pushing is a problem. Make sure you have a clear exit if things get tough. To diffuse the situation or in extreme case, to keep yourself safe it is sometimes best to leave the area. Call 911 if need be.

Medications Can Help with Aggression

Tranquilizing medications and mood stabilizing medications can be used for symptoms such as severe agitation and anxiety, violence, hostility, psychotic delusions, uncooperative, hostile or suspicious/paranoid behavior. The aims of tranquilizer treatment is to reduce or relieve symptoms but not impair consciousness.

Here is some more information about medications that can help.

Get Help from Healthcare Professionals

Research from the US Government Occupational Safety and Health Office in 2002, identifies care with the aged as one of the most dangerous worksites, and with the highest rates of work injuries. In other words aggression has to be taken seriously.

If you find you are unable to cope or just need some help and advice call your doctor or local social services. If aggression leads to violence you must get help.

More Information

The ABC's of Managing Challenging Behavior in Alzheimer's Disease

Coping with Disinhibited and Inappropriate Sexual Behavior

Treatments and Drugs for Alzheimer's disease

Christine Kennard
Meet Our Writer
Christine Kennard

Christine Kennard wrote about Alzheimer's for HealthCentral. She has many years of experience in private and public sector nursing care homes for people with dementia. She has worked in a variety of hospital, public and private health settings and specialized in community nursing. Christine is qualified in group analytic psychotherapy, is registered in general and mental health nursing and has a Masters degree.