One of the biggest challenges for people taking care of elderly parents with Alzheimer’s disease (AD) or other types of dementia is dealing with outbursts of agitation and aggression.
Techniques for managing AD aggression, such as redirecting their attention or medication, can certainly help. However, Cindy Steele, RN, nurse scholar for Copper Ridge, a residential care community located in Utah, says the key to handling anger and aggression is finding out what is causing the outburst.
“Dismissing aggression as a normal behavior associated with Alzheimer’s doesn’t enable the caregiver to fix whatever is causing the outburst,” explains Steele. “Why do they seem to get upset? What causes it?”
Steele focuses on behavior management for Alzheimer’s and dementia patients and says agitation and aggression are typically caused by one or more of the following five factors.
Five Factors That Contribute to Alzheimer’s Aggression
Cognitive ImpairmentSometimes caregivers overestimate what their care recipient is capable of accomplishing. If the individual is asked to do a task and they are not able to complete it, they can get upset and frustrated, which results in an outburst. Caregivers must adjust their expectations to match their loved ones’ capabilities and remember the nature of the degenerative disease. A dementia patient’s abilities will continue to decline over time, which means your expectations and approach must be shifted continually.
Psychological DisordersSteele says that around 40 percent of people with with this condition develop depression due to a neurochemical imbalance in the brain. Anxiety disorders and delusions are also quite common. Once these imbalances are identified and diagnosed, medication can be prescribed that has been proven to help tremendously with emotional and behavioral symptoms of dementia.
Physical ProblemsOutbursts might be associated with physical problems as well. The person you are caring for might have a headache, feel fatigued or be experiencing something more serious like a urinary tract infection. This means caregivers must be vigilant about monitoring their loved ones’ physical well-being and observing even subtle changes in mood and behavior. When dementia patients experience physical problems, they may be unable to communicate them to their caregivers or even their physicians. They communicate this discomfort in the only way they can: with an outburst or temper tantrum.
Their EnvironmentA dementia patient may also be reacting to discomfort or even overstimulation that is related to their environment. For example, a room may be too cold, too noisy or too crowded. Their inability to process all this stimuli and/or clearly communicate their anxiety, confusion, fear or distress can easily build up and lead to an emotional breakdown or embarrassing fit.
Caregiver DemeanorDementia patients react and respond to the way their caregivers approach them. While they may not be capable of clearly expressing their needs and feelings, they can still pick up on your moods. Trying to rush them or force them to do something they cannot or do not want to do can result in understandable agitation.
How you speak to your care recipient is key, Steele says. Use a gentle tone of voice, but do not be condescending. Don’t rush them as they try to complete a task or communicate with you, even if they are moving at a frustratingly slow pace. Do not demand that they do something. Try to maintain a respectful tone by simply asking or suggesting. Keep instructions or helpful hints easy to understand and provide them one at a time to help guide the process. Try to keep your body language positive and use calming gestures and a gentle touch.
Tips for Managing Alzheimer’s Aggression
Getting to the root cause of outbursts can help caregivers manage dementia-related behaviors more effectively and may lessen the frequency of agitation and aggression.
The advantage family members have when they become caregivers for their aging parents is knowing their likes and dislikes. Things that annoyed or frustrated them in the past will most likely continue to do so. These known triggers are then complicated by new challenges caused by the progression of the disease.
Learning to redirect their attention and having open and honest conversations with other family members and health care providers can be of great assistance. Support groups can offer an outlet for frustrations as well as new information on this condition and creative ideas on how to deal with common behaviors and situations.
Most importantly, patience is key for everyone involved. Providing care for someone with dementia is hard work. When frustration mounts, look to the advice of experienced caregivers to help you cope: Dementia Caregiving Tips from Teepa Snow.