One of the biggest challenges for people taking care of elderly parents with Alzheimer's or dementia is dealing with outbursts of agitation and aggression. There are so many complex pieces of the puzzle in regard to anticipating the outburst, handling their behavior in a public place and so on.

Techniques for managing AD aggression such as re-directing their attention or medication can certainly help, but Cindy Steele, an RN and Nurse Scholar for Copper Ridge, a residential care community located in Utah, says the key 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," says Steele. "Why do they seem to get upset? What causes it?"

Steele focuses on behavior management for Alzheimer's and dementia patients and she says agitation and aggression are typically caused by one or more of the following five factors.

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  1. Cognitive Impairment
    Sometimes caregivers overestimate what their parent with condition 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 their loved one's capabilities. And remember that you are dealing with a degenerative disease. A loved one's abilities will continue to decline over time, which means your expectations and approached must be shifted continually.
  2. Psychological Disorders
    Steele says that around 40% of people with with this condition develop depression due to a neuro-chemical 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 proven to help tremendously with emotional and behavioral symptoms.
  3. Physical Problems
    Outbursts might be associated with physical problems as well. The person you are caring for might have a headache, a rash, constipation or fatigue. This means caregivers must be vigilant about monitoring their loved one's physical well-being and observing even subtle changes. When these patients experience physical problems, they may be unable to communicate this to their caregiver. or even a physician. They communicate this discomfort in the only way they can—with an outburst or temper tantrum.
  4. Environment
    The person 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 of 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.
  5. Approach
    Individuals with the disease react and respond to how a caregiver approaches 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 them 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 or bark orders at them. Simply ask them. Keep instructions or helpful hints easy to understand and provide them one at a time to help them process and act on them. Try to keep your body language positive and use calming gestures and a gentle touch.

Getting to the root cause of outbursts will help caregivers manage behavior more effectively and may lessen the frequency of agitation and aggression.

The advantage a family member has 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, having open and honest conversations with other family members as and health care providers can be of great assistance. Support groups can offer an outlet as well as new information on this condition and creative ideas on how to deal with common behaviors and situations.