Outbursts of anger, agitation, and aggression are one of the biggest challenges that dementia caregivers face. It can be frustrating when a loved one’s personality turns hostile. Cognitive decline may cause dementia patients to be more prone to yelling, making rude remarks, and even turning violent.
There are several techniques for managing dementia aggression, like redirection. However, Cindy Steele, RN, MPH, former nurse scholar for the Copper Ridge Institute in Sykesville, Md., says the key to handling anger and aggression is finding out what’s causing the outburst in the first place.
“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?”
Use this article as a guide to help manage dementia anger outbursts.
Why do dementia patients get angry?
Anger occurs in dementia patients due to changes in the brain. The diagnosis of Alzheimer’s disease as well as other dementias can make typical life stressors harder to deal with. The easygoing person you once knew may now react to things more severely than before.
Though your loved one may be more emotionally reactive, these reactions are often triggered by something significant, like illness, pain, or environmental factors. Learning about the causes of aggressive behavior in dementia can help caregivers prevent and cope with outbursts.
Dementia and anger at loved ones: How dementia patients express discomfort
In patients with dementia, anger may present in various ways. As a caregiver, you may often be on the receiving end of it. Dementia patients may express anger and discomfort in the following ways:
- Verbal abuse
- Sudden mood swings
- Emotional outbursts
- Physical abuse
Even though dementia anger is often directed toward caregivers, it doesn’t necessarily mean the caregiver is the root cause of the behavior. During a loved one’s outbursts, it’s important to remember not to take their behavior personally. The problem likely isn’t you, but the dementia.
Dementia and violence
In the later stages of dementia, anger may escalate to violence and aggression. Aggressive behaviors in people with dementia may include:
- Throwing things
- Resisting care by pushing or hitting
- Accidentally hurting themselves
If your loved one’s aggression has escalated into violence, it’s important to take immediate action to manage these behaviors for their safety and yours. A geriatrician should be able to rule out factors that might be contributing to a senior’s outbursts, and an in-home caregiver with training in dementia care can help manage their aggression on an ongoing basis. An objective third party may be able to identify causes of anger more easily.
In what stage of dementia is anger a symptom?
Dementia is often broken up into seven stages, and anger typically begins in the middle stages (five to six) as cognitive decline becomes more severe. However, the dementia “anger stage” doesn’t affect all patients, and it hasn’t been clinically proven to be worse in certain types of dementia.
Other behavioral changes may also accompany anger and aggression as the disease progresses. For example, depression, anxiety, irritability, and repetitive behaviors are also commonly seen in the middle stages.
Is anger an early sign of dementia?
No. Anger is not typically seen as an early sign of dementia in existing research studies. If your aging loved one is displaying signs of anger, it isn’t necessarily a sign of dementia. Anger can be attributed to many causes, including health issues, grief, feeling misunderstood, communication problems, and fear of changes that come with aging.
Six causes of aggressive dementia behavior
Many factors can trigger anger outbursts in people with dementia. According to Steele, these are some of the main causes of aggressive behavior in dementia:
In people with dementia, progressive brain cell damage results in memory loss, which may cause confusion. This confusion often leads to frustration and anger. As your loved one starts to notice their inability to recall recent events, complete certain tasks, make decisions, or process information, they may become angry. Redirecting their attention away from what’s triggering them and toward an activity they enjoy can be helpful during these times.
2. Psychological disorders
One study has found that around 30% to 40% of people with dementia develop depression due to chemical changes in the brain. Anxiety disorders and delusions are also quite common in dementia patients. Once these disorders are identified and diagnosed, a variety of behavioral and therapeutic treatments can help manage their symptoms.
3. Physical discomfort
If your loved one with dementia frequently experiences physical discomfort, they may have a tough time communicating it. This often results in an emotional outburst, because it might be the only way they can express themselves. Physical problems could include headaches, fatigue, urinary tract infections (UTI), and more. Figuring out what may be causing your loved one’s physical discomfort and treating that might help to prevent their anger and aggressive behavior.
4. Environmental factors
A dementia patient may also react to discomfort or overstimulation related to their surroundings. For example, a room may be too cold, noisy, cluttered, or crowded. Your loved one with dementia may be unable to process all these stimuli or clearly communicate their anxiety, confusion, fear, or distress. These feelings can easily build up and lead to an emotional breakdown. For someone with dementia, a calm, controlled environment is key to their well-being.
Bad timing could also play a role in your loved one’s agitation. People with dementia commonly experience sundown syndrome — a term used to describe a group of symptoms that occur during the transition from daylight to darkness. If your loved one gets frustrated and overwhelmed in the evenings, sundown syndrome may be the culprit. There are a variety of clever treatments for “sundowning.” If sundown syndrome becomes difficult to manage at home, a professional caregiver who is trained in dementia care may be able to help.
6. Poor communication
How you speak to a senior with dementia is key, Steele says. While your loved one 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 can’t or don’t want to do can result in understandable agitation.
How to manage dementia anger and aggression
Getting to the root cause of outbursts can help caregivers manage anger and aggressive dementia behaviors more effectively and may lessen their frequency.
Here are some tips to help you address dementia-related anger and aggression:
- Be intentional about your tone and body language. Be patient and use a tender voice, but don’t be condescending. Don’t demand them to do anything, but kindly ask or suggest. Use calming gestures and a gentle touch.
- Know their triggers. As a family member, you likely have a good understanding of your loved one’s likes and dislikes. Use this information to help you avoid situations that have previously triggered outbursts or frustration.
- Adjust your expectations. As dementia progresses, your loved one’s abilities will likely decline. Continually adjust your expectations and care approach to match their changing needs and capabilities.
- Use therapies or medications. Depending on the stage of your loved one’s dementia and their mental and physical health, it may be useful to try various behavioral therapies or medicines. Talk to their doctor about suitable options for managing their symptoms.
- Monitor their physical health. Look for nonverbal signs of health complications and discomfort. For example, if your loved one is experiencing pain, they may wince or grimace from time to time. Their outbursts may be due to a physical condition, such as a UTI, constipation, or other treatable conditions.
- Prevent sundowning symptoms. Establish a routine where challenging activities are done earlier in the day, use light therapy, and avoid excess noise to prevent nighttime agitation.
Learning to redirect your loved one’s attention and having open and honest conversations with other family members and health care providers can help you cope. Additionally, caregiver forums can help you feel supported as well as provide new information on dementia care and creative ideas for dealing with common behaviors and situations.
Most importantly, patience is key for everyone involved. Providing care for someone with dementia is hard work. If your loved one’s anger or aggression is becoming unmanageable and you feel increasingly burnt out, it may be time to consider outside help.
An in-home caregiver who is professionally trained in dementia care techniques can provide support and much-needed respite for families. However, as dementia progresses, remaining at home may no longer be possible due to increasing safety concerns. Trained caregivers at memory care communities offer specialized care and support in a safe, secure environment.