Aggressive behavior in the later stages of a
dementing illness such as Alzheimer's Disease or vascular dementia
is not at all unusual. Not everyone with a dementing illness will
become aggressive. However, as we never know when this kind of
behavior may occur, it is important to know ahead of time how to
respond to potentially dangerous behavior.
Almost all violent behavior in someone with dementia with no
previous history of violence can be attributed to two primary
causes, often happening at the same time:
- Physical or emotional discomfort that
the person is unable to effectively communicate. The person with
dementia feels threatened, tired, hungry, insecure, embarrassed
or is uncomfortable because of being too warm, cold, needing the
bathroom or feeling ill (a urinary tract infection is often the
culprit);
- Loss of inhibitions brought on by the
brain changes caused by a dementing illness. A previously proper
individual may no longer be able to suppress the urge to do or
say things that are socially, or even legally, unacceptable.
Preventing or Minimizing Aggressive Behavior
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Maintain a predictable routine. Although
someone with a dementing illness may not be able to articulate the
schedule, doing the same things at the same time every day is
comforting and helps the individual cope with a world they feel is
out of control. As much as possible, meals, hygiene, activities
and rest/sleep periods should come at the same time and in the
same way every day.
Do your best to minimize physical discomfort. Make a toilet
run every two hours. Pay attention to behaviors such as plucking
at zippers and flys or lifting skirts, which may indicate the need
to go. Anxious pacing may also indicate a need for the rest room.
Check disposable undergarments often and change them as soon as
necessary. Be sure that clothing is not bunched and does not pinch
or rub the skin. Offer liquids frequently to prevent dehydration,
and schedule small snacks to prevent hunger.
Keep a written log of outbursts: As much as you believe you
will remember every bit about an outburst, stress and the passage
of time will blur things you will want to remember. Make a quick
note of the date, the time of day, the activity the individual was
engaged in or what you were trying to accomplish, and note the
kind of behavior that resulted and what you did. Over time you
will be able to identify patterns. This will help you anticipate
problem behavior and perhaps make changes to your approach.
Responding to Aggression or Violent Behavior
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Keep yourself safe. Your own safety is
primary. Stop what you were doing, step back, and leave the room
if necessary.
Don't argue. People with dementia do not have the capacity
to reason when they are upset.
Use distraction. If you do not feel physically threatened,
change to a new activity that your person with dementia usually
enjoys. Offer a snack or turn on favorite music. Sometimes just
moving to a different room is enough to break the mood. If it
can't be skipped you can try returning to the activity that
precipitated the aggressive behavior later.
Avoid punishment. The concept of cause and effect works for
most children because they can eventually understand "if this,
then that." A person with advanced dementia is no longer able to
make this kind of connection. Scolding or withholding something
pleasurable because of bad behavior will usually only make things
worse.
Consider alternative care options. If violent episodes
happen routinely there is a very real risk that your care
recipient, you, or other family members could be injured. It may
be time to turn to professionals to provide care that is no longer
safe at home.
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