Methods of Dealing With Aggressive Behaviors

Suggestions for Alzheimer's caregivers in dealing with aggressive or agitated behaviors.

If you can find out what may be upsetting the person with Alzheimer's you may be able to reassure them or you may be able to find ways of making situations less distressing. Try to obtain advice from other caregivers or from professionals. If appropriate:

• Reduce demands on the person if they do not seem to be coping, and ensure that there is an unrushed and stress-free routine.
• Explain things, wherever possible, calmly and in simple sentences, allowing more time for the person to respond than they would formerly have needed.
• Find tactful ways to offer help without seeming to take over. Guide or prompt the person and break down tasks into easily-manageable steps so that they can do as much as possible for themselves.
• Try not to criticize. Hide any irritation that you feel. Avoid situations where the person is set up to fail. Praise any achievements and focus on the things which the person can still do rather than on those which are no longer possible.

In addition:

• Watch out for warning signs such as anxious or agitated behavior or restlessness and offer more reassurance, if appropriate.
• Avoid sharp voices and sudden movement. Too much noise or too many people may add to their confusion.
• Avoid confrontation. Try to distract the person's attention if they seem upset. You might find that it helps if you leave the room for a few moments.
• Find activities to stimulate the person's interest . Make sure that they take enough exercise.
• Make sure that the person has regular health checks and consult the GP immediately if they seem to be ill or in discomfort.

Prevention is the best solution for aggressive behavior but it will not always work. If this type of behavior occurs, don't blame yourself. Concentrate instead on handling it as calmly and effectively as possible.

At the time:

• Try to stay calm and do not enter an argument however upset you feel. A heated response will probably make the situation worse.
• Take a deep breath and count to ten before you react. Reassure the person and try to distract their attention. Leave the room if necessary.
• Try not to show any anxiety as this may increase the person's agitation. Of course, this is easy to say and much harder to do if you feel threatened. You might be able to plan some strategies in advance which you could use in such situations.
• If the person is physically violent, give them plenty of space. Closing in on them or trying to restrain them, unless absolutely necessary, can make matters worse. You may need to leave them until you have both calmed down. You may have to call for help.

Afterwards:

• Do not try to punish the person by, for example, withdrawing a treat or ignoring them. They are not able to learn from experience and will probably forget the incident very quickly. However, they may feel a general sense of unease for some time. Try to behave as normally and reassuringly as possible.
• If aggressive incidents are frequent or worrying discuss them with a professional such as an old-age psychiatrist or a community psychiatric nurse. They may be able to offer support and suggest other ways of handling the situation.
• Generally, it is best to avoid treating aggressive behavior with drugs. These can suppress behavior without addressing its cause and may also add to confusion. However, if it seems impossible to avoid using such drugs, the doctor will want to prescribe the minimum dose and to review the treatment very regularly.

Your own feelings

It is important to remember that, although much of the aggression may be directed at you, it is not personal. It is simply because you are the person who is there. However, any such incident will probably leaving you quite shaky. For some people it is helpful to have a chat or share a cup of tea with a friend, relative or neighbor. Others will like to spend time quietly alone.

Don't feel guilty if you do lose your temper. You are under great stress. But do discuss things with a professional or another caregiver who may be able to suggest ways of handling such situations more calmly.

Don't bottle up your feelings or resentments. Talking things over with a friend, a professional or within a caregivers group may help.

Sources:

Special Care Problems: Aggressive and Violent Behavior, by Kenneth Hepburn, PhD. Department of Veterans Affairs Medical Center, Minneapolis, Minn.

Alzheimer's Society - UK