Why does dementia cause aggression?

It's one of the most upsetting and difficult symptoms of dementia. Find out what could be causing hostile or violent behaviour in the person you love or care for

Dealing with aggressive behaviour can be really tricky. However, once you begin to understand the reason behind the behaviour (which is often totally out of character) you can start to make sense of it and learn to respond in a way that helps to stop it.

Aggressive behaviour can be either verbal, such as swearing, screaming and shouting, or physical, such as hitting, pinching, scratching, hair-pulling and biting.

BUT – it’s important to remember that aggression isn’t a universal symptom of dementia – some people will get it, and some won’t.

Causes of aggression

1. Physical discomfort
2. The environment
3. Social issues
4. Psychological problems

Physical discomfort

If the person you’re caring for is ill or in pain, they may lash out because the pain makes them feel confused or frightened – they simply don't understand it.

It could be down to illnesses such as a bladder or throat infection, or they may feel uncomfortable because they’re constipated or thirsty.

And don’t forget about any long-term health issues which could be causing discomfort, such as arthritis, or the affect that medications could be having on their mental wellbeing.

The environment

Is the room too bright, noisy, crowded, hot, cold or just generally over-simulating? This could make someone with dementia feel lost or overwhelmed and then lash out in fear or frustration.

Social issues

Find out if the person you’re caring for is lonely, bored or lacking social contact. They may need some sensory stimulation.

If other people are involved in their care it's worth finding out if there's been any changes recently. For example, if a favourite carer is on holiday it might make someone with dementia feel unsafe, and start acting aggressively.

Psychological problems

Dementia affects your perception and understanding of the outside world. If you feel as if your rights are being ignored – as some people do – it can make you want to lash out.

Changes in the brain can also make people living with dementia feel more extreme reactions than they used to. So whereas before they might have reacted with frustration if they felt someone was being rude to them, now they respond with violence.

Did you know? You aren't alone. More than half of people with dementia are verbally or physically aggressive.

Dementia can also cause hallucinations, delusions and paranoia, which can lead to aggression, as they don’t really understand what is going on. If the person you’re caring for doesn’t recognise where they are, or who you are, they might think you’re a stranger trying to hurt them. So it makes sense that they might lash out and hit you – wouldn't you do the same?

How should you respond to aggressive behaviour?

Being on the receiving end of aggressive behaviour caused by dementia is undoubtedly difficult and often traumatic. However there are steps you can take to manage it both now and in the future.

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There’s no ‘one size fits all’ answer, but generally speaking it's best to:

1. Try to stay calm

While this might seem easier said than done, an angry or defensive response could make the situation worse. Try not to show any fear or alarm, take a deep breath and step back to give them some space to calm down.

2. Identify the cause

This won’t always be obvious, but think about what happened immediately before they became violent and ask yourself if that could have triggered it. For example, could they be in pain or uncomfortable and can you remedy it?

3. Step into their shoes

Try to look at the situation from their perspective. If they’ve reacted strongly after you’ve tried to bathe them or helped them use the toilet, it could be because they feel embarrassed or ashamed. Even though you know you’re only trying to help, dementia can mean the person you’re caring for no longer has the same level of reasoning or logic.

4. Reassure and listen

Once they have stopped acting violently, and are willing for you to approach them, maintain eye contact and talk in a low, soothing (but not patronising) voice. Explain calmly that you want to help and listen if they’re able to tell you what the problem is.

5. Use distraction tactics

Try shifting the focus to another activity if you think this is what is causing the aggression, or pick a pastime that is more relaxing, such as listening to music or going for a walk with them.

6. Don’t punish them

It can be easy to feel like you want to scold the person like a naughty toddler when they’ve been aggressive, but they probably have no real concept of what they’ve done wrong, or why it’s inappropriate (and may not even remember the incident the next day).

7. Talk to a friend

Try to avoid unleashing your frustrations on the person you’re caring for. Make time to meet with friends who understand your situation, talk to your GP, a counsellor or a dementia support worker, or even vent your feelings on a blog or forum. There will be other people out there who are in the same boat.

What about next time?

•  If you’re worried this could be the first of many aggressive incidents, think about how you might be able to prevent it happening in the future.

•  Make a note of the incident so you’ll remember exactly how it panned and what potential 'triggers' you can avoid. For example, if it was caused when you tried to help with bathing and washing, find out what products are available to help them maintain some independence in this area and reduce the risk of further flare-ups.

•  Look for common signs that they might be in pain. For example, rubbing or pulling at an area of the body, a change in appetite, a temperature or swelling and inflammation.

•  Expect some trial and error when working out how to manage aggressive behaviour, particularly as the person your caring for may not react in the same way the next time. However, the more 'triggers' you are able to pin down and learn how to avoid the more likely it is that you can curb distressing outbursts in the future.

Good to know

In the past, people who developed aggressive tendencies related to dementia were prescribed anti-psychotic drugs. There’s now a strong move away from the use of these drugs, and if they are used, it should only be as the very last resort and for a minimal amount of time.

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