Alzheimer's Aggression Is Scary, But You Can Get Through It

Last updated: January 15, 2009
Anger (IMG_5119_2.JPG)
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Hitting. Kicking. Grabbing. Pushing. Cursing. Biting. Throwing. Scratching. News this week about these explosive and combative behaviors that can appear in someone with mid- to late-stage Alzheimer's underscores just how challenging they are to deal with. (Although I admit, describing these incidents as a "challenge" is like calling a war "a slight disagreement.")

Proof you're not alone:

Aggression can be frightening. More than one third of Alzheimer's caregivers have observed aggressive behavior, finds a new survey from the Alzheimer's Foundation for Caregiving in Canada (AFCC). Almost one in four caregivers is scared or feels threatened by such incidents.

Caregivers don't feel free to discuss it. Two-thirds of caregivers felt free to discuss symptoms like disorientation and mood swings with people outside their immediate family, the AFCC survey also found. But just over half were willing to talk about aggressive acts.

As a social worker once told me, "Memory loss has become socially acceptable but aggressiveness still carries a stigma – it's the shameful secret burden of dementia caregivers."

Drug treatments are dangerous. Last week's Lancet Neurology reported that people with Alzheimer's who are prescribed antipsychotic drugs to treat aggression have a much higher risk of death after two years. The drugs included thioridazine, chlorpromazine, haloperidol, trifluorperazine and risperidone. Though widely used, especially in nursing homes, these meds aren't FDA-approved for use with dementia. Their "off label" use (legal but not approved) is considered a last resort -- moreso since a spate of similar research in the past year.

Where does that leave you? Seven words that help:

  • Separate. Don't take outbursts personally.
  • Breathe. Switch your focus from the behavior to your reaction. Keyword: Cool. Showing anger or arguing might make you feel momentarily better but it's like throwing oil on flame.
  • Safeguard. Step backward to avoid getting hurt if you need to. Resist using force unless the person is about to harm himself.
  • Empathize. Focus on the person's feelings, not their actions. Frustration over something they can't communicate is a common root of hurtful behavior.
  • Track. Surprisingly often there's a pattern to what triggers outbursts. Write down what was happening right beforehand: activity, mood, the conditions of the room, time of day. Crack the code and you can reduce or sometimes eliminate the problem.
  • Share. Don't let embarrassment keep you from opening up about these tough incidents -- to your relative's doctor, a trusted friend, or other dementia caregivers. (Especially other dementia caregivers.) What drives you crazy? What works? Share.

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11 Comments So Far. Add Your Wisdom.

9 months ago

The pills and the applesauce is a great idea! You actually can put the pill in the applesauce rather than separately into her mouth. They do this with people that have difficulty swallowing after strokes to get the meds down. After a while, my husband hated applesauce. You could even do it with a spoonful of jam or jelly. It's the thickening that helps. You can purchase thickened liquids at most pharmacies, or make them yourself with knox gelatin.

almost 2 years ago

It surely helps me so much to see how others are handeling these situations. I am absolutely and totaly confused about the aggression situations. They dont last very long but they sure are mean, and it happens every time she has to get dressed. Sometimes I have a tendency to blame myself even although I know better.

almost 2 years ago

I find "entering the hallucination and going along with her thoughts" is usually helpful. If she will agree, I will sit next to her and hug her (sometimes she fights me at first) and start saying the Our Father or Hail Mary... The repetitiveness seems to soothe her. She feels compelled to join me in prayer after a little while and thinking about the prayers distracts her. I find pain and constipation can be triggers. She is also struggling with taking her pills. She wants to chew them. Lately if I put the whole pill in her mouth and then a small spoon full of applesauce, she will swallow them. I am also finding drinking with a straw is working lately. Every time something works, it is usually only for a short while and the new obstacles get in the way and the aggression resurfaces. The biggest thing that helps me is remembering this is the disease and not to take any of it personally.

about 2 years ago

I take care of my friends mom .The problem is she wants to go out by herself. But she doesnt know where she is going and gets lost.I have to lock all the doors. She becomes violent and starts hitting me and throwing things at me what should i do

about 2 years ago

This disease is insidious and has changed my wonderful husband. I absolutely cannot understand why it has hit him as, as his mother said "he is God's perfect child. That being said the anger outbursts are so frightening that it has me walking as if on eggs. One word, one situation, anlything can set him off and I just do not know when anr dd where it will happen. I pray that a better drug or cure is close and I pray for all the caregivers as it is so hard to watch and of course we all should pray extra hard for the victims of this disease. Ann Cogan

Anonymous said over 2 years ago

Hand massage helps my husband greatly when restless or needing to settle down for sleep. Sometimes this helps avoid getting to agitation. Lavender lotion helps too.

over 2 years ago

these are exactly what they do where Mom is. They move them someplace alone. This usually calms them down for a while. It is hard not to follow your first reaction to it and remember it is only the disease doing this. Very hard. there isn't a pattern to it most of the time with mom.

almost 3 years ago

I haven't faced aggressive behavior in my DH yet, except for one incidence of "dream thrashing", but is is good to have some calm words and ideas in case the situation arises in the future

almost 3 years ago

Any advice is something to consider and implement when appropriate. Knowlege is power. Thank you!

over 3 years ago

I appreciate having the information about dealing with aggressive behaviors before they have occurred. My husband is a large man and physically very strong, so I can see the potential for situations that will need responses that will keep both of us safe. I will also share this good information with my support group.

almost 4 years ago

Reminding me to stay calm and look at the cause. Mother's slaps are so mild because she is tiny and weak but the mental impact does upset me. Usually the outburst is because I have had to touch something of hers - she is a like a person with ocd when it comes to her possessions.

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