What to Do When Someone With Dementia Lashes Out Physically

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Physical aggression -- hitting, biting, scratching, spitting, and otherwise lashing out -- is not uncommon in someone in the later stages of a dementia illness such as Alzheimer's disease.

There are two main reasons why people with dementia may turn violent:

  • Personality changes brought on by the disease include loss of inhibition and self-control. A mild-mannered individual may do things he or she never would have previously.

  • Emotional or physical discomfort is the top trigger for physical aggression. The person feels insecure, threatened, angry, tired, embarrassed, humiliated, or otherwise vulnerable but lacks the ability to communicate these emotions in a socially acceptable way.

How to prevent aggression

  • Try to keep the person calm, secure, and comfortable. Make sure the person is dry (if he or she wears adult sanitary products) and is neither hungry nor thirsty. People with Alzheimer's forget to eat and can't always tell you what they need.

  • Keep to basic household routines. Ideally, sleep and meals happen in a predictable way every day. Ideally, the person with Alzheimer's gets fresh air (weather permitting) every day and/or gets a little exercise, even if it's just walking through the house.

  • Keep a written log of what was happening just before violent outbursts. Try using the ABC method to understand Alzheimer's behavior. You may soon see a pattern. If bathing tends to spark violence, for example, can you tell what seems most upsetting about it? If it's being cold, maybe you can turn up the heat, shut the bathroom door, and run towels and a robe in the dryer before you begin.

  • Prepare the person for triggers as best you can. Obviously you can't preempt every upset -- if a substitute care helper shows up, you still need the help of that person even if the new face is upsetting to the person with Alzheimer's. But while it's not usually productive to rationalize with someone who has dementia, telling them about an upcoming change is considerate and may offer a little preparation. Keep your tone calm and upbeat -- letting your own frustration show through words or body language will only make your loved one tense and more on edge.

How to Respond in the Heat of the Moment

  • Try to stay calm. Don't fight back or raise your voice. Even cues that you're nervous might get picked up by someone with Alzheimer's, and that can increase the aggression. Leave the room if you need to pull yourself together.

  • Stay safe. Obviously you don't want your charge to fall or hurt herself, but your own safety needs to be paramount. Step back if the person is out of control, rather than stepping in to restrain or overpower.

  • Don't argue. Make it your goal to avoid escalating the behavior, not to get your way or prove yourself right.

  • Resist the temptation to punish. The notion of cause and effect is beyond the cognition of someone with serious dementia. Issuing consequences (no snack, a lecture) will only add to the person's upset, and to the violence.

  • Distract. Try breaking the mood by stopping and starting again in 15 minutes. Change to a new activity, or even just move to a new room. If bathing has gotten off on the wrong foot, for example, switch to something you know your loved one enjoys -- listening to music, having a snack. Then get back to the bath later, taking care to eliminate or soften the trigger if you can. (Maybe you play the favorite music in the bathroom this time.)

  • Self-soothe in healthy ways. After a troubling incident, take care of yourself, too. Call a friend or reach out to an online Alzheimer's forum. Do not isolate yourself physically from others (a common practice, since caregivers grow afraid to have others see their loved one "this way").

As a Final Resort

  • Ask the doctor about medication. Nobody likes to think about worst-case scenarios, but sometimes, in serious situations, prescription medications (ranging from antidepressants to antipsychotics) are used to curb physical aggression.

  • Consider -- or at least stay open-minded about -- a new living situation. Signs that home care may no longer be viable include violent episodes that become routine (weekly or more often), medication that doesn't help, and yourself or a family member being injured or at risk of injury.

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio

30 days, said...

My husband has dementia. We both have worked with children for years but he is increasingly becoming hostile to them, i.e cursing, pulling ears, especially the boys. The parents and children are complaining about his behavior. Its not though just the children but adults. He will go up to them and insult them. But I am more concerned about the children because I am always around them. I have to take him with me so he is always with them too. What do I do? There are no other paople who live in our home. I have discussed his hostile with his doctor who increased his meds - gabapentin to 600 mg. The outbursts lessened but now there are these other subtle forms of anger. He was taken off of prevagen due to kidney problems from diabetes. I need help. I cannot have these children exposed to this type of behavior.

over 3 years, said...

My MIL has moderate AD. She has been difficult for many years. She is a narcissist who has run off most members of the family. No one wants to be around her abuse and negativity.She has become physically violent threatening the caregiver. We have had police called twice and she has been in psyche unit twice in 3 months. Her language is vulgar and abusive. I'm just venting. I truly dislike this woman. I know there is a lesson in this. We are trying to walk thru this. Thanks for listening.

almost 4 years, said...

This website is great. Thank you!

almost 5 years, said...

Personally my advise to all of you with the frequent violent behavior of dementia patients is to either have them put away in a home to save you physically and mentally or medicate them. I don't understand why any home won't take them as they can give them shots to tranquilize them. If my husband starts these aggressive episodes again too frequently that is what I must do no matter how hard it is for me in order to save myself otherwise we'll both be lost. I am already a very sensitive person and his episodes are depressing me and I have lost a lot of weight while he eats better than ever. He has the disease but isn't that conscious of it while I am and so are you. We need to save ourselves and stop being in denial about how it is a disease which destroys everyone involved. Forgive me but I see nothing positive about the horrid disease of Alzheimer's.

almost 5 years, said...

I always find good advice from your articles. However, I find myself in a situation with my husband, who has cortical dementia an becomes aggressive and physically violent, for no apparent reason. Assisted living facilities refuse to admit people with aggressive behavior. I don't blame them but that leaves me to care for my husband, who also has numerous medical conditions, by myself, with no outside help. It's a 24/7/365 job and I've been doing it for over ten years. My husband is 84 and I am 66 years old. I can't even get friends to relieve me to go grocery shopping. I'm past tired, past exhausted; just fatigued, with no relief in sight!

about 5 years, said...

My 86 yr old Dad Struck My 83 yr old Mom when she was unable to locate a book he wanted quickly enough to suit him. He has understanding, but seems unable to control any frustration. He was diagnoised with Dementia and Parkinsons in the 1990's. He is very demanding and says very hurtful things to me (only child 54) and my Mom (who is emotionally hypersensitive anyway) and Mom is my primary concern. They have both been in denial for several years and resisted my efforts to "prepare" for this onslaught. Mom is dependant on Dad's income and IF he is institutiionalized will not have enough of an income to pay the power bill. What steps can be taken this late to protect assets like the jointly owned house, or to separate bank accts, so that I can insure my Mom has some way of living? She is functional and needs minimal help

over 5 years, said...

My dad is aggressive and angry with my mother often. Many times he thinks she is someone else. We tried an in home caregiver but he got too aggressive with her the second day. They won't come back unless he gets some kind of tranquilizers. My mom is getting so stressed and both my sister and I work full time and can't always be there to help. We tried calling his gerontologist to get something stronger but she won't give anything except the Ativan and Zoloft. That does help him little at night, but he also hallucinates more. He has been hallucinating pretty much all the time anyway, has conversations with people who aren't there. It frustrating to me that the gerontologist tells my mom to make sure she isn't overwhelmed but then won't give him stronger meds so she can have some help.

over 5 years, said...

advice on what meds to help!

over 5 years, said...

Hi, My mom had a stroke 2007, has dementia is in a skilled nursing facility sonce then. i used to go every other day . i had a heart attack 2009 have copd, chf, and have a pacemaker in me. everytime i go there she lashes out at me i don't know why, when or where this will happen i've been called such bad names, told to go to hell & never come back i have been thru so much I lost my hisband in 2002, then this and now this. i am lost completely no one else in the family i am the only child we have had a love/hate relationship all my life . But now is is extremely bad. i feel i don;t have to listen to this and it rips me apart inside. HELP FROM ANYONE??????

almost 6 years, said...

My mother has Alzheimer's and she has become violent. I removed her from my home and put her on medication. If she comes back to the home, the suggestions in this article will help me.

almost 6 years, said...

I'm watching my husband sink slowly into an unexplaainable slump...but I noticed it got much worse whem his mother fell and hurt her head and body./.went to hospital..seemed to get better,then suddenly had a massive stroke...that one put her completely down..She mentally alert,but her body has given up.He said her health really bothers him,but he won't visit her.She's 85 yrs now///but my brother has had the same thing happen to him,and now his body is giving up on him!!! I have an aunt in her 90's I can't even find,because my brother can't recall where she's at. We're watching our elders drop like flies...We don't visit him either because he'd so far away....too much..too much. My hubby seems to have given up.i'm in a holding pattern,because I can't just take a car,(we have two)and just GO to see any of them.All my kids live except (one) 2 doors from us...The rest are 70 miles/350 miles 340 miles and 450 milrs from us.The one neatrest is disabled,and I won't let her use my car any ,more...my kids have cost ME thousands of repair dollars.There is much I don't understand,but I'm doing the best I can.i make no excuses any more...mostly I've learned how to say NO!..infatically,and anyone stubborn enough to figure out how to get their stuff done without me,i figure has learned a valuable lesson.If I died tomorrow ,that's exactly what they'd have to do anyway.I'm not giving up...I'll br reading morre thank you. GBG

almost 6 years, said...

As I've been skimming along.I find there is more actions going on that /i wasn't paying attention to.Yet here it is in black in black and white...exactly what I didn'twant to take so much time to talk about in the beginning. Bathing,and changing his clothes is most noticable.He wants only his only favorite foods,so I make him do his wown cooking...In fact he argues with me about every little thing I do differently than him,yet denies he even notices it.I can set my clock 24 hours a day by his footsteps and activities.He only eats certain things...but his health isn't suffering for it.The VA said he's much better health wise now than for years back..He's great for where he stands....and I so the same,and i'm physically great for where I stand....His short term memory is dissappearing...but he recalls EVERYthing from 10 years ago back. I'm the opposit...I recall weeks ago but completely lost deminishing huge chunks of long times ago.i'm improving in that league.

almost 6 years, said...

Could physcial aggression as mentioned in the first paragraph co-relate, to anger build up in childhood or formative age towards one or both parents? These symptoms were observed in a female in her twenties and intensifying progressively as age advanced.

about 6 years, said...

Everything was helpful except for the part about giving the person advance notice of schedule changes. I find that when I give my 87 year-old roommate advance notice of my plan to spend the weekend at my sister's house (an hour away), he becomes hostile and makes threats in anticipation of the date. Then he feigns an illness or need for me to cancel and stay with him. I stick to my original plan and that causes another argument.

about 6 years, said...

This article gives practical tips. That is what caregivers need. Is throwing things considered physical aggression or just a forerunner of it? AD is a scary thing to deal with, especially when everything a caregiver does or doesn't do is wrong.