Caring Currents

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

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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.