Dealing With Aggressive Behavior

While violent behavior isn’t a common symptom of Alzheimer’s disease, you need to know what to do if your loved one becomes hostile.

Violent behavior is not a frequent symptom of Alzheimer’s, but it may appear as a phase of the disease. Violence seems to be most common in the middle stage of Alzheimer’s, when the sufferer is still physically strong, but his or her judgment and memory have begun to fail. When such a person has a hard time performing daily activities, it can lead to frustration and anger.

As the caregiver for someone with Alzheimer’s, it’s important to remember that your loved one can become easily confused and suspicious. He or she may think that others are trying to harm him or her. Other causes of violence include delusions or hallucinations, reactions to drugs, and pain. Your loved one could become violent as a defense against real discomfort (as from being too cold in a bath) or real abuse (by a friend, family member, or substitute caregiver). No matter what the cause, outbursts of aggressive or violent behavior are frightening and may be dangerous; they need to be controlled to protect your loved one and everyone else involved.

If Your Loved One Becomes Violent

A doctor should promptly treat all cases of aggression and violence. Some causes of this behavior may respond to treatment, and the problem may be easily solved. Even if you learn that the behavior is another symptom of the disease itself, your health care team may have ideas about how to cope with the problem.

As a caregiver, you play a key role in helping your health care team treat and manage this problem. They rely on detailed reports about your loved one’s behavior, and they count on you to carry out any treatment or care plan.

If your loved one does become aggressive, it will add to your burden as a caregiver. You may have to:

  • Cope with the extra work, worry, and embarrassment the problem creates
  • Find ways to ensure your loved one’s comfort and safety, as well as your own
  • Physically restrain him or her at times

Aggressive or violent behavior may trouble you in ways that other symptoms of Alzheimer’s don’t. If so, you may find that your loved one’s outbursts provoke strong feelings such as anger, guilt, shock, and embarrassment. Although it may be difficult, try to remember that violent behavior is a care problem, like wandering or sleep disturbances. You are faced with a behavior—caused by the disease—you want to control. Your loved one isn’t acting on purpose or out of spite.

Observation And Diagnosis

If your loved one begins to act aggressively, a doctor will want to examine him or her promptly. First, the doctor will make a tentative diagnosis. You then may be asked to observe the problem for a period of time. Ask the doctor about ways to ensure everyone’s safety while you’re performing this period of observation.

As you observe your loved one, you may need to look for signs of a pattern or of side effects from prescribed drugs. These observations will help the doctor to make a final diagnosis and plan a treatment routine. Your doctor may have questions or comments pertaining to your case. As you care for your loved one, try to observe him or her closely in order to answer the following questions:

  • Do you notice any pattern to the behavior?
    • Does the behavior occur at any set time of day?
    • Does it occur after your loved one takes a certain drug?
    • Does it occur when he or she is hungry or frustrated?
    • Does the behavior come out only when a certain person is present?
  • When you first noticed the problem, did you notice any other changes in the way your loved one was acting?
  • Were any big changes occurring in the home at that time?
    • Did you move?
    • Did anyone move in or out?
    • Did anyone in the family die or become ill?
    • Did you make any changes in care arrangements?
  • Has your loved one started any new drugs or changed drug dosage?
  • Has your loved one suffered a recent injury?

Be sure your doctor knows all the drugs that your loved one takes, even over-the-counter drugs.
Treatment And Management

Depending upon the cause of the aggressive behavior, a doctor may be able to treat some of your loved one’s symptoms. Treatment may be administered at home, and may be as simple as setting up rest periods or quiet times, or providing small snacks between meals. Or your loved one may need new medications to treat a depression that is causing the behavior. You should watch carefully for responses to the treatment.

The prescribed treatment may not work, or it may solve only part of the problem. No capable treatment for the problem may be available. Outbursts of anger and violence may be part of the progression of Alzheimer’s disease itself. Even so, you and your health care team can set up techniques to manage the care problems that remain.

Your goal is to ensure the safety and peace of mind of everyone involved. In some cases, prescription drugs may only achieve these goals. Medication may reduce aggression and violence, but might also create unwanted side effects. Drugs that calm your loved one may produce sleepiness or increase confusion. Some have more physical side effects, like constipation or dizziness. Usually, doctors prescribe the lowest useful dose and attempt to minimize side effects. Carefully discuss the subject of side effects with your loved one’s doctor.

Coping With The Problem

Managing problems of aggression and violence without using drugs is possible. Discuss ideas with your doctor, make a plan, and see what works best. If a plan doesn’t seem to be working, call the doctor immediately to discuss the problems you’re having. You should also discuss any new ideas that you want to try. Alzheimer’s support groups may also offer good ideas for managing the problem, based on others’ own experiences.

Some coping suggestions:

  • For safety, check the entire house and remove any object that your loved one might use as a weapon.
  • Protect yourself. Stand out of range and, if you feel that your loved one may injure you, leave the room.
  • Some outbursts may just happen, with no pattern or warning; others may be the endpoint of a slow build-up of tension. You can better control the problem if you predict when outbursts may occur and avoid things that trigger the behavior.
  • Set up ways to distract your loved one when you see a violent outburst coming. Keep a written list of things he or she likes (such as going for a walk, listening to music, having a snack) and offer these as diversions.
  • Seek help.
    • If you see that these behaviors come on during certain daily activities (like bathing or dressing) try to get others to help you at these times.
    • Make a list of the phone numbers of neighbors or family members who can help on short notice.
    • Keep a list of emergency numbers (police, fire department, doctor, ambulance) by the phone.
    • If the problem becomes too difficult to manage, you may want to look into hiring professional help or moving your loved one to a long-term care facility.

Physical Restraints

Experts do not agree about physically restraining a person during a violent outburst. If you are strong enough to restrain your loved one, you might try doing so. The danger is that you might frighten or further anger him or her, making the situation worse. If your loved one struggles, there is the chance that one or both of you could be hurt. Discuss the matter with your health care team.

Living With The Problem

If the person in your care becomes aggressive or violent, your caregiving role has been magnified. Your role is increased even more if the problem cannot be helped by treatment. You need to observe the patterns of the problem and work with your loved one’s doctor or nurse to plan techniques for coping. If you can, figure out methods to predict and prevent the problem.

Your role of caregiver does not include allowing yourself to be physically hurt. As in all aspects of caregiving, don’t ignore your own needs and feelings. Dealing with aggression or violence can frighten and exhaust you and you may feel any number of emotions ranging from anger to depression to guilt. Try to keep in mind that these problems are not happening because you are a poor caregiver; the problems are part of the disease itself.

Share your problems and reactions with others. Speak to a friend, family member, counselor, or clergy member, or go to a support group. The Alzheimer’s Disease and Related Disorders Association may be able to help find a support group near you. Ask your health care team or a local hospital for a referral. At times like this, sharing what you feel can be very helpful.

© Copyright FamilyCare America, Inc. All Rights Reserved.

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

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