Understanding and Managing Aggression and Violence in the Dementia Patient

An article in the Banner Alzheimer’s Institute February 2014 Family and Community Services Newsletter discusses an issue in the area of dementia care that is pressing but often ignored. Violent behavior associated with dementia is relatively rare but is always serious because the person is generally unable to control his emotions and has limited insight and poor judgment.

 There are several triggers for aggression in Dementia patients:

1. By far, the majority of aggression occurs when people are resisting assistance with personal care. Adjusting their routine, giving them a choice about when and how to clean up, walking away, and realizing that “no one ever died from not bathing” can help to prevent care-related aggression.

2. Some types of dementia have more potential for aggression than others. This includes people who develop psychosis including hallucinations and delusions with anger as a result of Frontotemporal Dementia (FTD) in the moderate to advanced stages. These people must be treated with medications to ease their psychosis.

3. People who have led aggressive lifestyles throughout their lives may be more aggressive as they lose judgment along with the ability to inhibit or suppress aggressive personalities. This may include people with dementia who were in contact sports, people who have been aggressive in relationships, had substance abuse issues, those who have had “anger issues,” were aggressive as part of their career, or had an argumentative “in your face” personality.

4. People with acute illness may develop delirium (sudden and additional confusion) on top of dementia and reject care, particularly in hospital or long term care facilities.

 While not all people in these categories become violent, it is important for families to recognize and acknowledge when there is danger and seek professional help.

 The Newsletter article lists several things you need to do to protect yourself.

1. Admit that there is potential for violence.

2. If the person has threatened violence – even casually – take it very seriously and seek help from your doctor.

3. Diffuse an aggressive situation by apologizing to the person that they are upset; agree with their anger; and state your intention to resolve the problem.

4. Do not deny the situation or think it will only happen once. Untreated behavioral problems go from bad to worse. Get professional help immediately.

5. Obtain a medical evaluation for potential causes of delirium. When speaking with a medical professional do not try to minimize the behavior to them. If the person looks good and you try to “save face” by not being entirely forthright, the doctor will not understand the problem. If you can’t say it aloud, write what happened down and hand it to the doctor or make the office staff aware that you need to speak to the doctor away from your person. Families do themselves a disservice when they present the patient as calm and kind when this is not what they are living with.

6. Remove weapons from the home. Make sure ANY weapons are not loaded and, if still in the home, the guns are in a gun safe with you having the key.

7. If the aggression is related to personal care, contact the Alzheimer’s Association or Banner Alzheimer’s Institute/Family and Community Services at www.banneralz.org to discuss how to minimize the potential for resistance.

8. Discuss the danger with your family.

9. Do not think you can offload a violent person to long-term care. They have no magic for managing violence. If medications fail, it is best to start with an acute care psychiatric hospitalization.

 The Newsletter article concludes by saying that, ”We live in a society that is becoming increasingly violent and more tolerant of aggression. Violence in someone with dementia is a dangerous and complicated situation. Immediate steps must be taken to protect the person with dementia and their family. Due to the changes in the brain, the person with dementia who threatens violence must be taken seriously and medical attention sought early and often.”

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