Changes in behaviour
Mr. Williams had been standing near the door for some time muttering something under his breath. The nurses ignored him. Then he started knocking his walking stick against the door. One of the nurses took his arm to lead him away. He tried to pull away but she didn't seem to notice and then he suddenly slapped her. My husband was a real gentleman, but now he swears like a trooper. He isn't aggressive, he just uses words he never would have used in the presence of a lady. At first I was shocked. But now I realise he can't help it and doesn't mean the way it sounds. He looks so surprised and hurt if I tell him off; he doesn't realise what he's doing wrong. I warn people before they meet him and they usually cope very well.
People with dementia sometimes behave in an aggressive manner, either verbally or physically (although verbal aggression tends to be more common). This may shock you and you may find it difficult to deal with. However, it is important to remember that aggressive behaviour is caused by the disease rather than the person with dementia. For this reason, no- one is spared. Even someone with a very gentle character might at some time behave aggressively. This is why aggressive behaviour can be so shocking and disconcerting. There are many possible reasons for aggressive behaviour, such as frustration or anxiety. However, it is usually caused by fear - a natural, defensive reaction to a falsely perceived danger or threat. You might not always be able to prevent it from happening, but it is a good idea to think about minimising damage and looking after yourself.
How to prevent aggressive behaviour
Try to work out what caused the situation
Anxiety, fear, agitation, nervousness, anger and frustration can all lead to aggressive behaviour and the advice contained in the chapters on these problems may prove useful. However, as with other problems, it is not always possible to prevent the person with dementia from behaving in an aggressive manner and you should certainly not blame yourself if it does occur.
How to cope with aggressive behaviour
Remain calm and reassuring
It is important to try to stay calm, so that you can remain in control of the situation. This will probably not be an easy task, particularly if the person with dementia is shouting at you or behaving in a threatening manner. It might help to bear in mind that the person’s actions and words are not meant personally against you and are caused by the disease. Also, just as you may feel angry or afraid, so too might the person with dementia. For this reason, they might need reassuring. You could perhaps do this through words, by gentle touching and by explaining what is happening.
Try to distract the person with dementia
It is sometimes possible to stop someone from behaving in an aggressive manner by distracting them. For example, you could suggest having a drink together, going somewhere or doing something that the person likes.
- confrontational behaviour and arguing
- taking personal offence
- provocation through physical confrontation, teasing or laughing
- showing fear
- attempting forcibly to restrain the person with dementia
- trying to corner the person or getting yourself cornered
- not giving enough space
- struggling to break free when gripped
- using punishments
Look after your own safety
People with dementia can be a lot stronger than you would expect, particularly when they feel threatened or are nervous. You should therefore make sure that you provide yourself with an escape route and use it if necessary. It would be a good idea to find a trained person who could teach you how to free yourself from a tight grip. This might give you courage and enable you to remain calm. If done gently, it can be transformed into a caring gesture. Don’t feel guilty about looking after your own safety. If reassurance and distraction do not work, there is not a lot you can do. By leaving the room you will not only give the person with dementia the time and space to calm down, but you will also ensure that you will be in a fit state to carry on caring. You would not be able to do this if you were injured. It is best to warn people in advance about the possibility of aggressive behaviour and reassure them that they are not to blame if it does occur.
Talk about what happened and inform a doctor
After an aggressive incident, it is best to talk about it to someone you trust. Even if you think that you handled the situation well, you might be affected later. Perhaps something the person with dementia said or did is playing on your mind, or you may be concerned about managing in the future. The incident might even have awakened memories of previous unrelated personal experiences.
If the problem is becoming uncontrollable or you are afraid, don’t hesitate to consult a doctor. He or she may be able to advise you and even prescribe medication, although you should bear in mind that medication can have unpleasant side effects.
Last Updated: Monday 10 August 2009