Why do Alzheimer’s patients become aggressive and sometimes violent?: As the disease of Alzheimer’s progresses, it destroys more and more portions of the brain that store short-term memories, the ability to retrieve information, names and words – and starts to impact speech, balance, and normal bodily functions. In addition all the ‘firewalls’ and mental ‘stop gates’ that help us filter and temper our emotional reactions to external stimulus are rapidly dying and no longer do their job. Growing feelings of confusion and paranoia trigger the ‘fight or flight’ reflex in even the most neutral situations. When this happens the person with Alzheimer’s will often react to their environment in an increasingly explosive and violent way – and sometimes with tragic results. At this stage of the disease families often realize they are no longer able to safely care for their loved one at home, and start to look for placement in a specialized memory care facility.
Treatment for Alzheimer’s aggression: For families still caregiving in the home, you need to evaluate the environment and remove anything that (in an unexpected rage or outburst) can be used as a weapon. This includes removal of firearms in the home, and items such as knives and scissors. Even then, it’s not unheard of for the aggression to become physical, and include grabbing, hitting and shoving. Remember: This is the disease doing this, and has nothing to do with true feelings of the person suffering with Alzheimer’s. Stories of caregivers being pushed out of the home, and locked out by the patient are common, along with grabbing and shoving.
Consider seeking the help of a Gerio-psychiatrist for a complete physical and mental evaluation. A Gerio-psychiatrist may prescribe medication that could help to de-escalate the violent behaviors for a while. Constant adjustments will need to be made as the disease state progresses, and to evaluate how the person with Alzheimer’s is responding to new medications. Every person with Alzheimer’s is different, and every medication acts differently in each person.
Another important medical evaluation that should be made is to check to see if the person with Alzheimer’s has a urinary tract infection, or UTI. UTIs in seniors are fairly common as they try to ‘control’ incontinence issues by withholding fluids – or simply forgetting to drink enough water. An UTI in an elderly person is different (symptom-wise) than in a younger person, and often the first indication that the person is suffering from an infection is a change in behavior that is often delusional and aggressive. It’s important for your medical provider to rule that out.
Pain is a big trigger for aggression in people suffering from Alzheimer’s. Common undetected infections (along with UTIs) are sinus, inner ear and tooth pain. People suffering from Alzheimer’s often cannot communicate they are in pain, and becoming angry and aggressive is an outlet for their frustration. Always have your health care provider eliminate the chance there is an underlying medical reason for the behavior changes.
Strategies for dealing with Alzheimer’s agitation and aggression:
• Reassure the person. Speak calmly.
• Distract the person with a favorite snack, object, or activity.
• Build quiet times into the day.
• Know what the triggers are.
• Use calm, logic and compassionate reason.
• Validate their feelings.
• Stick to a regular routine.
• Reduce noise, clutter, or the number of people in the room.
• Ignore the angry behavior – if distraction and support do not work.
• Maintain a sense of humor.
• Understand there will be ups and downs.
• Try gentle touching, soothing music, reading, or walks
• Debrief after an incident and identify what caused it.
• Remember that this phase will pass.
• If you have to, stay at a safe distance from the person until the behavior stops. Also try to protect the person from hurting himself or herself.
Ask for help: The Alzheimer’s Association has a free 24/7 Hotline manned by a trained and experienced person who can answer any question, coach you through your situation, and help you find local resources and help.
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