October 18, 2004
Aggressive behavior is one of the most frightening behaviors in someone who has Alzheimer's disease. It can make home care extremely difficult and is a common reason why a loved one must be placed in a nursing home. Fortunately, steps can be taken to help prevent and treat aggression in a loved one with Alzheimer's.
Someone afflicted with Alzheimer's may go through periods of swearing, screaming, throwing objects, resisting care, or attempting to hit others. Verbal assaults are more common than physical ones. Fortunately, such hostile behaviors are usually temporary.
Disruptions commonly occur if a person with Alzheimer's feels their personal space has been invaded, for example, during dressing, bathing, or a doctor's appointment. It's important to understand that someone with Alzheimer's is more likely to misinterpret certain actions and respond aggressively. Aggression can also arise as a result of a physical illness such as constipation or infection, pain, depression or anxiety, or lack of sleep.
What to Do
It's important that a doctor evaluate the person with Alzheimer's to identify any physical complaints that may be contributing to the problem. The caregiver should also keep a written journal of events that lead to aggressive behavior. Describe what happened just before an outburst, how the person acted, and what ensued. The journal should also list how often aggressive behaviors occur and what, if anything, reduces the outbursts.
Identifying patterns that set off aggressive behavior can help to avoid outbursts in the future. For example, if a loved one becomes combative when trying to decide what to eat or wear, you can limit the choices available. Rather than asking, "What would you like for lunch?" for example, prepare a sandwich. Or, instead of saying, "Get dressed," say "Put these pants on."
Maintaining a regular routine may also help to avoid conflicts. Playing music the person with Alzheimer's finds soothing during problem times such as bathing may also help. Regular and gentle exercise on days when the person with Alzheimer's must visit the doctor, for example, may also help to reduce aggressive behavior. Your doctor may also prescribe medications to reduce agitation.
Despite your best efforts, outbursts will still occur. Try your best to remain calm and stop whatever it is that you are trying to get your loved one to do. Do not argue or punish the person. He or she may not be able to remember the incident or be able to learn from it because of the nature of Alzheimer's.
If an outburst occurs, talk to the person in a calm and non-threatening manner. Keep your voice low and soothing. If the TV or radio is on, turn it down or off. If someone is upset because they can't find their wallet, for example, spend a few minutes with them helping to look for it. Or, switch to a new activity, like sitting in a rocking chair.
For more on caring for a loved one with Alzheimer's who has become disruptive, see the www.ALZinfo.org. The Fisher Center for Alzheimer's Research Foundation offers many additional tips for communicating with someone with Alzheimer's disease, traveling with a loved with Alzheimer's, and more.
Johns Hopkins Medical Institutions White Papers, Alzheimer's Disease, 2004.