Are all Dementia clients aggressive?

Sometimes people who have Dementia behave in ways which are not acceptable, in that they may become either physically or verbally aggressive. This can be towards everyone in general or to just selected people. For the person on the receiving end of this aggression, it can be a very frightening time. Live-in carers may find themselves having to deal with this at any stage of the condition.

Some studies have indicated that the way the person behaved before they had Dementia is an indication of how they will be further along. So, a calm and friendly person could be expected to stay that way as their condition changes. This is not always the case and you should not depend on this to give an indication of how your client will react. Every case of Dementia affects people in different ways and there is no guarantee that the previous behaviour will carry on.

Aggressive behaviour can be verbal or physical

• Verbal: this includes swearing, shouting or making threats.
• Physical: this can include pinching, kicking, hair pulling, biting and hitting.

It is widely thought that aggressive behaviour happens when the person cannot make themselves understood or if they are in pain and cannot explain where it hurts. It may be that specific needs are not met because the carer simply does not understand and aggression then follows. The aggressive behaviour is a form of letting people know that they are not in a happy place.

Understanding the reasons for aggressive behaviour will go a long way to relieving the problem and calming your client.

• Physical needs: your client may be in pain. This includes possible infections such as a UTI. They may be thirsty or sore from sitting for extended periods of time. Medication may make some people drowsy and unable to tell you where they are sore.
• Sometimes the environment may bother them. Bright lights or music which is too loud may upset them, as will too many noisy people around them.
• Hallucinations happen with Dementia and these may be very real to your client who may react to them by crying or shouting.
• Psychological: sometimes your client may feel lost or alone, with only you to help them. They may also be bored or confused by different carers who are needed during the day.

Sometimes the carer can be seen as invading their personal space when they need to be washed or cleaned, and they may react in an angry way.

Many people with Dementia forget that they are in their own homes and imagine they are elsewhere. Sometimes they are not happy about being in a strange place. At other times they will feel as if their home is filled with strangers.

How to respond

• Find the cause: you may find that there is something which affects them at a certain time of day, every day. It may be something like they do not like the cup and saucer you give them tea in because they can’t hold the cup easily.
• Eliminate pain: make sure that you have checked for red patches from sitting too long, that they are not hungry or thirsty or bothered by bright lights, loud noises and too much movement.
• Stay calm yourself: by being calm and still you will be more in control of the situation. Speak slowly and calmly to your client, never shouting or being upset yourself.
• Shift the focus: Distraction from whatever is annoying them will mean that they forget what is bothering them. Focus on another area or even take your client into another room until they calm down.
• Try something calming soft music, dimmed lights, a shoulder massage – these are things which may calm your client.
• Walk away: once you have made sure that your client is in a safe place and cannot hurt themselves, walk away until things have calmed down. You may need to go into another room, or out of sight to change the visual picture.
• Ensure your safety: if all else fails and you feel that you are in danger, you should call for help right away. Never put yourself in a position where you are being threatened and cannot protect yourself. If you do need to call 911, make sure that you let the responder know that your client has Dementia, and this is the reason for their aggressive behaviour.

To sum up

With so many more people who suffer from Dementia, you are more than likely to find yourself at one at some time. It is a good idea to join one of the online forums where you can see how other people handle aggressive behaviour. ALZConnected is an online support community where you can share your concerns with other people who are in similar situations.

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