Caring for a loved one with Alzheimer’s disease or another form of dementia can bring changes that families never expected. One of the most difficult is aggressive behavior.
A person who was once gentle and patient may begin shouting, threatening, pushing, grabbing or even striking a spouse or caregiver. For families, these episodes can be frightening and emotionally confusing.
It is important to understand two things at the same time: the person with dementia may not fully understand or control the behavior, but the danger to others can still be very real.
Aggressive behavior may be verbal or physical. It can appear suddenly or develop gradually as dementia progresses. The Alzheimer’s Association notes that aggression can result from physical discomfort, environmental conditions and difficulty communicating.
Before assuming that the dementia itself has simply become worse, families should consider possible triggers such as:
A sudden behavioral change deserves particular attention. The Alzheimer’s Association recommends a thorough medical evaluation when behavioral symptoms occur, especially when they appear suddenly.
The family should tell the physician exactly what has happened. Saying “Dad has been a little agitated” may not communicate the seriousness of the situation. If Dad pushed his wife to the floor, threatened a caregiver or struck someone, the physician needs to know that.
This can be especially difficult.
A husband or wife may excuse increasingly dangerous behavior by saying, “He doesn’t mean it. It’s the Alzheimer’s.”
That may very well be true. Dementia can affect judgment, reasoning, communication and the person’s perception of what is happening around them. The person may believe a spouse is a stranger, misunderstand an attempt to help with bathing or dressing, or react defensively to something that seems threatening.
But dementia explaining the behavior does not make an injury less serious.
The Alzheimer’s Association notes that abuse or harmful behavior can originate from either the caregiver or the person with dementia, and that no one should live under threat of harm to themselves or others.
Families should take repeated pushing, hitting, grabbing, threats or other dangerous behaviors seriously—particularly when the other spouse is elderly or physically frail.
Arguing with someone experiencing dementia is rarely productive. Trying to prove that the person is wrong can increase frustration.
Instead:
The Alzheimer’s Association recommends focusing on the person’s feelings rather than arguing about facts and trying to identify what occurred immediately before the aggressive response.
Most importantly, do not sacrifice someone’s safety in an attempt to calm the situation.
If there is an immediate danger of serious injury and the situation cannot be safely controlled, call 911. Tell the dispatcher and responding personnel that the individual has dementia and is exhibiting aggressive behavior.
Texas also provides 24-hour crisis resources through local mental health and behavioral health authorities. Texas Health and Human Services advises contacting the local crisis hotline or 911 when someone presents an immediate danger to themselves or others.
Families sometimes hear about referring an older person with dementia to a “medical board.” This can create confusion.
The Texas Medical Advisory Board does have a physician referral process. However, its role includes evaluating medical conditions in connection with matters such as a person’s ability to safely operate a motor vehicle. Texas physicians may voluntarily report certain diagnosed disorders or disabilities to the Medical Advisory Board.
That can become relevant when dementia raises concerns about driving, but a Medical Advisory Board referral is not the normal mechanism for addressing aggressive behavior toward a spouse or caregiver in the home.
Those concerns should instead begin with the person’s treating physician and, when necessary, appropriate emergency or crisis services.
One aggressive episode does not necessarily mean that someone with dementia can no longer live at home.
A medical evaluation may identify a treatable problem. Changes in routine, improved communication, environmental modifications, additional supervision or professional caregiving assistance may also help.
Families should, however, reconsider the care plan when:
Access to firearms deserves particular attention. The Alzheimer’s Association recommends considering removing guns and other weapons from a home where someone has dementia or securing them appropriately, because dementia may cause the person to misidentify even someone they have known for years as a threat.
The answer may be additional help at home, respite care, changes to the home environment, specialized dementia care or, in some situations, a more supervised residential setting.
The goal should not simply be to keep someone at home at any cost. The goal is to provide the person with dementia with compassionate, appropriate care while protecting everyone involved.
Families facing these decisions should not be embarrassed to ask for help. Dementia changes over time, and the care plan that worked six months ago may no longer be appropriate today.
At Divine Home Care Services, we believe good dementia care begins with understanding the individual, recognizing changes early, communicating with the family and helping create an environment that supports both dignity and safety.
Eduardo Berdegué
Divine Home Care Services
www.divinehomecareservices.com
Call today for a free in-home consultation to assess care needs. We provide personalized, confidential, and compassionate support—available 24/7 for your family.
