When Your Loved One With Dementia Lashes Out

As Mom’s Alzheimer’s disease progresses, the family are sometimes shocked by her behavior. Formerly the most gentle and calm of women, Mom has been making angry accusations and yelling at family members, even young grandchildren. Last week she threw a clock on the floor because she couldn’t read the time.

People who have never had a loved one with Alzheimer’s disease or other dementia often think that surely the most distressing effect of the disease would be forgetfulness. But in reality, these diseases cause personality changes that can be far more challenging than memory loss. The kindest, most patient elder may become aggressive and angry.

It’s important to keep in mind that a person with dementia has no control over these personality changes. These are symptoms caused by the disease. Yet that doesn’t mean that nothing can be done to improve the situation.

A recent study from Penn State University analyzed studies on aggression and other common behavioral and psychological symptoms of dementia (BPSD). Study author Prof. Ann Kolanowski said, “We need to learn more about the factors precipitating these symptoms, so we can design approaches and interventions that will reduce them. Not only for the benefit of the person suffering from dementia, but also the caregivers.”

Kolanowski found that most of the research on BPSD has focused on the physical causes—a person’s specific type of dementia and how far along the disease has progressed. But, she said, it’s also important to understand how a patient’s environment and caregiver interactions can increase aggression. She said, “In order to best treat people living with dementia, we need to learn more about all the possible causes of behavioral and psychological symptoms, and further research into these specific areas is needed.”

What do we know so far? In the old days, families might immediately be advised to move their loved one to a memory care facility or the person might be prescribed a powerful drug. But today, more emphasis is on understanding what a person with dementia is experiencing, and responding appropriately and effectively. Aggression and other negative behaviors are better understood as expressions of unmet needs. Your loved one may not be able to express what they want or what’s troubling them, and aggression born of frustration or fear is the result.

Here are tips from experts to help reduce and cope with aggressive behavior from a loved one with dementia:

Understand where the behavior is coming from. There is almost always an underlying reason that your loved one lashes out verbally, throws objects or tries to hit someone. They may be unable to express that they are in pain, lonely or afraid. They may be upset that they can’t remember something or perform a once-familiar task, especially if they feel pressured by someone else to do so. Their brain may be overloaded in a noisy room with too much stimulation.

Don’t argue. If the disease is causing your loved one to believe something that isn’t true—even if it is an accusation—don’t try to talk them out of it. Ask questions and allow them to express what they’re experiencing. Change the subject if you can, perhaps to a pleasurable memory from the past. People with dementia retain old memories longest, and the conversation may take a better turn when focusing on treasured times of long ago.

Talk to the doctor. A medical examination may reveal underlying causes of aggression—an infection or a painful condition that your loved one is unable to describe, the side effects of medications, sleep problems, even constipation.

Don’t take it personally. Yes, this is easier said than done. When your parent or spouse lashes out at you, it’s tempting to judge the behavior by old standards. Remember it’s the disease talking and acting. Understanding and compassion can give you the patience you need to translate what your loved one is trying to express, rather than triggering your own anxiety and anger, which can lead to a downward spiral.

Take a break. Family caregivers whose loved one has Alzheimer’s disease or other dementia cannot do it alone! It’s vital to take care of yourself. Get enough exercise, eat a healthy diet and take time for yourself. Look into dementia care resources in your community, such as a memory care community, adult day centers for people with dementia, or in-home care provided by a trained caregiver. Check out support groups—sharing ideas and experiences with others who have “been there” can provide a tremendous emotional boost.

Learn some skills. Here are some practical tips from the National Institute on Aging:

• Reassure your loved one. Speak calmly. Listen to your loved one’s concerns and frustrations. Try to show that you understand.
• Reduce noise, clutter and the number of people in your loved one’s space.
• Try to keep a routine, such as bathing, eating and dressing at the same time each day. But also allow your loved one to keep as much control in their life as possible.
• Build quiet times into the day, along with appropriate activities. Try gentle touching, soothing music, reading or walks.
• Limit the amount of caffeine, sugar and junk food that your loved one eats.
• When your loved one is aggressive, stay at a safe distance until the behavior stops.

The Alzheimer’s Association advises that if a person with dementia is a danger to themselves or others, call 911. Alert the 911 operator and responders that your loved one has dementia.