Understanding Alzheimer’s aggression
In order to understand the phenomenon known as “Alzheimer’s aggression”
or “Elder Rage”, as author of the book with the same title Jacquelin Marcell
calls it, takes a bit of background information. For one thing, it is not
necessarily caused by a single factor. Yes, a patient may have been officially
diagnosed with Alzheimer’s disease, but this does not mean that the damages
done by the disease itself are what lead to aggression.
Consider that of the 4.5 million people diagnosed with Alzheimer’s each
year; at least half of these folks will manifest some sort of Alzheimer’s
aggression. This can be something as simple as hostile or strange vocalizations
to full-blown hitting, biting, and punching. Clearly, there will usually be a
reason for this sort of behavior, but each person will be different.
Most medical professionals now understand that Alzheimer’s aggression can
be indicative of physical discomfort that results from common medications (for
example, many of the anti-anxiety medications often given to patients can cause
headaches and nausea), it might be caused by delusions and/or neuropsychiatric
symptoms, or it could be triggered by the return of memories or emotions that
were from long before. In fact, Alzheimer’s aggression can be something as
simple as frustration with an inability to communicate or remember something,
and this leads to irritation and a “lashing out” at those around them. Often,
this is particularly the case when an Alzheimer’s patient has lost the ability
to communicate easily or clearly.
So, the first real step in understanding Alzheimer’s aggression is to
identify the “trigger”. Interestingly enough, this often helps the caregivers
to find a bit of peace and comfort because it helps to prove that the Alzheimer’s
aggression is not directed at them “personally”.
So often, an adult child or primary caregiver experiences enormous
emotional pain when they feel that a person is physically attacking them or
directing anger and rage at them. Simply, working at identifying the trigger
for Alzheimer’s aggression usually allows them to actually eliminate themselves
from the proverbial equation. Unfortunately, the process by which triggers are
identified can often take a substantial amount of time.
Dealing with
Alzheimer’s aggression
Dealing with
aggressive behavior is not easy, and there are no simple solutions to it.
However, it is possible to make it less of a problem through a gradual process
of identifying what triggers the aggression, and finding some effective ways to
deal with it. It is important to remember that all behavior is a form of
communication. If we can establish quickly what the person is trying to
communicate, it may prevent them from feeling frustrated and acting
aggressively towards us.
The most important
advice to caregiver is: Don’t take it personally. This is a hard thing to do,
but you have to remember that you are dealing with a person who is manifesting
the symptoms of a disease. It isn’t personal to them either.
Any form of
aggression can be upsetting, but the most important thing to remember is that
the person is not being aggressive deliberately. The behavior may appear to be
targeted at you, but that is probably just because you are the one that is
there at that particular moment. The fact that the person is aggressive towards
you doesn’t mean that their feelings towards you have changed − just that their
reactions have become different as the structure of their brain has changed.
So, what can someone do to help a loved one suffering from the condition
and also lashing out with Alzheimer’s aggression? There are currently some
prescription medications given to patients with “dementia” but most are still
in the testing phases or considered questionable. They come in a range of
intensities and can reduce some incidents of Alzheimer’s aggression, but most
physicians recommend that the “first line” of defense begins with individual
patient-oriented strategies.
For example, if Alzheimer’s aggression is triggered by anything from
hunger, fear or confusion, to actual anger or physical discomfort, it is
necessary to find ways to address and/or eliminate all of the possible issues.
This might be through actual, physical methods or it can be through thought and
patience.
As you observe your
loved one, you may need to look for signs of a pattern or of side effects from
prescribed drugs. These observations will help the doctor to make a final
diagnosis and plan a treatment routine. Your doctor may have questions or
comments pertaining to your case. As you care for your loved one, try to
observe him or her closely in order to answer the following questions:
- Do you notice any pattern to the
behavior?
- Does the behavior occur at any set time
of day?
- Does it occur after your loved one
takes a certain drug?
- Does it occur when he or she is hungry
or frustrated?
- Does the behavior come out only when a
certain person is present?
- When you first noticed the problem, did
you notice any other changes in the way your loved one was acting?
- Were any big changes occurring in the
home at that time?
- Did you move?
- Did anyone move in or out?
- Did anyone in the family die or become
ill?
- Did you make any changes in care
arrangements?
- Has your loved one started any new drugs
or changed drug dosage?
- Has your loved one suffered a recent
injury?
Be sure your doctor
knows all the drugs that your loved one takes, even over-the-counter drugs.
General advices for those dealing with family or friends showing bouts of
Alzheimer’s aggression are to:
- Learn
diversionary tactics – if you suspect a “trigger”, such as a behavior (on
your part) that seems to make them react, it is up to you as a caregiver
to stop and step away from them in the most appropriate way possible.
Never try to argue the point, just try to distract the patient from the
issue and then get them into another or a new line of thought. For
example, if the person seems to become upset when their clothing is
removed, you cannot avoid bathing them, but you can speak the words such
as “Here, let me get you ready for a warm bath,” and then move directly
into the bathing process. Don’t quit at the first signs of trouble, but
definitely bring the issue to a close if there is an escalation of
aggression from them. Keep
a written list of things he or she likes (such as going for a walk,
listening to music, having a snack) and offer these as diversions.
- Don’t
forget signals – when your diversionary tactic is failing, it is a time to
use the gentlest tones and the most reassuring touches you can. If you can
put a sincere smile on your face, and try to convey that “all is well”
through touches and expressions, it often calms a patient down at a
remarkably hasty pace.
- Consider
communication – many Alzheimer’s patients lash out violently because they
cannot remember something, they have forgotten where they are, or what a
common item is for, or because they cannot communicate an idea clearly. If
you make a point of putting labels and signs on everything with which they
interact, you are going to greatly reduce the times when their lack of
memory triggers a reaction. This can go so far as leaving lists of things
“to do” in obvious places. For example, it is often a good idea to put a
few words on a piece of paper tacked to the outside of the kitchen
cabinets. These might be as simple as “Food and Snacks” that helps them to
easily remember where they are and what they were doing.
- Focus on
the past – communicating with the patient, remember that Alzheimer’s strongly
affects short-term memory. It’s often easier - and less stressful - for
someone with Alzheimer’s disease to recall and talk about distant memories
than it is for them to remember what they watched on TV the night before.
- Stress
factors - limit the amount of the generally recognized stress factors for
the Alzheimer’s patients as loud noises, frenetic movement, and clutter. Remember
that they may be easily frightened by a sudden noise, sharp voices, abrupt
movements or a person approaching them from behind without warning.
- Get into a
routine – along with signs and notes, a solid routine is another fantastic
way to help overcome moments of aggression. Not only does this reduce the
opportunity for unexpected events, but it also ensures that hunger or
bathroom related aggression is kept to a minimal level too.
- Validation
– when an Alzheimer’s patient is upset, angry, or severely frustrated,
don’t argue with them about this. The last thing anyone wants to hear is
“there’s no need to be so angry/sad/confused” when they don’t have any
control over the issue or the environment. Instead, you MUST tell them
that it is perfectly fine to feel as they do, and then work with them to
get through the moment. Again, this is best done with reassuring words and
gestures.
- Try a bit
of logic – if the patient has a relatively calm demeanor about a
situation, you can actually ask them to think a bit about a situation to
see if that helps resolve the issue. Try and stay calm, while also
providing reassurance and support at all times. It is important the person
understand you are not upset and you are there to help.
- Safety - check the entire house and remove any
object that your patient might use as a weapon. Stand out of range and, if
you feel that your loved one may injure you, leave the room. Experts do
not agree about physically restraining a person during a violent outburst.
If you are strong enough to restrain your patient, you might try doing so.
The danger is that you might frighten or further anger him or her, making
the situation worse. If your patient struggles, there is the chance that
one or both of you could be hurt.
- Nothing is
working? – the most common cures for the moments when a patient refuses to
calm down include, ignoring them if they cannot do harm, trying to find a
bit of humor in the moment, putting on a bit of soothing music, and making
notes about the situation in order to help determine a better outcome for
the next time that it occurs. If aggressive incidents are frequent or
worrying, discuss them with a professional, such as a psychiatrist specializing
in older people or a community psychiatric nurse. They may be able to
offer support and suggest other ways of handling the situation.
Sources and Additional Information:
