How to Handle Dementia Outbursts from the Elderly

A caregiver is typically a special type of person, they are kind, caring, compassionate, and have a general nature of caring for people, and they can generally handle anything that needs to be done for the care of another person. It is difficult and sometimes deeply upsetting when a senior you care for is verbally or physically aggressive on a regular basis, but understanding what causes these outbursts and how to redirect and let go of the pain will help both you and the senior you are caring for move through the outbursts.

Knowing the cause of aggression, how to react in the moment and ways to reduce incidents of aggression can help you cope.

One of the first questions you want to ask yourself is: What is Causing the Aggression?” Unfortunately, aggression in seniors with dementia is common and finding the trigger is not always easy. It is important to be aware that depending on the stage of dementia, the senior may not be able to communicate their needs to their caregiver which can be a trigger to an episode. At the moderate to severe stages of dementia a person may also have difficulty understanding what behavior is socially acceptable. These are just a few of the issues caregivers face when dealing with a moderate to severe level dementia senior.

There are three basic triggers that can aggravate a senior and set them off into an aggressive outburst, they are; biological, social and psychological.

Biological Triggers

–              Pain or Illness

–              Difficulty Hearing or Seeing

–              Hallucinations or Delusions

–              Physical Discomfort

–              Medication

If these triggers cause aggressive behavior, talk to your senior’s physician about the issues, make sure to note triggers, time of day, how long the episode lasted, and how the senior was redirected.  Your doctor will help rule out some of these biological triggers. If the senior is on medication, perhaps it needs to be adjusted or changed. Or, maybe a new medication can help. Talk to your doctor about a treatment and care plan for your loved one. Remember to act as their care advocate and ensure that any medication they are on is safe, if not over prescribed and is effective.

Social Triggers

–              Confusing or unfamiliar settings

–              People who remind the senior of someone from their past

–              Someone or something that causes fear

–              Large, unfamiliar crowds

–              Boredom

–              Feelings of loneliness, mistrust, anxiety and paranoia

A number of social triggers can confuse, upset or cause fear for a senior who may react aggressively. Although not all of these scenarios can be controlled or reduced, when you understand the trigger you can address the aggressive behavior in a more understanding and knowledgeable way. Knowing the trigger may help you to avoid or at least diffuse the situation more effectively.

Psychological Triggers

–              Memory loss

–              Difficulty processing information

–              Loss of touch with reality

–              Paranoia

–              Fear

–              Anxiety

Psychological problems resulting from dementia can lead to misunderstandings, misperceptions and difficulty communicating. These psychological symptoms often cause frustration and aggressive outbursts. Again, you may not be able to avoid or reduce these triggers but knowing the cause may help you take command of the situation before it escalates into a serious aggressive outburst.

What You Should Do When a Senior with Dementia Acts Aggressively

Sometimes it is easier to say than do, but when it comes to an aggressive outburst from a senior, there are some things you can do to help yourself and the senior through:

–              Take a deep breath and try not to get frustrated or take the aggression personally (yes, this is hard but don’t give up).

–              Acclimate to the viewpoint and wishes of your senior.

–              Remain composed, even if it means stepping out of the room.

–              Do not show anger, fear, alarm or anxiety, even if you feel it. Showing these emotions could increase the senior’s aggression or agitation and escalate the situation.

–              When you talk use a soft, calm voice.

–              Acknowledge the senior’s feelings and listen to what they are saying. This will help you try to understand and determine the trigger while also showing that you want to help.

–              Look the senior in the eye while talking, it is important to keep eye contact.

–              Attempt to identify what is causing the outburst.

–              Redirect or distract the senior if you are unable to resolve the outburst or eliminate the trigger all together.

–              Give them the space they need in the moment.

Afterwards, you should:

–              Always focus on the person, not the behavior

–              Do not make the senior feel bad or punish them for their behavior, and do not try to reexamine the event with them (they may not remember it and revisiting it could upset them again)

–              Be reassuring while carrying on as normal, the senior may still be confused or even a little agitated; acting normal will help deflate the situation.

–              As a caregiver, having a sounding board to talk to about the incident will help. Talking about it will help you gain perspective and maybe find a way to help handle or reduce the outbursts.

–              Take care of your own emotional needs and seek the help of your doctor, family members, community support groups, and counsellor or dementia support worker

How to Reduce the Instances of Aggression

There are additional therapeutic approaches you can take once you and the senior’s doctor have ruled out biological causes and/or been unsuccessful resolving the trigger.

–              Regular physical activities: Exercise is a great option for you and your senior because it can help you both relieve stress, combat boredom and encourage good health. Even a short, daily walk can make a huge difference to the emotional state of someone with dementia. Always ask your doctor before implementing a new exercise regime.

–              Social interaction: Spending time one-on-one with individuals can help combat loneliness. If you don’t have family or friends to help there are many local programs through which you can connect with volunteers who can give you a break while spending quality time with your senior. There are also Adult Day Care Programs that will help stimulate your senior, and allow you a little break.

–              Stay busy: Watering plants, folding laundry, organizing pictures, or even just reorganizing an area of the home are good ways to keep your senior occupied, feeling useful and may help improve their overall mood.

–              Music therapy: Calming music is a great way to get someone to relax and many music therapy programs have proved to help combat the effects of dementia. Try adding music to your daily routine, especially at times where you are faced with unavoidable triggers (like bath time).

–              Art therapy: Art therapy is calming and may help your senior find new ways to communicate or express their emotions, thoughts and feelings.

–              Pet therapy: Many cats and dogs are trained to be companions to seniors with dementia. Studies show that the simple touch and love of these animals can help decrease aggressive behavior in seniors with dementia.

–              Doll therapy: Doll therapy is a new form of therapy in which a patient with dementia cares for a doll as if it were their child. A study found that doll therapy is an effective approach when trying to increase positive behaviors and decrease negative behaviors in Alzheimer’s patients.

If you are caring for a senior with dementia that has aggressive outbursts the most important thing is to remember to seek help. You don’t have to deal with this extremely stressful and distressing situation on your own.

Don’t be afraid to share what you’re going through with your doctor, friends and family and ask for their help. Your local Alzheimer’s Society can also offer support, help and advice. Remember, it’s important that you take care of yourself so that you can better care for your senior.

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