What is aggressive behaviour in dementia?


Aggression is a common challenging behaviour seen in dementia patients. Aggressive dementia can manifest in the physical or verbal form. Physically, patients may attack the caregiver. They can hit and throw objects, kick, pinch and scratch, bite and pull hair. Verbally, they may become abusive and curse, yell insults and threaten the caregiver.

This behaviour is very disturbing for both the patient and family. The severest form of aggression in the dementia patient is physical aggression. Residing in a community, this type of behaviour has serious consequences. This aggression may lead to mental suffering, injury, hospitalisation, and increased need for an assisted living or admission to institutional care settings. Aggression in dementia patients can affect the carer too, increasing their burden and causing other consequences. The carer may become depressed, mentally exhausted, or maybe injured because of an assault, which may in turn lead to elder abuse.

What are the causes of aggression in dementia?

  • Developing symptoms of dementia – Confusion, forgetfulness, and decreased cognitive function are some of the earliest and most important signs of dementia. All these are interconnected and have long-term consequences. The inability to understand and adapt to the surrounding changes often increases confusion in dementia. Additionally, worsening communication can cause additional confusion. Patients cannot express well what they feel, their needs, and their emotions. The result can be that they become agitated and manifest aggression.
  • Psychotic Symptoms – Psychotic symptoms, i.e. distortion of reality, such as delusions, paranoia, and hallucination worsen dementia. These aggravate agitation, and ultimately aggression. Psychotic symptoms are seen more frequently in Lewy body dementia.
  • Brain Injury – Dementia is a manifestation of impaired brain activity and the resultant misprocessing of the neuronal signals. Different types of dementia affect different regions of the brain. For instance, frontotemporal dementia affects the frontal and temporal lobes, which are responsible for emotions, impulse control, memory, understanding language, personality, and motor function. Aggressive behaviour develops earlier in these patients. On the other hand, Alzheimer's dementia, in which the damage is nearer to the back of the brain, shows dementia symptoms more in the memory functions.
  • Poor dietary intake – Some studies have also shown that poor dietary intake in dementia patients can increase problematic behaviours, such as aggression.
  • Other causes
    • Other common causes of aggression in someone with dementia:
    • Improper sleep, disruption of sleep, and sleep deprivation
    • Fatigue
    • Pain, illness, or fever
    • Adverse effects of medication
    • Impulsive behaviour
    • Impaired hearing or vision

What does aggression in dementia mean?

Aggressive behaviour by a dementia patient can indicate the following emotions:

  • Feeling unprotected – the involvement of a caregiver in the daily task such as bathing, dressing-undressing, and helping with personal care make the person feel insecure and helpless. The loss of independence may upset them and show in the form of aggression.
  • Frustration – the inability to take care of themselves can cause a sense of failure and increases irritation, which may manifest in the form of aggressive behaviour.
  • Confusion – worsening cognition affect the orientation to surroundings. The person can feel lost, leading to a sense of bewilderment.
  • Feeling afraid – inability to recognise certain places and faces develops fear in the person. The unfamiliar places also increase confusion in these patients. Sometimes, a certain place or a person makes them recall an unpleasant or frightening memory.
  • Needing attention – severely affected communication skills in dementia render a patient helpless when they want to communicate something.

How to identify aggression in dementia?

The aggressive symptoms may vary in different patients. If your loved one is manifesting problematic behaviour, look for these early signs of dementia aggression:

  • Anger
  • Loss of impulse control
  • Raised voice
  • Increased agitation
  • Throwing objects
  • Yelling and screaming
  • Threatening
  • Hitting
  • Lashing out
  • Kicking

When does aggression start in dementia?

Aggression usually starts in the mid-stage of dementia. This is the time when other behaviours, such as hoarding wandering, and compulsive behaviour are also prone to develop. In most types of dementia, the aggressive symptoms occur when the patient becomes more dependent with daily activities. This can create a sense of helplessness; the inability to communicate and call for help can trigger anger and agitation.

How do you deal with aggressive behaviour in dementia?

Coping with aggressive dementia patients at the time of aggression is clearly challenging. It is important to control your frustration and manage your exhaustion. There are various interventions and best practice to help with challenging behaviour and aggression in dementia.

Here are some tips to help you deal with aggression in dementia:

  • Give them space. When your loved one is agitated and is showing aggression, give them some time. Sometimes simply what a patient wants is his/her privacy.
  • Control your frustration in front of them. If your loved one is angry, you don't have to react similarly. Have patience and be considerate of them. Take a deep breath and do not let your anger out. Keep your voice even and balanced. Try and walk away and get some space.
  • Keep the environment calm. Unnecessary noise and improper lighting irritate dementia patients, especially those who have a hearing impairment and deteriorating eyesight. Turn off the TV and draw the curtains.
  • Do not raise their voice as this only makes the situation worse.
  • Turn on soft and soothing music. This has been of great help for managing many different symptoms of dementia.
  • Try massaging, yoga and meditation, aromatherapy, and other calming activities.
  • Try to identify triggers for the behaviour and remove the trigger.

How to prevent aggression in dementia?

To prevent aggressive behaviours in dementia patients following tips can help.

  • Understand. Try to acknowledge their feelings. Comprehend what they are trying to say and what they want.
  • Do not do distressing activities around them. Involve them in creative activities but do respect their likes and dislikes.
  • Identify any organic cause. Discuss with a doctor, if there is any illness or pain that is causing aggressive behaviour. Get treatment for any prior or new illness such as a urine infection. Change or revise medication, if necessary.
  • Make things easier for them. Label rooms, belonging, and other items to decrease confusion.
  • Talk with them. Provide companionship. Don’t talk to them in a high-tone voice.
  • Try to provide them care at a place where they have spent most of their life. Avoid unnecessarily taking them to the gatherings as unfamiliarity increases confusion.
  • Keep a good check on their general well-being. Make sure they eat healthily, remain hydrated, and are exercising regularly.
  • Understand their routine, make a schedule and give care accordingly.

Being a caregiver, take equal care of yourself equally. Eat healthy, exercise, try meditation and keep yourself calm. If you feel taking care of your loved one is compromising your wellbeing, try speaking to a counsellor or contacting charities such as the Alzheimer’s Society.

Care options for aggression in dementia

Caregiving to dementia patients requires a lot of effort, time, and patience. Depending on the stage of dementia, these patients exhibit different symptoms which are managed accordingly. In the mid-to-late course of the disease when the patient starts showing aggression, caregiving becomes challenging. At this point, both the patient and family can suffer a lot. At Hometouch, we believe in empathy and compassion. The different care options for aggression in dementia are:

Live in Care for Dementia Aggression:

In this, a professional caregiver resides with a dementia patient in their own home. This option is more feasible for the aggression experienced by dementia sufferers. One of the causes of aggravation of dementia symptoms is unfamiliar surroundings and people. The inability to recognise the location and unfamiliar faces increases confusion in patients and ultimately worsens symptoms. When a live in carer resides with the dementia patient, matters can often settled down.

At Hometouch, our professional caregivers for dementia are experts in providing round the clock care. They help the patient with their daily tasks, provide companionship, takes them to social gatherings and doctor's appointments. They are also trained to manage anger, agitation, and aggression in dementia.

Care homes for aggressive dementia patients:

When the dementia patient becomes increasingly aggressive and is harming themselves and the people around the, admission to a care home may be required. The staff here are trained to handle the aggressive behavioural symptoms of dementia. The capability of the institute's staff to handle the emotions of your loved ones tells how helpful a caring home will be for them.

  • The caretakers in nursing homes for aggressive dementia patients provide companionship. They form an emotional connection with your loved ones, so the patients don't feel strange.
  • They also have doctors and nurses who deliver the nursing care plans for aggression in dementia.
  • They know how to tackle the mood changes and try to understand the likes and dislikes. Carers try to avoid activities that increase confusion and agitation in the dementia patient.
  • They know how to communicate and understand what a dementia patient wants or needs to say. They also teach and encourage them to communicate with others.
  • The care includes 24-hour care. They help with domestic tasks, such as bathing, washing, eating, dressing-undressing and taking medicine, etc, while maintaining the patient's dignity and independence.

FAQs

What happens when a dementia patient gets too aggressive?

This aggression may lead to mental suffering, injury, hospitalisation, and increased need for an assisted living or admission to institutional care settings.

What dementia makes you aggressive?

Aggression can occur in any form of dementia. However, depending on the type of dementia, the time of presentation of aggression varies.

What factors contribute to aggression with dementia?

Decreased sleep, illness, pain, boredom, unfamiliar surroundings and people, emotional distress, and increased confusion are some of the factors that contribute to aggression with dementia.

What is not a common cause of aggression in dementia?

Psychotic symptoms, such as hallucination, delusion, and paranoia, leading to aggression, are not commonly seen in all types of dementia. These occur more frequently in Lewy body dementia but can also occur in Alzheimer’s less commonly.

What type of care home is best for dementia with aggression?

Dementia care homes and EMI (Elderly Medical Infirm) Nursing homes are specialist nursing care homes that provide 24 hours care by specially trained professional staff. The carers here are trained to manage and control different behaviours of dementia people including aggression.

Which shows more aggression Alzheimer’s or Lewy body dementia?

Lewy body dementia is associated with some severe symptoms such as psychosis. Because of these symptoms, Lewy body dementia can show more aggression than Alzheimer's dementia.

How far into vascular dementia does someone get aggressive behaviour?

Aggression in dementia of most types such as Vascular dementia, Alzheimer's dementia, and Lewy body dementia, starts in the mid-to-late stage.

How is aggression in dementia different?

Aggression in dementia may manifest as physical or verbal abuse. Physically, these patients throw objects, hit, bite and can assault the caregiver. Verbally, the patient may threaten, shout and use abusive language.

How many people with dementia show aggression?

One-third of the patients diagnosed with dementia show aggression.

Is it wrong to leave a physically aggressive dementia with a spouse?

People taking care of dementia patients at some point may feel frustrated and exhausted, which is normal. The nursing home that cares for dementia patients are created with the vision to provide home-like care to your loved ones and make them feel alive again.

Is early-onset dementia more aggressive?

Early-onset dementia can lead to more pronounced behavioural and psychological symptoms than late-onset dementia.

Dr Jamie Wilson
Founder and Chief Medical Officer at Hometouch
Dr Jamie Wilson is hometouch’s founder and Chief Medical Officer. Jamie’s creation of hometouch was inspired by his work as a dementia psychiatrist in the NHS, and he has written about healthcare issues in The Times and the Evening Standard. Jamie has a MBBS from the University of Leeds and has spent a decade in the NHS, working as a Psychiatric Registrar and Memory Specialist at Imperial College Hospital.