What to look for?
Aggression | Common Signs
- Yells, shouts or screams
- Physical outbursts against the caregiver
- Verbal outbursts against the caregiver
- Physically attack others (e.g kicking, punching, hitting)
- Verbally attacks others (e.g shouts, insults)
- Causes injury to themselves
- Causes injury to others or the caregiver
- Physically or verbally threatens the caregiver or others
- Resists and refuses assistance with verbal outburst
- Resists and refuses assistance with physical outburst
Aggression | General Description
Aggression can occur at any stage in dementia, although typically it is associated with the moderate to severe stages . Acting out in hostile and aggressive ways can occur without warning or provocation, or can occur as an overreaction to distressing things in the person's environment. Sometimes, aggression can be understood as an extreme way of expressing feelings of resentment, anger, or frustration. The person with Alzheimer's disease is often frustrated about the diagnosis of the disease, their declining abilities and their increasing reliance on a caregiver. Aggression can take verbal or physical forms. Sadly, these are most often directed towards the caregiver. The person you care for might feel humiliated or frustrated that they require assistance to complete personal tasks or tasks they were once able to complete independently. This can happen even when that care is provided with great skill or even love.
The person you care for also may lash out verbally or physically because of feelings of suspicion. Often, these feelings are not controllable. In such cases, they are an example of the symptom of delusions/paranoia. Aggressive actions may also be a response to feelings that they are being criticized or judged because they are completing a task slowly or incorrectly as a result of their decreased abilities.
If the person you care for has difficulty communicating, physically expressing him or herself through kicking or hitting may be the only way that they can convey how they are feeling. Especially as the disease progresses to the moderate or severe stages, aggression happens when they are frightened by their surroundings. They can feel lost or threatened, not recognizing the people who are around them. This understandably makes the people around them feel upset and the patients then pick up on this and react to those feelings.
When things go wrong like this, they can go very wrong, because a vicious cycle has started. Being able to break this vicious cycle is a great skill, so if you are in this position, it is very likely that you will need expert help.
People with Frontotemporal dementia commonly experience a major change in their personality and behaviour. Often a gentle calm person may become increasingly hostile and aggressive towards family and friends. These behaviour changes are the most difficult for caregivers to deal with. This behaviour change is further complicated by the fact that the person with Frontotemporal dementia does not identify with the fact that their behaviour has changed. Where the potential for aggression is present, the caregiver must learn to notice the early signs of agitation and make appropriate changes to the person's environment to reduce the risk of aggression (e.g. decrease the stimulations of a noisy television or yelling children by moving the person to a quiet setting).
When a person is actively aggressive, the caregiver should have a plan of safety for him/herself. This may require the caregiver to actually move to a safe place (for example, a bathroom with a lock or leave the home entirely and go to a neighbour's home). Having a family member or friend who you can call anytime to come over to defuse the situation or stay with you as protection is also helpful.
In Lewy body dementia, and in some types of vascular dementia where hallucinations occur, aggression can be a sign that the person is acting on the hallucinations that they are experiencing. In such cases, treating the hallucinations is an important part of treating the aggression.
It is important that caregivers know that they do not have to accept violence or aggression from a loved one and that social agencies are in place to help protect them. These are often the most difficult calls for the family to make. In general, families want to protect their loved ones at all costs - even if that person is harming them. Your local support organizations and agencies are familiar with these concerns - they will help you through this decision making.
The first step in taking a more active role in symptom management is understanding how a symptom is affecting everyday life; the next step is communicating this knowledge to the care planning team and family members. SymptomGuideTM is designed with these goals in mind.