Dementia affects people in different ways and changes in the behaviour or emotional state of someone living with dementia are common.
Aggressive behaviours can be:
- verbal, including swearing, screaming, shouting and making threats
- physical, including hitting out, damaging property or physical violence towards another person.
These can be distressing for the person with dementia, their family, carer and friends.
There are many reasons why behaviours change. Every person living with dementia reacts to circumstances in their own way.
Sometimes the behaviour may be related to changes in the brain. There may be something in the environment, such as overstimulation due to crowds or noise, that triggers the behaviour. Other times, a task may be too complex, or the person may not be feeling well or feeling pain.
Understanding the causes of the behaviour can help you find ways to minimise or respond to changes in behaviour.
Some causes of aggressive behaviours in someone living with dementia are:
Health. Aggressive behaviours may be caused by changes in health, including:
- tiredness due to disrupted sleep
- physical discomfort (such as pain, fever, illness or constipation)
- physical changes in the brain
- adverse side effects of medication
- impaired vision or hearing causing misinterpretation of sights and sounds
Feeling defensive. A feeling of humiliation when being supported with personal care (such as bathing). The person may feel their independence and privacy are being threatened.
Failure. Someone may feel pressured, embarrassed or frustrated when they can no longer carry out routine tasks.
Misunderstanding. Declining abilities can lead to a lack of understanding about what is going on around them, causing bewilderment and distress.
Fear. The person may be frightened because they no longer recognise certain places or people. Or they may have recalled a past life experience that is frightening or uncomfortable to remember.
In need of attention. You loved one may be trying to let someone know that they are bored, distressed, have excess energy or feel unwell, but are unable to due to declining communications skills.
Tips to minimise aggressive behaviours
Always discuss concerns about aggressive behaviour with the person’s doctor. They can check for physical illness or discomfort and provide advice. The doctor can also look for underlying psychiatric illness or possible side effects of medication. Be aware of any specific warning signs of aggression.
- Reduce or remove possible causes of stress.
- Try to maintain an unrushed and consistent routine.
- Keep the environment consistent and minimise changes.
- Avoid overstimulating environments, such as lots of people or background noise.
- Communicate in a way that matches the person’s abilities to understand and respond.
- Avoid confrontation. Try distractions or suggest a different activity.
- Encourage regular exercise and participation in enjoyable activities.
- Maximise feelings of comfort and safety.
Despite your best efforts, some aggression may still occur.
Ways to respond to aggressive behaviours
Stay calm and speak in a reassuring voice.
- If possible, address the underlying feeling that has triggered the aggression.
- Distraction is often a useful approach. Suggest having a cup of tea, going for a walk or looking at a magazine together.
- Stand out of reach if you feel unsafe.
- Do not crowd or use restraint, unless necessary. This can increase aggression. You may need to move away until the person has calmed down.
- Share strategies for responding to aggressive behaviours with others involved in their care to support consistent approaches.
Aggressive behaviours can be very distressing for families and carers. The behaviours are symptoms of dementia and are not meant to deliberately upset you. Remember to look after yourself and take regular breaks from carer duties.
Look after yourself
Aggressive incidents may leave you feeling shaken, unsafe, anxious, frustrated, depressed or a range of other emotions.
- Try to remain calm.
- If you regularly become frustrated or lose your temper, you may need extra support. Talk to a doctor, friend or counsellor.
- Prepare a safe place for yourself. This may be a room that locks from the inside, preferably with a phone.
- Take regular breaks from carer duties.
Where to get help
- Discuss with the person’s doctor your concerns about changes in behaviour, and the impact on you and the person you care for.
- Call the National Dementia Helpline on 1800 100 500 to learn about support services and education programs, including carer support groups, counselling, and services and programs to assist you to understand and respond to changes and maintain your health and wellbeing.
- Call the Dementia Behaviour Management Advisory Service on 1800 699 799. They support people living with dementia who experience changes in behaviour that impact their care or the carer.