Aggressive behaviour from people with dementia

Being on the receiving end of aggression is often frightening and distressing. When this has come from a person we are trying to help, we may also feel hurt and rejected. But if the person has dementia, we need to be aware that such behaviour is unlikely to be a deliberate act of aggression – in fact, it is much more likely to suggest fear or desperation.

When we realise that aggression is usually a reaction, there’s good news – we can do something about it.

A reaction – not a symptom

Aggressive behaviour is by no means a common response from people with dementia. Only rarely is it actually a symptom of the dementia. If aggression does occur, the most likely reason is that the person is reacting to a distressing situation – for example, they are being stopped from leaving their own home or being helped with bathing by a person they do not recognise who has not explained what they are doing. The starting point in understanding aggressive behaviour from a person with dementia is to consider what might be going on from their point of view.

Why is this happening?

Some reasons why a person with dementia might be aggressive include:

The message behind the behaviour

Because of the way dementia affects the brain, the person may have lost some of the inhibitions that would have prevented them from showing their feelings in this way previously. But the feelings being expressed now are important because they represent the person’s way of saying something significant. And we need to understand the message. This could be, for example, ‘I feel like a prisoner’, ‘I’m frightened – I don’t understand what’s going on’, ‘I’m in pain’, or ‘I’m so frustrated’.

Responding effectively

When we look for the message behind a person’s behaviour, we are well on the way to finding an effective response. The important thing is to try to see things from the person’s point of view.

It might be that we can do something different straight away to respond to the person’s feelings, for example, we could take a walk around the garden with the person who is feeling trapped. (See the Gardens feature in the Dementia-friendly environments section.) Or perhaps there’s nothing that would help immediately, but we can put plans in place to sort out the issue that has upset the individual. For instance, if we realise that a person’s aggression comes from feeling frustrated about things they can’t do now, it will be vital to find things that the person can still do, and encourage them to use these remaining strengths as much as possible.

Learning and improving

We may need to face up to the fact that there’s something we did – without meaning to – that brought on the person’s difficult feelings and reaction. For example, we may realise that we have been focusing on the personal care task we’ve come to do, but forgetting that the person’s poor memory and problems with recognition mean that they don’t know who we are or what we are doing. So we need to slow down, introduce ourselves, help the person feel safe and secure in our company and explain our intentions. We shouldn’t blame ourselves, but it’s important to keep learning.

For more on these ideas, look at the section on Communicating well.

Individual differences

We might find out something about the person’s background that explains why they react as they do – for example, someone who was once the victim of a mugging may become frightened if they are approached from behind. We might simply find out, through picking up the messages communicated through behaviour, that there is a specific way an individual needs things to be done. One person may need her food to be cut up before it is served. Another may feel very distressed when he is not wearing a tie.

When we realise that aggression is usually a reaction, there’s good news – we can do something about it. And when we work out what has been troubling the person with dementia, we may well be able to prevent a similar situation from occurring again.

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