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 person might be feeling unheard or misunderstood.
- The person might be feeling threatened or frightened.
- The person might be feeling embarrassed, frustrated or annoyed because they need help to do things they used to do independently.
- The person might be asserting their own wishes when others are trying to make them do something they don’t want to do.
- The person might be in pain.
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’.
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.
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.
All SCIE resources are free to download, however to access the following downloads you will need a free MySCIE account:
- Activity: Aggressive behaviour
- What the research says: Difficult situations
Further reading Open
Berg, G. (2006) The importance of food and mealtimes in dementia care, London: Jessica Kingsley Publishers.
British Association for Parenteral and Enteral Nutrition (BAPEN) ‘Introducting MUST’, online information. The Malnutrition Universal Screening Tool is also available to download for free from the BAPEN website, www.bapen.org.uk.Coleman, G. (2009) Alzheimer’s Society guide to catering for people with dementia, London: Alzheimer’s Society.
Crawley, H. and Hocking, E. (2011) Eating well: Supporting older people and older people with dementia, London: The Caroline Walker Trust.
Malnutrition Task Force (2013) Prevention and early intervention of malnutrition in later life: Best practice principles and implementation guide, London: MTF.
Marshall, M. (ed) (2003) Food glorious food: perspectives on food and dementia, London: Hawker.
National Institute for Health and Clinical Excellence (2010) Delirium: Diagnosis, prevention and management, quick reference guide, London: NICE.
Peters, J.M., Hummel, T., Kratzsch, T., Lotsch, J., Skarke, C. and Frolich, L. (2003) ‘Olfactory function in mild cognitive impairment and Alzheimer’s disease’, American Journal of Psychiatry, vol 160, no 11, pp 1995–2002.
Useful links Open
Alternatives to antipsychotic medication: psychological approaches in managing psychological and behavioural distress in people with dementia
This 2013 British Psychological Society briefing paper sets out guidance for practitioners on how to respond to distress in people with dementia by following a ‘staged approach’: a series of steps involving identifying, understanding and implementing individualised interventions.
The Alzheimer’s Society produces over 80 factsheets on all sorts of topics related to dementia, including many that relate to difficult situations in supporting a person living with dementia: Dementia and aggressive behaviour (509), Sight, perceptions and hallucinations in dementia (520), Managing toilet problems and incontinence (502), Walking about (501), and Sex and intimate relationships (514).
Dementia: Supporting people with dementia and their carers in health and social care
This 2006 guideline jointly published by the National Institute for Health and Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) offers comprehensive best-practice advice on the care of people with dementia and on support for carers.
Positive and proactive care: reducing the need for restrictive interventions
The Department of Health’s 2014 guidance on restraint is aimed at all health and social care staff working with adults in England.
Related pages from this section Open