People with dementia may sometimes behave aggressively, either physically or verbally, and this can be very distressing for the person and for their carer, family and friends.

What is Aggressive Behaviour?

Aggressive behaviour is not unique to people with dementia.  However, more than one third of people living with dementia have at times behaved aggressively, particularly in the moderate to severe stages of the condition.  There are reasons why a person with dementia may act in an aggressive way.

 Aggressive behaviour can be very stressful and upsetting for the person with dementia and their carers.  It can also be a factor in the decision to move the person with dementia into a care home.

 Aggressive behaviour may be:

• VERBAL, e.g. swearing, screaming, shouting, making threats, or 
• PHYSICAL, e.g. hitting, punching, scratching, hair-pulling, biting 

 Aggression may be linked to the person’s personality that can result from dementia.  Other behaviours that challenge include agitation, restlessness, walking about and being sexually inappropriate.  It can also be hard for carers to deal with restlessness, repeated questioning and being followed around.

 Tips for Carers:  Reacting to Aggressive Behaviour:

At the time:

It is often necessary for you to make changes to how you approach the situation.  It is important to adapt to the perspective and needs of the person with dementia.  It can be frustrating but it is important to understand that reasoning or logical argument are unlikely to result in insight and change on the part of the person with dementia. 

Before you react, take a deep breath, step back to give the person space and take some time.  You may need to leave the room until you have both calmed down.

 Try to stay calm and avoid any potential confrontation.  A heated response may make the situation worse.

 Try not to show any fear, alarm or anxiety, as this may increase the person’s threatening behaviour.  If the person’s behaviour is physically violent, give them plenty of space and time.  Unless it is absolutely necessary, avoid closing in or trying to restrain someone, as this can make things worse.

 Reassure the person and acknowledge their feelings.

 Try not to take the behaviour personally – the person is most likely trying to communicate a need, not attacking you on a personal level.  If you find the cause of the behaviour, you may be able to prevent future incidents.

 Listen to what they are saying.  This shows that you are not against them and that you want to help.

 Maintain eye contact and try to explain calmly why you are there.

 Encourage communication.

 Try to find out what is causing the behaviour.

 Try to distract their attention if they remain angry.

 Ask yourself if whatever you are trying to do for the person really needs to be done at that moment.  If you are able to give them space, come back later and try again – you may be able to avoid a confrontation.

 After the Incident:

Don’t punish the person for their behaviour, try to carry on as normal and be as reassuring as possible.

 Focus on the person, not the behaviour that they displayed.  They may still be upset and distressed after the incident.

 Take some time and talk through your feelings with others – for example, the GP, family, counsellor or dementia support worker.

 Bottling up your feelings may make it harder to care for the person with dementia and also mean that you find yourself focusing on the behaviour instead of the person.

 The person may forget the behaviour and, if you punish them for it after the incident, it may lead to them becoming upset and distressed.

 The Problem-Solving Approach:

A problem-solving approaching may help manage the aggressive behaviour.

The first step is to define the problem:

• Is it the behaviour of the person with dementia that is causing the problem?
• Is it the reaction or attitudes of other people?
• Is it the living situation?

What are the other factors? 

• Is the person in pain?
• Are they getting enough stimulation?
• Is the environment suitable? 

Next you should consider the situation:

Look at all the circumstances that might be contributing to the problem

• When and where does the problem happen?
• Does the person always act in the same way in the same place?
• Does it always happen with the same person or in similar circumstances?
• Who are the other people involved?  Visitors, a family member, a friend?

Look for patterns of behaviour.  It may be helpful to make a diary of when aggressive behaviour occurs, noting down everything that was going on at that time that could have triggered the behaviour.

Assess the person in the situation.  Are they:

• Unwell, in pain, uncomfortable?

• Overtired, overstimulated, bored, anxious or frustrated?

• Embarrassed, ignored, misunderstood, feeling patronised?

• Delusional, having hallucinations, depressed?

• Under-stimulated, lacking in social contact?

• In a suitable environment?

 Use what you know about the person to think about whether they could be reacting to:

• An unpleasant incident or association 
• Change 
• A memory 
• Provocation or a personality conflict 

Possible Solutions:

Go with the person to the GP so that they can be checked for any physical problems that might be causing them to behave aggressively.  Pain is common in people with dementia but is often not recognised, even in formal care settings like care homes.  Carers should look for signs that the person is in pain or discomfort and look for things that could potentially cause the person pain.  Signs may include:

• Rubbing or pulling at a particular body part

• Facial expressions - looking scared or clenching their teeth

• Body language - are they huddled or rocking for example? 

• A change in appetite

• Being more restless

• New swellings or inflammations

• Having a temperature  

Causes may include:

• Infections, including chest infections and urinary tract infections (UTIs)
• Existing injuries such as cuts or bruises 
• Constipation 
• Existing conditions such as arthritis 
• Being in an uncomfortable position or being moved in an uncomfortable way 
• Toenails or fingernails need cutting 
• Toothache, earache or problems with dentures  

 Music

Listening to the favourite music of the person with dementia may help to reduce aggressive behaviour.  For example, if there is a certain time of day when the person tends to become aggressive, it may help to put on some music that you know they enjoy at that time.  If a particular activity, such as bathing, can lead to the person behaving aggressively, put on some music before you begin.  

 Everyone is different and carers will find a range of ways to cope.  If you still have difficulty, speak to your GP or the dementia support worker.