Aggression in dementia is a common and complex issue characterised by physical or verbal actions directed towards others or objects, often stemming from the individual’s cognitive and behavioural changes. It can be a challenging symptom for caregivers to manage and requires understanding its potential causes and implementing appropriate strategies.
- Definition:
Aggression in dementia includes physical actions like hitting, kicking, or throwing objects, as well as verbal expressions like shouting, screaming, or making threats.
- Prevalence:
Aggression is a frequent non-cognitive symptom in dementia, with many individuals experiencing it as the disease progresses. Research indicates that about 96% of individuals with dementia will exhibit some form of aggressive behaviour during the course of the disease.
- Causes:
Aggression can be triggered by various factors, including:
- Cognitive and Behavioural Changes: Dementia can impair judgment, communication, and emotional regulation, leading to frustration, confusion, and subsequent aggression.
- Environmental Factors: Overstimulation, noise, or unfamiliar environments can contribute to agitation and aggression.
- Physical Discomfort: Pain, illness, or discomfort can also manifest as aggression, as individuals may not be able to verbalise their needs.
- Communication Difficulties: Frustration with communication breakdowns or unmet needs can trigger aggression.
- Psychological Factors: Loneliness, isolation, or feeling a loss of control can also contribute to aggressive outbursts.
- Sundowning: Aggression may be more pronounced in the late afternoon or evening, a phenomenon known as sundowning.
- Types of Aggression:
Aggression can be reactive, triggered by a specific event or situation, or proactive, stemming from underlying neurological or personality factors.
- Distinguishing Aggression from Other Behaviours:
Aggression should be differentiated from other behavioural symptoms like agitation, which involves restlessness and an inability to settle down.
Managing Aggression:
- Identify the Cause:
Try to understand what might be triggering the aggression. Consider the individual’s environment, physical needs, communication style, and emotional state.
- Create a Calm and Safe Environment:
Minimise noise, distractions, and potential triggers. Ensure the environment is familiar and comfortable.
- Effective Communication:
Speak softly, calmly, and use clear, simple language.
- Validate Feelings:
Acknowledge and validate the individual’s emotions, even if they seem illogical.
- Distraction and Redirection:
If possible, try to distract the individual from the source of frustration or redirect their attention to a more positive activity.
- Physical Intervention:
In cases of physical aggression, prioritize safety. Step away if necessary and seek help from others.
- Medication:
In some cases, medications like antipsychotics may be considered, but non-pharmacological approaches should be prioritized as first-line treatments.
- Seek Support:
Caregivers should seek support from healthcare professionals, counselors, or support groups to manage the challenges of caring for someone with dementia and aggression.
- Self-Care:
Caregivers must prioritise their well-being and seek support when needed, as caring for someone with dementia can be emotionally and physically demanding.
Importance of Distinguishing Reactive and Proactive Aggression:
- Reactive aggression:
Often responds well to non-pharmacological interventions like addressing unmet needs, improving communication, and providing a supportive environment.
- Proactive aggression:
May require medication or other interventions to address underlying causes like hallucinations or delusions.
In conclusion, aggression in dementia is a multifaceted symptom with various potential causes and requires a tailored approach to management. Understanding the individual’s specific needs and implementing appropriate strategies, along with seeking support, can help caregivers navigate this challenging aspect of dementia.
This is for informational purposes only. For medical advice or diagnosis, consult a professional. Learn more
National Institute of Ageing, Alzheimer’s Society, WebMD, Defuse-De-Escalation Training, National Institute of Health (USA Gov.) Considra Care, UltimateCare NY, ScienceDirect.com, UCLA Health, Hometouch, Wiley.