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Dealing With Aggression

Aggression is a problem that many persons with dementia have to deal with.  This can be especially hard for friends and loved ones to watch, but they need to remember that this is most often the disease at fault.  Here are some strategies that may help:

To prevent aggression:

—  Make sure that the person is not in pain, or suffering from some illness.  Even minor symptoms, such as a cold or increased pain due to arthritis, can trigger behavioral problems.

—  When speaking to the person, try to do so in concrete terms.  In the latter stages of dementia, especially, a person may have difficulty understanding abstract or figurative language.

—  Try to reduce environmental distractions when speaking to the person (i.e., loud televisions, children playing, telephones ringing, etc.)

—  Be sure to keep to a routine, as much as possible.  Make any changes gradually, preparing the person for them.

—  Try to avoid making the person feel rushed.

—  Try not to argue with the person, or insist on being right.

To manage aggression, once it occurs:

—  Do not try to restrain the person by yourself, and risk hurting him or yourself.  Call 911 if you are afraid the person may become violent.  Do let the police know, however, that the person has dementia.

—  Try to remain calm.  Use a moderate tone of voice, and watch your body language.  This may not help calm the person, but will help you to stay in control of yourself.

—  After the incident of aggression is over, look back and see if you can figure out what may have caused it.  What can you learn from it that will help you avoid a repetition of it.

—  Do not argue with the person, or try to rationalize.  In an individual with impaired reasoning abilities, this will most likely only make him more angry.

— Try to empathize with the person, and validate his feelings.  What may seem silly or unrealistic to you may be perfectly reasonable to him.  Too, the real source of the anger may not be readily apparent, even to the person who is feeling it.

—  See if you can distract the person:  a walk, a favorite song, some preferred activity.

—  If nothing else seems to be working, take a break and leave the room.  Sometimes a cooling-down period is good for both sides.

Here are some other suggestions that may be of help:

—  Be sure that the person is not hungry or thirsty, or has to go to the bathroom.  Often those in the latter stages of dementia lose the ability to communicate their basic needs, or to recognize them.

—  Touching someone who is angry or agitated is sometimes counter-productive.  It may be seen as a threatening move, and may worsen the situation.

—  Talk about things the person loves, or that interests him, in an effort to distract or calm him.

—  Keep your voice calm, and don’t let the person’s agitation affect your own mood.

—  Be sure the person is getting enough sleep.

—  Try to maintain a quiet environment, and stick to a regular schedule.

—  Sometimes a cool, damp cloth to the face can help alleviate fear or anxiety.

—  Try reminiscing with the person, or telling stories from a shared past.

—  Watch to see how the person responds to visitors, and see if their visits are upsetting to him.  Try to keep visits short, and discourage the visitor from getting him over-excited.

—  If you have people coming in to help you, try to stick to the same small group of people, so that the person isn’t upset by strangers repeatedly coming into their environment.

—  Limit choices to two or three things (options for dinner, or clothing for the day, etc.), as too many choices may be overwhelming.

—  Speak in short, simple sentences.  Keep conversation concrete, and limited to familiar topics.

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