Someone living with dementia may sometimes become aggressive verbally or physically. This can be referred to as “behavioural challenges”. These challenges may also result in inappropriate behaviour, agitation, restlessness and excessive walking around. This can be very distressing when you see someone you know behaving in this way and, knowing how to respond in this situation can be invaluable. In this article we are going to focus on aggressive behaviour but, some of the principals can be applied across a number of the “behavioural challenges”. It is important to remember that during an incident that this is dementia causing the action and to respond accordingly.
So why might someone become abusive?
There are several things that could be causing abusive behaviour, and these could be as simple as some need not being met and the person is trying to communicate this to you. The Alzheimer’s Society split these into Physical, Social, and Psychological needs.
It is important that if you are ministering to someone who has been aggressive before and, you sense a shift in behaviour, that your first thought is “is there an obvious need that this person needs fulfilling (like needing the toilet)?”. If their carer is present, ask them politely. It is far better to diffuse the situation before it goes anywhere. They are not likely to be doing this on purpose and trying to reason with them is not likely to bring about any change in behaviour as this is not meeting the need.
Although not an exhaustive list, some of the needs that could be causing the behaviour are listed below for information:
Physical needs - could be anything from them being in pain (this pain could even be a result of them having been sat or stood too long), they need the bathroom, they’re feeling unwell, it’s too busy or noisy where you are, too hot or cold, they’re feeling confused or overwhelmed, it could even be a result of medication side effects.
Social needs - could be they’re lonely, not feeling valued, bored, might feel awkward or unsure of you or the conversation you are having, they may even be struggling to hide their dementia from you.
Psychological needs - could include, that they’re feeling overlooked or ignored, they’re frustrated as they want to do something else or can’t complete a task they want to, they’re feeling threatened or are misunderstanding any help being offered, frustrated that they are not being allowed to do something when they still have the capability.
Think through the list above and see if there is anything obvious that could be causing the beginnings of agitation.
What should I do if they start to become abusive or aggressive?
It is important that you stay calm and in control as an angry response could well make the situation far worse. So, take a breath, step back and try to give them some space. Try not to show any fear or alarm but calmly back away. It may even be necessary to leave the room.
Your priority must be to remain safe and you should not tolerate any violence against you.
If you feel safe in the same room, try and work out what is causing the reaction from what they are saying. Be reassuring, keep your body language open, keep eye contact, acknowledge what they are saying and how they say they’re feeling. Try and encourage dialogue and say that you just want to help. It may even help to try and distract them from a current task.
Don’t take their behaviour personally as it is probably just them trying to communicate a need with you and, because of their dementia, not knowing how to do this.
Involve their carer and check that they too are OK. This could especially be relevant in any follow up with the carer as they may need pastoral and professional support and you may be able to help.