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Coping With Challenging Behaviors in Alzheimer’s

8 Tips for Handling Agitation and Aggression

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Updated March 03, 2014

One of the more difficult aspects of Alzheimer's disease is that it changes the way an individual thinks and reacts to every-day situations. Whether you're providing physical care, bringing your loved one to a doctor's appointment or just spending time with them, you may experience a variety of behavioral challenges, including agitation and physical or emotional aggression. Here are 8 practical suggestions for coping with these behaviors:

  • Allow extra time.
    When you're helping your loved one get ready for the day, plan ahead so that you will not have to rush. A slow, calm approach can prevent or minimize a negative reaction.
     
  • If agitation or aggression increases, take a break.
    For example, if you are trying to help your mom get dressed and she's becoming more resistive and angry, take a 15 minute break and then come back in the room to try again. Fifteen minutes later may feel like a new day to her, so return with a smile and try again. Don't use this as a threat to her, but rather as a way to allow her a little control over her day. It also provides you with a chance to take a deep breath and refill your patience level.
     
  • Provide something for your loved one to hold while you give care.
    Have you ever had the experience of getting slapped or pushed away when you're trying to help someone with Alzheimer's? Maybe you're helping brush her teeth and it's just not going well. If you're able, try to engage her by asking for her help with brushing the teeth. If this doesn't work, give her something to do or hold with her hands. This serves as a distraction for her and also helps you be able to provide necessary care. I've seen several individuals respond very positively when offered a baby doll, stuffed animal, their wallet, or a book to hold while care is provided.
     
  • Approach with a smile.
    It's easy to expect a negative response from your dad if the day before was not a good one. However, individuals with Alzheimer's or other dementias often react to our facial expression and non-verbal signs, so watch what you project. The words you speak may not always make sense to them, but if you're smiling and gentle each time you approach them, this can help calm them and reassure them.
     
  • Explain before doing.
    While your daily routine may always be the same as you care for your loved one, don't assume that they know why you're there and what you want them to do. Using simple words and short sentences, explain that it's time to get dressed and that you would like to help them. You can also try using a picture flashcard to visually display what you would like him or her to do.
     
  • Focus on the feeling behind the behavior.
    Do you ever feel like it's a battle between opposing teams just to get your spouse ready for the day? Try to validate, or acknowledge, the feelings he has rather than focusing on the behavior he exhibits. For the person with Alzheimer's, sometimes hearing you put into words what he's feeling can put you both on the same team in his mind. You might identify his frustration or pain, empathize with him, and reassure him that you love him.
     
  • Depersonalize.
    It can be very difficult emotionally when loved ones with Alzheimer's accuse a spouse or adult child of purposely hurting them, hiding things, betraying them or lying to them. To depersonalize this, remember that this is the disease speaking, and not your loved one.

    I know of a situation where a wife continually fretted that her husband was going to kick her out of their home and not allow her to call anyone for help. They had been married for 45 years and there was no basis for her fears. Despite reassurance, promises, and declarations that his love for her would always continue, she persisted in this fear and accused him daily of planning for the time when he would make her leave their home. I spoke with him several times and reminded him that this behavior was a result of her confusion, rather than her true feelings for him. This helped him to remain calm and avoid verbally escalating the argument. Eventually she was able to let this delusion go.

    Reminding yourself that the disease is a common enemy of both of you can help you to decrease your loved one's agitation by allowing you to approach the situation more calmly.

  • Ask for help.
    Know when to get assistance. As the caregiver, if your own physical, emotional or mental health is declining, seek help. A physician, social worker, other family members and community organizations such as your local Alzheimer's Association can all provide direction for assistance.

    Some medications can be helpful in decreasing challenging behaviors. There are also adult day care programs that provide activities during the day time and home health aides that can come in to your home to assist with bathing or other care needs. Sharing the challenge and honor of caring for your loved one with others can lighten the load as well as improve the quality of life for you both.

    Sources:

    Alzheimer's Association. Aggression. Accessed July 31, 2011. http://www.alz.org/living_with_alzheimers_aggression.asp

    Alzheimer's Association. Agitation. Accessed July 31, 2011. http://www.alz.org/living_with_alzheimers_agitation.asp#6

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