How to Respond to Combative Behavior In Dementia

Combative Behavior is a term often used to describe physical aggression in people with dementia. Combativeness can include hitting, pushing, kicking, spitting, and grabbing.

What Causes the Combative Behavior

The most common trigger is the provision of care. Because of memory loss and confusion, people with dementia might not understand why you're trying to help them and begin to display challenging behaviors

At times, a catastrophic reaction might sometimes be the trigger for combative behavior. A catastrophic reaction is a sudden mood or behavior change that appears to be caused by an over-reaction to normal situation.

It might help you understand the cause if you picture the day through the eyes of someone living with dementia.

Imagine These Common Scenarios in Dementia

• Shower Time: Someone you don't know or recognize approaches you and tells you it's time to take a shower. She starts reaching toward you and tries to remove your clothes. You don't feel like taking a shower and don't know why she's bugging you. It's cold, you're not getting out of your clothes, and you're fine just the way you are.
• Dinner Time: You're peacefully dozing off in your chair when suddenly a stranger wakes you up and tells you that you have to eat now. You're not hungry and you don't want to get up, but he starts tying a belt around your waist and keeps telling you to get up. You try to push his hands away, but he persists in badgering you to get out of that chair. He then brings a bunch of food to you and starts trying to feed you. By now, you're really irritated.
• Getting Dressed: You put on your clothes for the day, unaware that these are the same ones from yesterday, and that they're badly in need of washing and deodorizing. You recognize your daughter, but she starts to act as if she's your boss and tells you that you have to change your clothes. You tell her "No", but she doesn't listen. She continues to repeat some baloney about why she wants you to change clothes. You've already told her, but she's not listening to you. Then she comes up to you and starts taking your arm out of your sleeve. That's the last straw.

Imagine How You Would Feel

Perhaps one or more of those scenarios sound familiar to you. Maybe you've seen your loved one or resident look at you warily and then become combative, pushing you away. Looking at it from the other perspective can often help caregivers be more compassionate and understanding of why people with dementia might resist care or become combative.

How Caregivers Can Help Reduce Combative Behavior

• Don't Rush: Allow plenty of time when helping your loved one get ready for the day. Repeatedly telling her that it's time to go and that she's going to be late just increases her stress, anxiety, and frustration, which typically will decrease her ability to function well.
• Talk Before Trying: Reminisce about something you know he's interested in before you attempt to physically care for the person. Take three minutes to establish a rapport with him by talking about his favorite baseball team or his job as a teacher. Three minutes upfront might save you 30 minutes that you might otherwise spend on trying to calm him down.
• Use a Visual Cue: When you explain what you're hoping to help her do, show her with your own body. For example, if you want to help her brush her teeth, tell her that and make a gesture of brushing your own teeth with the toothbrush.
• Take a Time Out: If it's not going well, ensure the safety of your loved one or resident and come back in 15-20 minutes. A few minutes can sometimes seem like an entire day.
• Switch Caregivers: If you have the luxury of multiple caregivers such as in a facility environment, try having a different staff approach the person with dementia. Sometimes, the fresh face of a different caregiver can yield better results.
• Less Is More: Is what you're trying to help her with really necessary? Then continue to work on it. But, if you can let something else go that's not as important for the day, both you and your loved one will benefit if you pick your battles.
• Offer a Familiar Item to Hold: Sometimes, a person can be reassured and calmed simply by holding her stuffed kitten, therapeutic baby doll or favorite photo album.
• Don't Argue: It's never helpful to argue with someone who has Alzheimer's or another dementia. Rather, use distraction or just listen.
• Remain Calm: Even though you might feel frustrated, your family member will respond better if you stay calm and relaxed. If your tone becomes escalated and irritated, it's very likely your loved ones will, too. People who have dementia often reflect back to their family members or caregivers the emotions that they see.

A Word from Verywell

It's normal to feel frustrated if you're trying to help someone and, instead of appreciating the assistance, they become combative and try to take a swing at you. Remembering what it may feel like to someone living with dementia who doesn't understand what you're doing may help you anticipate their behavior and prevent some of its occurrences.