How to Manage Anger and Aggression in Alzheimer's Disease?

“When older adults are acting badly, that is a sign of
an unmet need.”Melissa Batchelor, PhD, RN, FNPBC, FGSA, FAAN

Older adults with Alzheimer's disease can get angry or be aggressive. These types of behaviors, when associated with Alzheimer's disease, can be a challenge for care providers and family members alike. These behaviors should not be overlooked and should be taken into consideration of the context in which the behaviors occur to try to find a solution.
Join me for this episode of This Is Getting Old: Moving Towards an AgeFriendly World, where we'll talk about How To Manage Anger and Aggression in Alzheimer's Disease.

Part One of 'How To Manage Anger and Aggression in Alzheimer's Disease.'

Anger and aggression generally happen in response to some underlying trigger, resulting in the behavior(s) observed. Below are some of the underlying causes of anger and aggression for an older adult living with Alzheimer's disease and the best ways to respond as a caregiver.
Understanding The Underlying Cause(s) Or Trigger

Possible Cause 1: Brain Changes

As caregivers or family members, you need to understand what cognitive abilities remain intact versus what deteriorates. Alzheimer's disease is essentially “brain failure” meaning memory ability is lost over time, and thinking and problemsolving become much more difficult. At a certain point, the person also loses the ability to use and understand language. However, one part of the brain that remains intact is the basic responses of Fight, Fright, or Flight. The Fight, Flight or Fright response may be what’s coming out as angry or aggressive behavior in the person with Alzhiemer’s disease, so we need to be mindful of this when interacting with a person. To make sure that they hear us and see us, before we touch them.

Possible Cause 2: A General Health Problem or Physical Discomfort

Another trigger for angry and/or aggressive behaviors are a general health problem or physical discomfort. You need to understand that when a person with Alzheimer's disease is experiencing pain or discomfort, they aren't going to be able to tell you what's hurting. They may hurt in their elbow or their hip, but they can't tell you exactly where they're hurting because they can’t localize pain (what this means is that when they feel pain all over rather than in one specific spot).
To figure out if or where they are hurting, you will have to look at nonverbal behavior, such as facial grimaces or holding a specific part of their body. Look for any nonverbal behavior as the way the person will communicate with you rather than just straight out telling you what's wrong when they can no longer use or understand words.

Possible Cause 3: Environmental Factors

The environment does have an impact on someone with Alzheimer's disease. If your home is generally quiet or you live by yourself when you have a little bit of cognitive impairment, if the whole family shows up and there are twentyfive people in the room, that is a totally different level of activity. The sudden change of environmental noise may be too much stimulation and this can create anxiety, which might drive angry and/ or aggressive behavior(s).

Possible Cause 4: Poor Communication

When a person living with Alzheimer's disease loses the ability to use and understand words, their only option is to use behavior to communicate with you. When you see someone acting badly, that is usually a sign of an “unmet need” so trying to figure out what they may need will be the better strategy for managing the behavior.

Part Two of 'How To Manage Anger and Aggression in Alzheimer's Disease.'

Best Ways to Respond?

Response 1: Safety First

If you're dealing with someone that's very angry and they are being very aggressive, the first thing to do is to make sure to maintain their safety. Once you know they are safe, it would also be best if you back off and give them space to calm down. You may need to remove yourself from the room if the anger or aggression is directed towards you. Give them the time and the space they need to calm themselves down in a safe place.

Response 2: Become A Detective

After making sure the person is safe, the next best response is to become a detective. I usually teach what I call the 3CP Model. The 3C’s are: Change the person, Change the people, or Change the place. This is a simple way to think through identifying behavioral triggers and preventing or resolving problematic behaviors.

Read the full article here https://melissabphd.com/podcastblog/