Anger, Aggression, and Dementia: What’s the Connection and How to Cope

Anger typically becomes more pronounced in the middle stages of dementia and is often the result of agitation and the progressive behavioral disturbances associated with a dementia diagnosis. Many caregivers can expect to experience angry and aggressive behavior from a person in the advanced stages of dementia. This is because dementia makes it difficult for them to communicate or express their thoughts and emotions, leading to outbursts.

As the connections between regions of the brain deteriorate, a person with dementia can regress to an almost infantile state. Your loved one may no longer be able to express or understand life stressors and may grow frustrated and angry.

It’s helpful to remember that unaddressed anger can lead to aggressive behavior, which can lead to dangerous or violent behavior. But, as a caregiver, you have a lot of power to help curb those aggressive symptoms.

Why does anger happen in dementia?

Physical or environmental factors may be contributing to the anger or aggression.^[01] Know that your loved one with dementia isn’t acting this way on purpose. Instead, try to look out for what might be contributing to their discomfort that leads to anger:

• Physical discomfort. Hunger, thirst, or lack of a good night’s sleep can impact anyone’s mood. But, imagine being unable to even express these needs. Physical discomfort also comes from many treatable underlying conditions that aren’t so easy to spot, like urinary tract infections (UTIs) or gastrointestinal (GI) issues.
• Negative side effects of medications. Anti-psychotic medications can cause anger in dementia patients.Uncomfortable side effects may also occur when a person is taking multiple medications for a variety of health conditions.
• Poor communication. Lack of communication from a caregiver may agitate your loved one and make them feel frustrated, detached, or embarrassed. Inability to communicate is a result of their dementia diagnosis and can lead to immense frustration between both parties.
• Environmental factors. Agitation is common when someone is in a constantly disorienting environment. Dementia can cause unfamiliarity across all the senses that would be very alarming to anyone. Dementia patients may develop increased sensitivities to things like bright lights, loud or even moderate noise, and large crowds, even if some of these common phenomena occur in the home.

What symptoms may result in anger in dementia?

As a result of chronic discomfort, your loved one may begin to display the following symptoms related to anger ^[02]:

• Restless or weak legs
• Frequent urination
• Sweating
• Rapid or increased heartbeat
• Shaking or trembling
• Dizziness

How can I help a loved one with dementia anger?

Now that you have a better idea of what may be contributing to your loved one’s anger — and what symptoms to look out for — it’s important to know that there are ways you can help at home.

• Help ensure your loved one’s comfort. As a caregiver, do your best to make sure your loved one is eating enough, staying hydrated, and maintaining healthy sleep patterns. Monitoring healthy eating habits also helps offset discomfort caused by GI issues. Progressive GI issues are common to dementia patients and can lead to much pain and anxiety.
• Double check any medications. Always read the warnings and list of side effects that come with your loved one’s medication. Prepare yourself and your loved one for what’s to come and remain attentive to all symptoms.
• Speak calmly and clearly. Make sure your language is easy to understand, without being condescending. The person with dementia is often very responsive to the emotions of others, especially family members. Your loved one may pick up on your own irritability and react to that, so do your best to remain calm, patient, and empathetic.
• Provide a soothing environment. When searching for patience and empathy in the face of your loved one’s anger, it helps to remember how much of that anger is simply a fear of the environment as a whole. Make sure their space is free of loud noises, clutter, and too many people. Some senior living communities even offer intentionally designed spaces just for memory care to offset symptoms caused by the environment.

If your loved one with dementia is displaying aggressive behavior, take this as a sign that their dementia symptoms are worsening. While anger is an emotional feeling caused by frustration or discomfort, aggression is any physical or verbal behavior that harms or repels others. Dementia anger which leads to aggression includes verbal abuse and, in advanced dementia, it can result in hitting, kicking, and screaming.

Why does aggression happen in dementia?

Unaddressed discomfort leads to anger and agitation in most people but even more so in people with dementia. If your loved one’s dementia anger or agitation continues to go unaddressed, they may start to display aggressive behaviors.

Aggressive outbursts may be the result of long-term physical discomfort, medication side effects, a disorienting environment, or poor communication. Even just an inability to communicate can cause anger during assistance with activities of daily living (ADLs), like feeding, grooming, toileting, or dressing.^[04] This doesn’t mean you’re doing something wrong. It simply may mean your loved one may be agitated by some element of an activity but can’t express to you the problem.

What are the symptoms of aggression in dementia?

As dementia progresses into anger and aggression, your loved one’s symptoms may begin to include drastic behavioral changes ^[03]:

• General emotional distress
• Physical or verbal outbursts
• Restlessness or pacing
• Hallucinations
• Delusions and paranoia
• Sleep issues
• Incontinence

How can I help a loved one with aggressive dementia?

It helps to find ways to reduce triggers of agitation in and around the home. Taking the time to practice the following with your loved one will hopefully pay off:

• Speak calmly to them.
• Listen to their frustrations.
• Track symptoms and side effects of medications.
• Track and treat uncomfortable underlying conditions.
• Acknowledge their independence as much as possible.
• Modify the environment to reduce noise and clutter.

Person-centered care techniques can work well to promote a comfortable environment for people with dementia. Take these three situations for examples of person-centered, behavior-modifying techniques:

1. If your loved one acts out during meal times, try adding music they enjoy to the ambience. Guided reminiscence of happier times will go a long way with a person with dementia.
2. If bath time feels overstimulating, try incorporating relaxing nature sounds and pictures of your loved one’s favorite animal.
3. Studies also show that dementia patients are typically more at ease with towel/sponge baths instead of showers. Try out different methods to see what they tolerate.

Let our care assessment guide you

A loved one can exhibit violence in mid to late stages of dementia. It’s generally the result of worsening dementia and unaddressed anger and aggression.

What’s causing my loved one with dementia to be violent?

Unaddressed aggressive behaviors can eventually lead to violence. For caregivers, these situations are scary and often heartbreaking. Not everyone with dementia will experience violent outbursts. But, as a dementia caregiver, it’s best to prepare yourself just in case.

Why does violence happen in dementia?

Violence is often the end result of unaddressed agitation, anger, and aggression. Ultimately, it may be a signal that your loved one’s distress and discomfort has reached a breaking point.

However, remember that your loved one’s change in behavior does not necessarily mean you’ve done something wrong as their caregiver. Sometimes, aggressive or violent behavior can occur simply because of your loved one’s condition, as dementia can make it incredibly difficult to regulate and express emotions and make sense of different life stressors.

What are the symptoms of violence in dementia?

If your loved one is in the midst of a violent outburst, they may display physical or verbal aggression, and even dangerous behaviors:

• Yelling and screaming
• Cursing
• Crying
• Biting
• Hitting or punching
• Pushing
• Throwing objects
• Self-harm

How can I help a loved one with violent dementia?

In a violent situation, the caregiver’s first priority is de-escalation. As a first step, make sure everyone is out of harm’s way, and remove any environmental stimuli that could be agitating your loved one. If possible, remove any objects that could either harm your loved one or that they could use to harm others.

Keep in mind that restraint, grabbing, or verbal interaction may only increase a person with dementia’s agitation and aggression.^[05] Dangerous aggression and violence in a person with dementia may be a signal that they just want others to leave them alone for a while. Give them space, but closely monitor the surroundings. If the person is unable to calm down, seek help. You may need to call 911, and if you do, make sure to tell the responders that your loved one has dementia so they’ll know how to best approach the situation.

Do your best to approach regular occurrences of angry or aggressive behavior calmly using the above guidance, keeping in mind that, at some point, anger, aggression, or violence from a senior with dementia may require thorough medical evaluation or intervention.^[03]Although dementia is unpredictable, and what works today may not work tomorrow, the following tactics may help calm your loved one during an outburst:

• Securing the environment. Make sure everyone is out of harm’s way, including yourself, your loved one, and any bystanders. If someone could potentially hurt you, it may help to place a piece of furniture in between the two of you. Be sure to also remove any sharp or dangerous objects nearby like glassware or knives.
• Identifying the immediate cause. Rule out pain as the cause of the outburst if you can, and consider what happened right before the outburst started. Try to identify what may have triggered the behavior so you’ll know what to avoid next time.
• Remaining calm and empathetic. Keep your voice low and calm when addressing your loved one, and avoid arguing, patronizing, or trying to prove who’s in the wrong. Avoid using aggressive body language like scowling or clenching your fists.
• Speaking one at a time. This can be hard for families with multiple people involved in caregiving, but several voices can add confusion and provoke your loved one’s agitation further.
• Offering a distraction. If you can, shift your loved one’s focus to a different activity. If you’re in a safe environment, you might try playing music they enjoy or turning on their favorite TV show. A massage or light exercise may also be a relaxing change of pace.

Talk with a Senior Living Advisor

To provide adequate care for your loved one, you also need to feel your best. Remaining calm and empathic to a consistently angry person takes energy. So, it’s important to never neglect your own health needs. Avoid caregiver burnout by practicing mindfulness and setting clear boundaries as a caregiver. If you’d benefit from having someone to lean on, consider joining a caregiver support group. Online and in-person support groups can provide insight, advice, and encouragement to anyone caring for a person with dementia.

If you’re feeling overwhelmed, or if your loved one’s behavior is becoming unpredictable and violent, you should seek help as soon as possible. In-home care services and memory care communities can be excellent options for families struggling to care for their loved one with dementia.

Memory care for aggressive patients can provide a safe, healthy, and supportive space for your loved one, as well as caregiver relief for you. Many memory care communities can tailor their services to persons with behavioral issues and offer person-centered, behavioral therapies with specially trained memory care staff on-site.

When you decide it’s time for advanced care, our Senior Living Advisors can offer you free advice with local options tailored to your loved one’s individualized, dementia-care needs.