Memory Care for Aggressive Patients: Compassionate Community Coping Strategies

Aggression is a common symptom of Alzheimer’s disease and other forms of dementia. In fact, 35% of dementia patients display frequent aggression throughout their disease, according to a study of 281 seniors published in Geriatric Psychiatry.^[01]

“In so many ways, if you’ve met one person with Alzheimer’s, you’ve met one person with Alzheimer’s. Everyone is different,” says Troxel. “The best facilities and programs develop an individualized care plan that focuses on remaining abilities and strengths. I believe 90% of the time, you can make things better.”

How does aggression manifest in people with dementia?

There are three primary types of aggression seniors with dementia exhibit:^[02]

• Verbal. Verbal aggression may include screaming, using obscenities, making threats or insults, or loudly rejecting care or assistance.
• Physical. Physical outbursts may include hitting, biting, spitting, throwing things, or generally resisting personal care.
• Accusatory. Escalating accusations of theft, harm, or lying can become aggressive.

Some people’s dementia aggression can be traced back to their pre-diagnosis behaviors. But many family members and caregivers, even those who’ve tried to prepare, are shocked by the dramatic shift in temperament in a parent or relative they’d generally viewed as loving and kind.

“I spend a lot of time on dementia forums online,” says Olivia, 57, of Pensacola, Florida. “People always talk about these outbursts, but when my mother started behaving in ways that were so unusual for her, I was still surprised. People told me, ‘Oh, that’s just part of the territory with Alzheimer’s.’ But this sweet woman was trying to bite and scratch my partner, and she was saying terrible things.”

Many people assume aggression is a symptom of dementia. While this can be true, it’s more likely there’s an underlying cause that triggers these behaviors.

Common causes of aggressive behavior in seniors with dementia include:

• Health issues
• Discomfort
• Pain
• Fear
• Frustration

As dementia progresses, people often lose their ability to communicate in direct ways and may feel confused or disoriented. Aggression and other dementia behaviors can become ways of conveying these underlying causes.

“Any of us would get aggressive if we were frightened, in pain, or frustrated,” says Troxel. “Sometimes, these behaviors are not all that mysterious. Being reflective can help you understand if the behavior was something inadvertently caused.”

Let our care assessment guide you

Memory care may be a good fit for aggressive dementia patients. These facilities have staff trained in dementia care who can help manage aggression and keep residents calm.

Instead of focusing solely on combative actions, memory care communities analyze situational factors like health, medication, and discomfort to find the root of the problem.

Staff might perform a root cause analysis — sometimes called a root cause assessment — to understand a resident’s background and personality. The results can give insight into how to effectively communicate with and assist the individual.^[03]

Though caregivers may be cautious about seeking memory care for a loved one who displays aggression, staff members at these specialized communities undergo extensive memory care training, which teaches caregivers how to respond to aggressive behavior and how to prevent future altercations. For example, to deescalate episodes, memory care employees are trained to prioritize calm communication, transparent body language, and soothing environmental cues.

Qualified and experienced staff can also help educate family members in dementia care techniques.

“They didn’t just know how to talk to my mom — they helped teach me and my husband techniques of how to talk to her again,” Olivia says. “She still gets really angry sometimes, but if she didn’t go to memory care, I literally don’t think we ever would’ve been able to communicate without it just being a one-sided yelling match, with me not knowing what to do.”

Read on to learn more about some of the strategies employed by memory care caregivers. You might also find success by applying these techniques with your loved one.

Communication strategies in memory care homes for aggressive patients

Appropriately communicating with people with dementia is a major component of memory care staff training. One of the first things anyone should learn to do with a potentially violent dementia patient is to speak to them calmly and in a controlled manner. Professional memory care staff use the following techniques to encourage gentle and patient communication with residents.

Adjusting tone. Keeping a light, supportive tone of voice can have a calming effect.

Asking questions. “Talk to the person about interesting elements of their life story,” says Troxel. To initiate a warm and positive conversation, staff at memory care communities may ask a dementia patient about their past career, travels, or children.

Diverting attention. Staff members may invite a resident undergoing an aggressive episode to partake in an activity they enjoy. This could include asking the resident if they want to get coffee, complete a puzzle, or watch a favorite show.

Using simple, concise phrasing. Memory care employees try to focus on the present when speaking and avoid drawn-out, complicated language.

Responding to and validating emotion. Sometimes, seniors with dementia might be seeking emotional validation in moments of aggression. Memory care staff members avoid ignoring or dismissing a senior’s feelings and are trained instead to validate these feelings by listening empathetically and letting the senior express their emotions in a safe, productive way. For example, a memory care resident asking to see their late mother might be a sign of loneliness, which could indicate they want to spend time with a caregiver or attend a group activity.

Speaking with, and not at, the resident. Memory care employees strive to make communication a collaborative effort. Overexerting a sense of authority may lead to rebellion and further agitation.

Holding regular staff and family meetings. Creating senior care plans and regularly communicating with every member of a senior’s care team can help standardize treatments across caregivers. This consistency can really help keep aggression at bay. Additionally, when staff members come together, they’re more likely to recognize a dementia patient’s triggers and find strategies to address them.

Read related article:Memory Care vs. In-Home Care for Dementia: What’s the Difference?

Talk with a Senior Living Advisor

Body language strategies in memory care homes for aggressive patients

Communicating with dementia patients involves much more than just words. As their condition progresses, people living with Alzheimer’s or other types of dementia become more dependent on physical cues, eye contact, and body language. Staff at memory care homes for aggressive dementia patients respond to and reduce aggression by remaining attuned to these types of physical communication and practicing the following techniques.

Pausing before taking any other action. When a person with dementia feels distressed, taking a moment to pause is a crucial step. The person is likely signaling that they’re uncomfortable with the situation or your response, but they’re unable to communicate that distress directly. Respecting their boundary and taking a breath is a necessary de-escalation tactic.

Getting into a “supportive stance.” Consider turning your body away or stepping to the side to discourage your loved one from feeling cornered or trapped. A “supportive stance” model is a common tool used by memory care communities, and it can help a person with dementia regain control of the situation.^[04]

Approaching from the front, never from the side or from behind. Startling a resident is a primary cause of aggression. By approaching someone from the front, staff members try to avoid catching them off-guard and aim to ensure that the resident can see them the whole time.

Holding space. Staff members may sit quietly and calmly in the general vicinity of an agitated resident to be there as they calm down. By “holding space,” the caregiver can show a supportive physical presence.

Making eye contact. Eye contact can guide individuals with dementia during a conversation. It can also be a grounding technique.

Incorporating touch therapy or massage. Touch is one of the most relaxing senses for dementia patients. In fact, touch therapy can enhance feelings of trust between seniors with dementia and their caregivers. Memory care employees may brush a resident’s hair, provide a hand massage, or simply place their hand on the resident’s arm. Engaging in a familiar activity, like folding laundry, can expose the senior to a comforting texture they recognize.

Separating residents when necessary. In the event of an altercation between residents, memory care staff are trained to safely and efficiently separate them to eliminate potential danger.

Going for a walk or getting outside with a resident. With dementia medications showing only moderate benefits, physical exercise can possibly help improve cognitive symptoms in people with dementia, as noted in the Mayo Clinic Proceedings, a peer-reviewed medical journal.^[05] Memory care staff members will ask residents to take a walk to help them get exercise, provide a change of scenery, and to tap into the benefits of nature.

Removing seniors from loud or overactive settings. When a senior is overstimulated, they may respond with aggression. Community caregivers can remove them from bustling settings, such as a cafeteria or chapel service, and relocate them to a quieter, more private space.

Environmental elements in memory care homes for aggressive patients

Memory care facilities promote a soothing environment by concentrating on sensory therapies and dementia-conscious community design. These design elements work well to ease aggression in violent dementia patients.

The following are some examples of environmental adjustments common to memory care communities. These small adjustments can also help ease tensions at home and create a more peaceful environment to minimize aggression.

Music. Memory care staff members have long relied on the power of music therapy for dementia. Studies show that music can lower dementia patients’ stress levels and evoke positive memories. In particular, memory care communities often select classical music, church hymns, or cheerful sing-alongs to provide a sense of comfort.

Aromatherapy. Diffusing lavender essential oil twice a day can significantly reduce aggression among dementia patients, according to a recent study.^[06] Aromatherapy can also be used to remind residents of cherished memories or daily events, like mealtimes.

Lighting. Harsh or fluorescent lighting can trigger aggression. Memory care communities may use dimmers and full-spectrum light bulbs to alleviate this.

Clear signage. Individuals with dementia often experience difficulty navigating spaces. Clearly marked restrooms, exits, and communal areas can prevent outbursts that result from residents being lost or confused.

Gardens and other outdoor spaces. Access to plants and naturecan boost seniors’ happiness and reduce feelings of being overwhelmed. For these reasons, many memory care communities feature what they call “healing gardens.”

Pets. Residing in a pet-friendly environment where residents can have pets or access pet therapy programs can help alleviate symptoms of anger or aggression in dementia patients. Certain dog breeds work especially well as service animals for dementia patients.

Some caregivers may turn to medication to manage an individual’s aggression. However, most dementia care experts caution against psychotropic medications.^[07]

“The problem with using medication for dementia is that you often trade one problem for another,” says Troxel. “It could knock down a patient’s aggression, but side effects could cause them to fall and break their hip a week later. With good care planning and productive activities, about nine out of 10 times dementia patients don’t need to be medicated.”

Both caregivers and memory care staff members should consult a dementia patient’s doctor before adding medication to their care plan.

Yes, but evicting an aggressive resident from a memory care community is both rare and a last resort.

Before taking this action, a senior’s care team will often work with the individual and their family to explore other options. Memory care communities will typically highlight eviction guidelines and standards in resident contracts.

While causes for eviction vary depending on the community, most facilities will only evict a resident who is a persistent danger to other residents, to staff members, or to themselves. Troxel notes that residents who are “spontaneously aggressive” — versus those with consistent, predictable triggers — are more likely to be evicted.

When you begin your search for a memory care community, be sure to share information about your loved one’s behavior openly with community care and admissions staff. They understand the ins-and-outs of dementia behaviors and will plan accordingly rather than judging your loved one. The better the community understands your relative’s care needs, the more they’ll be able to help.

In other words, if the community can’t understand and address what’s causing a resident’s unpredictable and aggressive behavior, then they may feel they can no longer help them.

If your relative is exhibiting aggressive behaviors, using some of the above techniques at home may help. But if caregiving has become overwhelming, or you feel like your loved one’s violent behaviors are unsafe to you or your family, it may be time for a transition to memory care. A memory care needs assessment can help identify if it’s time to seek help.

“Early on in her dementia, I really thought I could care for mom at home throughout,” says Olivia. “But her doctor helped talk me through the symptoms and let me know that they weren’t going to get better if we did this on our own.”

Discuss your loved one’s behaviors with their doctor to determine if memory care may be the next step.

While finding care for a loved one who exhibits aggressive tendencies can seem difficult, A Place for Mom’s Senior Living Advisors can help your family find memory care that fits your loved one’s specific needs. These expert advisors help you consider your loved one’s unique situation, expectations for their care, and financial resources to help you find the best fit — all at no cost to your family.