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. Aggression may complicate caregiving, and often requires specialized care.
The prevalence of this issue carries a valuable significance for caregivers: They’re not alone. Staff at most memory care communities receive expert training in both anticipating and redirecting hostility. According to David Troxel, the former president and CEO of the California Central Coast Alzheimer’s Association, caregivers can take comfort in this personalized and compassionate approach to treating dementia aggression.
“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.”
Read on to understand what leads to aggression in individuals with dementia, how to manage it, and how communities facilitate effective, person-centered memory care for aggressive patients.
“Any of us would get aggressive if we were frightened, in pain, or frustrated,” says Troxel. “Sometimes, these behaviors are not all that mysterious.”
For individuals with dementia, many of whom have lost their ability to communicate in direct ways, aggression and other dementia behaviors can be a way of conveying health issues, pain, discomfort, medication reactions, or fear.
Accounting for these situational factors, which Troxel calls “triggers,” is a key first step that staff at memory care take. Staff will perform a root cause analysis — sometimes called a root cause assessment — to understand a resident’s background and personality. The results can offer insight into how to best communicate with and assist a senior.
“Sometimes, being reflective can help you understand if the behavior was something inadvertently caused,” says Troxel. “A good rule of thumb to remember is that dementia is slowly progressive. So, if there’s a sudden change in aggression, it often means that a person is sick — not that their dementia has suddenly entered a new stage.”
Though caregivers may be nervous about finding memory care for a loved one who displays aggression, staff members at these communities receive training in how to react, as well as in how to prevent future altercations. Memory care employees prioritize calm communication, transparent body language, and soothing environmental cues to deescalate belligerent episodes.
Communication is a major component of memory care training. Generally, staff use the following techniques:
Communication with dementia patients involves much more than just words. As their condition progresses, those living with dementia and Alzheimer’s become more dependent on physical cues, eye contact, and body language. Memory care staff respond to and reduce aggression by:
Memory care communities are designed with de-escalation and relaxation in mind. Facilities promote a soothing environment through:
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Some caregivers may turn to medication to manage aggressive residents, and often assume memory care communities do the same. However, most dementia care experts caution against psychotropic medications.
“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 cause them to fall and break their hip a week later. With good care planning and productive activities, about 9 out of 10 times dementia patients don’t need to be medicated.”
While there are exceptions to this, a recent analysis of 148 dementia studies encompassing 21,686 patients found that holistic, multidisciplinary therapies—including touch therapy and music therapy—were more effective in reducing aggression than medication. Both caregivers and memory care staff members should consult a dementia patient’s doctor before implementing medication into their care plan.
Evictions in memory care are the notable exception—not the rule. Memory care communities will typically highlight guidelines and standards for evictions 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 also notes that residents who are “spontaneously aggressive” are more likely to be evicted—that is, when a root cause assessment does not uncover any consistent, predictable triggers.
Evicting an aggressive resident from a memory care community is a rare last resort. Before taking this action, a senior’s care team will work with the resident and their family to explore other options.
A Place for Mom’s Senior Living Advisors can help connect you with memory care communities in your area. Our local senior living experts can help you consider your loved one’s needs, your expectations for care, and your financial resources to find the right care for your loved one.
Collier, Stephanie. “What’s the best way to manage agitation related to dementia?” https://www.health.harvard.edu/blog/whats-the-best-way-to-manage-agitation-related-to-dementia-2020021418816
Liljegren, M, Landqvist Waldö, M, Englund, E. “Physical aggression among patients with dementia, neuropathologically confirmed post‐mortem.” https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4777
Moorman, Li R., Gilbert, B., Orman, A., et al. “Evaluating the effects of diffused lavender in an adult day care center for patients with dementia in an effort to decrease behavioral issues: a pilot study.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327916/
Watt, J., Zahra, G., Nincic, V., et al. “Comparative efficacy of interventions for aggressive and agitated behaviors in dementia.” https://www.acpjournals.org/doi/10.7326/M19-0993
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