Memory Care for Aggressive Patients: Benefits, Management Techniques, and Finding Care

Some people’s dementia aggression can be traced back to their pre-diagnosis behaviors. But many family members and caregivers are shocked by the dramatic shift in a loved one’s temperament.

As dementia progresses, people often lose their ability to communicate clearly, leading to frustration, confusion, disorientation, and fear. However, aggression and other dementia behaviors might be a person’s way of communicating a basic need.

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

Memory care communities or care homes 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. They use a more person-centered approach to care and communication that helps center and soothe the individual.

“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,” said Troxel.

Here are some common ways memory care communities manage aggressive behavior in combative dementia patients.

Offering staff extensive dementia care training

To help ensure that employees are able to manage aggressive behavior, memory care staff training and ongoing dementia care education are typically required of all on-site staff. The extensive training teaches caregivers how to respond to aggressive dementia behaviors and how to prevent future altercations.

Within A Place for Mom’s nationwide memory care network, over 75% of communities require specialized memory care training for staff.^[01] And, over 45% of communities specifically train staff to handle and manage anxiety, aggression, and agitation.

Understanding root causes

Clinically called root cause analysis, this practice requires staff to understand a resident’s background, personality, and health history. Staff are taught to figure out the cause of a resident’s aggression through person-centered care. Analyzing individualized needs helps caregivers to effectively communicate with and assist the person with dementia.^[02]

Educating families

Qualified and experienced staff can also help educate family members in dementia care techniques. This can create better communication with your loved one in the memory care community, as caregivers facilitate family relationships through education.

“They helped teach me and my husband techniques of how to talk to her again,” said Olivia, 57, whose mother resides in one of A Place for Mom’s partner memory care communities in Pensacola, Florida. “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.”

Using specialized communication strategies

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, patient, and nonthreatening manner.

Staff in memory care communities and care homes use the following research-driven strategies to manage aggression in residents. If you ever find yourself wondering about what to do with a violent dementia patient at home, you might also find success by applying these techniques with your loved one.

Redirecting attention

Memory care staff will often redirect a dementia patient’s attention away from the cause of their aggression by using these redirection techniques:

• Suggest an activity. Staff often use a resident’s favorite activity to divert their attention. This is one reason why it’s important that staff get to know the resident on a personal level.
• Ask questions. Staff may ask thoughtful questions about interesting elements of a resident’s life story to divert attention and help initiate a warm and positive conversation.
• Change the environment. Sometimes, going for a walk with the resident or moving them to a different room can be calming.

About 90% of memory care communities within A Place for Mom’s network utilize the above redirection and reorientation techniques to help manage common dementia behaviors like aggression.^[01]

Validating feelings

Instead of ignoring or dismissing a senior’s feelings, memory care staff are trained to validate them using the following methods:

• Listen empathetically. This offers a safe space for seniors to productively express their feelings, allowing the caregiver to find a solution.
• Speak with, and not at, the resident. Overexerting a sense of authority may lead to rebellion and further agitation.

Adjusting tone and body language

As dementia progresses, dementia patients become more dependent on physical cues, eye contact, and body language to communicate. Staff at memory care homes for aggressive dementia patients reduce aggression in residents by using the following types of physical and conversational cues:

• Use a supportive tone of voice and language. A gentle tone and simple, concise phrasing can calm the resident and make it easier for them to focus and comprehend. When following this approach, caregivers must not come across as condescending, which could make the situation worse.
• Sit or stand next to the resident, rather than over them. Facing an agitated resident directly can make them feel scolded and cornered. Stepping to the side can be seen as less demanding and may help the resident feel in control of the situation.^[03]
• Maintain eye contact. Eye contact can guide individuals during a conversation, and it can also be a grounding technique. Keep your eye contact calm and empathic, rather than anxious or angry, as that could lead to more anxiety or anger in the person with dementia. Facial cues mean a lot to a person with dementia.

Collaborating with staff and family

Memory care staff are known for their collaborative efforts between residents and their families. Getting everyone on the same page is crucial. Here are some of the collaboration techniques memory care staff use to support aggressive dementia patients and their families:

• Create senior care plans. These plans help standardize treatments across caregivers in the community as well as family members.
• Host regular staff meetings. Meeting regularly helps all involved parties stay aware of the patient’s triggers and the various strategies to address them.
• Meet with families regularly. Keeping a resident’s family members informed on updates to their care plans and behavior can be reassuring. These meetings also enable staff to get input from family on how to further personalize their approach to their loved one’s care.

Is memory care the right fit?

Memory care facilities promote a soothing environment with research-backed, dementia-conscious community design features. These helpful design elements can ease aggression in violent dementia patients.

The following are some examples of design features common to memory care communities and care homes. These small adjustments can help create a more peaceful environment that minimizes aggression in people with dementia:

• Lighting. Harsh or fluorescent lighting can trigger aggression. Memory care communities often use dimmers and full-spectrum light bulbs instead.
• Clear signage. Individuals with dementia often experience difficulty navigating spaces. Clearly marked bathrooms, exits, and communal areas can prevent outbursts that result from residents being lost or confused.
• Gardens and outdoor spaces. Access to plants and nature can boost seniors’ happiness and reduce feelings of being overwhelmed. For these reasons, many memory care communities feature what they call healing gardens.

Another way memory care communities and care homes combat aggression in dementia patients is by incorporating memory care activities and calming therapies into everyday routines. Some of the most popular activities and therapies include the following:

• Music therapy. 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 staff 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.^[04] Aromatherapy can also be used to remind residents of cherished memories or daily events, like mealtimes.
• Engaging activities. Memory care programs include tailored social events, brain-stimulating games, crafts, and holiday celebrations. These fun events can redirect attention, soothe aggression, and spark memories.

Medical intervention is typically used as a last resort in dementia patients. Although some caregivers may turn to medication to manage an individual’s aggression, most dementia care experts caution against psychotropic medications.^[05]

“The problem with using medication for dementia is that you often trade one problem for another,” said 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 family caregivers and memory care staff members should consult a dementia patient’s doctor before adding any medication to a care plan.

Memory care questions? Get expert help

Yes, but evicting an aggressive resident from a memory care community or care home 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 noted 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 or care home, 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 judge 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.

One family’s story

Mark Young, who worked with A Place for Mom to find care for his mom, said her community worked with them to offer a solution to her changing behavior. His mom was living in the assisted living unit when she was diagnosed with sudden onset dementia and her symptoms, including verbal aggression, began to progress quickly.

“She was really disturbing the other residents in assisted living with her swearing and loud outbursts,” Young said. “And when someone would come in to change her or give her a shower, it became a dramatic event for the facility and [the caregivers].”

Rather than evict his mother, staff kept everyone’s best interests in mind and helped place her in the proper setting to meet her new care needs.

“[The community] recommended we move her [from the assisted living unit] into memory care because of her states of agitation.”

Read more:When to Move From Assisted Living to Memory Care

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 to find a memory care facility.

“Early on in her dementia, I really thought I could care for mom at home throughout,” Olivia said. “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. If your loved one has dementia along with other serious medical conditions, doctors may recommend a nursing home with a memory care unit equipped to handle aggressive dementia patients.

A Place for Mom’s Senior Living Advisors can help your family find memory care that fits your loved one’s specific needs. These local experts consider your loved one’s unique situation, care needs, and budget to help you find the best fit — all at no cost to your family.

Memory care reviews from residents and families