In order to understand the phenomenon known as “Alzheimer's aggression” or “Elder Rage”, as author Jacquelin Marcell calls it, takes a bit of background information. For one thing, it is not necessarily caused by a single factor. Yes, a patient may have been officially diagnosed with Alzheimer’s Disease, but this does not mean that the damages done by the disease itself are what lead to aggression.
Consider that of the 4.5 million people diagnosed with Alzheimer’s every year; at least half of these folks will manifest some sort of Alzheimer's aggression. This can be something as simple as hostile or strange vocalizations to full-blown hitting, biting, and punching. Clearly, there will usually be a reason for this sort of behavior, but each person will be different.
Most medical professionals now understand that Alzheimer's aggression can be indicative of physical discomfort that results from common medications (for example, many of the anti-anxiety medications often given to patients can cause headaches and nausea), it might be caused by delusions and/or neuropsychiatric symptoms, or it could be triggered by the return of memories or emotions that were from long before. In fact, Alzheimer's aggression can be something as simple as frustration with an inability to communicate or remember something, and this leads to irritation and a “lashing out” at those around them. Often, this is particularly the case when an Alzheimer’s patient has lost the ability to communicate easily or clearly.
So, the first real step in understanding Alzheimer's aggression is to identify the “trigger”. Interestingly enough, this often helps the caregivers to find a bit of peace and comfort because it helps to prove that Alzheimer's aggression is not directed at them “personally”.
So often, an adult child or primary caregiver experiences enormous emotional pain when they feel that a person is physically attacking them or directing anger and rage at them. Simply, working at identifying the trigger for Alzheimer's aggression usually allows them to actually eliminate themselves from the proverbial equation. Unfortunately, the process by which triggers are identified can often take a substantial amount of time.
For instance, in the book “Elder Rage” the author explains that it took her more than a full year to learn which situations led to her father’s moments of Alzheimer's aggression.
So, what can someone do to help a loved one suffering from the condition and also lashing out with Alzheimer's aggression? There are currently some prescription medications given to patients with “dementia” but most are still in the testing phases or considered questionable. They come in a range of intensities and can reduce some incidents of Alzheimer's aggression, but most physicians recommend that the “first line” of defense begins with one on one strategies.
For example, if Alzheimer's aggression is triggered by anything from hunger, fear or confusion, to actual anger or physical discomfort, it is necessary to find ways to address and/or eliminate all of the possible issues. This might be through actual, physical methods or it can be through thought and patience.
The most common advice for those dealing with family or friends showing bouts of Alzheimer's aggression is to:
• Learn diversionary tactics – if you suspect a “trigger”, such as a behavior (on your part) that seems to make them react, it is up to you as a caregiver to stop and step away from them in the most appropriate way possible. Never try to argue the point, just try to distract the patient from the issue and then get them into another or a new line of thought. For example, if the person seems to become upset when their clothing is removed, you cannot avoid bathing them, but you can speak the words such as “Here, let me get you ready for a warm bath,” and then move directly into the bathing process. Don’t quit at the first signs of trouble, but definitely bring the issue to a close if there is an escalation of aggression from them.
• Don’t forget signals – when your diversionary tactic is failing, it is a time to use the gentlest tones and the most reassuring touches you can. If you can put a sincere smile on your face, and try to convey that “all is well” through touches and expressions, it often calms a patient down at a remarkably hasty pace.
• Consider communication – many Alzheimer’s patients lash out violently because they cannot remember something, they have forgotten where they are, or what a common item is for, or because they cannot communicate an idea clearly. If you make a point of putting labels and signs on everything with which they interact, you are going to greatly reduce the times when their lack of memory triggers a reaction. This can go so far as leaving lists of things “to do” in obvious places. For example, it is often a good idea to put a few words on a piece of paper tacked to the outside of the kitchen cabinets. These might be as simple as “Food and Snacks” that helps them to easily remember where they are and what they were doing.
• Get into a routine – along with signs and notes, a solid routine is another fantastic way to help overcome moments of aggression. Not only does this reduce the opportunity for unexpected events, but it also ensures that hunger or bathroom related aggression is kept to a minimal level too. • Validation – when an Alzheimer’s patient is upset, angry, or severely frustrated, don’t argue with them about this. The last thing anyone wants to hear is “there’s no need to be so angry/sad/confused” when they don’t have any control over the issue or the environment. Instead, you MUST tell them that it is perfectly fine to feel as they do, and then work with them to get through the moment. Again, this is best done with reassuring words and gestures.
• Try a bit of logic – if the patient has a relatively calm demeanor about a situation, you can actually ask them to think a bit about a situation to see if that helps resolve the issue. In the article “A Place for Mom: Alzheimer's Aggression,” the author cites an instance when a woman would question as opposed to accuse her mother about certain events. For instance, when a watch frequently appeared in the sugar bowl, the woman would ask her mother why there was a watch in the bowl, and after the mother had answered that she didn’t know, she would ask her how she thought it got there. This use of logic can help some patients (usually at the less advanced stages of the disease) to find solutions for themselves and overcome confusion and anger.
• Nothing is working? – the most common cures for the moments when a patient refuses to calm down include, ignoring them if they cannot do harm, trying to find a bit of humor in the moment, putting on a bit of soothing music, and making notes about the situation in order to help determine a better outcome for the next time that it occurs.
The last point is often one of the most difficult for caregivers to accept, but the fact of the matter is that you can reduce the amount of Alzheimer's aggression that occurs, but cannot usually bring it to an end. This is the reason that so many people suggest support groups such as those listed at the Alzheimer’s Disease Education and Referral Center (ADEAR) and The Alzheimer’s Association.