Coping with Anger and Aggression

     Many family caregivers provide care to family members who have dementia (i.e., someone with memory loss), either as their main reason for needing care or as one of many reasons. Caregivers and dementia patients often struggle with anger and aggression arguments.

Unexplained Anger

     When we think of someone being angry or aggressive toward us, we tend to think first about the person who willfully attacks us with a planned intent or purpose for the harm. However, when we experience anger and aggression from a dementia family member, we realize they may not know why they attack us or remember the attack after it occurs. Dementia patients may show aggressive behavior verbally or physically without warning for no apparent reason, making it hard to identify the thing that agitated them.

Potential Causes

     For caregivers, figuring out the cause (trigger) behind the explosion of anger can be very frustrating. Due to the loss of memory and thinking functions, the individual cannot say what causes them to feel angry.

So, the game of 20-questions begins for the caregiver.

• Are they in pain or hurting somewhere?
• Do they have an infection, or are they feeling ill?
• Are they tired from lack of sleep or exhaustion?
• Are they hungry or thirsty?
• Have they gotten frustrated attempting to do something and need help?
• Are they wound-up (over-stimulated) by noise, people, activities, lights, or something else?
• Is this a side effect of a new medication?
• Are they picking up on your irritability and stress or someone else’s?
• Are you asking them too many questions or giving them too many instructions at one time?
• Are they feeling overwhelmed?
• Are they afraid? Feeling lost and alone?

Identify Cause

     If you can identify the cause, you can work toward correcting it. Knowing the cause allows you to work with your family member to develop a plan to prevent the explosion next time.  From your family member’s point of view, the underlying reason for the outburst is reasonable and justifiable. You may even be able to see the merit in their thought processes once you know the background. Sharing a solution may be a way of coming closer together.

     When family members experience stress due to rising emotions, physical pain, illness, or being uncomfortable for a long time, they may start to get agitated. Therefore, it’s important to figure out what is causing the problem and correct it as soon as possible. By removing the cause of the agitation, you might keep the aggressive action from occurring.  In addition, the following is characteristically true.

• Feelings of anger and aggression turned inward and not addressed can turn into depression and thoughts of suicide.
• A direct link exists between pain and suffering and acting out. As pain and suffering increase, tolerance and patience decrease leading to a greater incidence of anger and aggression.
• Low blood sugar from not eating enough, dehydration due to not drinking enough fluid, and electrolyte imbalances from not eating the right combination of foods can cause a person to become very irritated and difficult to tolerate.
• Personal anguish, stress, fear, substance abuse, grief, and other family crises can upset a family member’s state of mind, throw them off balance, and lead to an angry meltdown.

 

Preventing Anger and Aggression 

     Any of the above situations could lead to agitation and ultimately anger and aggression. The difference between someone who has dementia and someone who does not is the amount of control present.  A dementia patient may feel their emotions developing and certainly sense themselves spiraling out of control; however, they have no clue what to do about it. They do not recognize what is happening to them or know how to calm themselves. That’s where the caregiver steps in to rescue them.

Steps to Take:

• Identify what sets them off (i.e., their triggers, what upsets them),
• Create a calm environment for them (not loud, overly bright, overly crowded),
• Monitor their comfort level (comfortable, not too hot, or cold),
• Keep tasks and routines simple (short instructions; only 1 or 2 tasks at a time), and
• Provide them with opportunities to burn off their energy during work or play.

Remove Unnecessary Stimulants

    Studies show that when people with anxiety problems get overly excited or wound up, they become angry and have greater difficulty acting as they should in public or getting along with others. As a result, they become easily frustrated and become angry quickly. Although research could not directly connect the dots, a strong indirect connection exists. That being the case, one way to keep anger from getting out of hand is to not let it happen. The following suggestions may help with that effort.

     Avoid foods or drinks with chemical stimulants like caffeine in them that speed up the heart rate, or sodium that causes fluid retention (fingers and toes swell), or cause you to feel hyper after you eat them.  

• Foods high in sugars: cakes, cookies, ice cream, soft drinks, power bars.
• Foods high in sodium: Chips, lunch meats, sausages, pizza, power drinks.
• Foods high in caffeine: coffee, power drinks, specialty coffees.

Remove (turn off) irritating, loud, erratic, or chaotic sounds that increase tension.  

     Examples include low electronic humming, loud music, underlying erratic continuous sounds, bugs that have come inside and made noise, light bulbs that need changing, high-volume television shows, high-pitched noises on other equipment, etc.

Change or remove continuously flickering or strobing lights. 

     Dying fluorescent light bulbs flicker, strobe, and pulsate for hours before shining their last. If you can’t remove the bulb, turn off the light, bring in a lamp, or take the person to another room.

Limit the number of people in small spaces.

     When multiple conversations occur in a small space, the sound becomes excessively loud and overwhelming, resulting in the desire to run away and escape. If the person can’t get away, the panic and frustration may make the person feel like he has to fight his way out of the room.

Keep Surroundings Simple

     Keep color themes to 1-2 colors and textures, limiting tactile and visual stimulation further. Think plan and simple.  Too much variety (i.e., too many textures, tastes, colors, sounds, or other stimuli) is overwhelming and may lead to bouts of agitation. On the other hand, limiting choices and stimuli to only a few makes achieving peace easier for them to reach.

Try Not to Show That You’re Getting Frustrated

     As a person’s caregiver, you hold all power over your family member’s life as far as they are concerned.  You control when they eat and sleep and what and when they do it. Therefore, their lives are in your hands. They know that if you were angry, their safety and well-being could be affected if you no longer cared about them. A person with dementia or any other mental health issue that doesn’t reason well may convince themselves that an angry tone, a stern look, or a reprimand signals that they are no longer safe with you.

Your Anger May Cause Fear

     If you act frustrated, angry, or aggressive with them, their anger and agitation may be a defense mechanism. When reading your body language, your family members may sense a need to protect themselves. Even though you may have no intention of ever causing them harm, they may not be able to understand that to be true. Your family member sees signs of anger, and to them, it means danger. Therefore, be aware of signals you might be unconsciously giving off that say you’re frustrated. 

     If you can make a super-human effort to change that behavior before interacting with them, you might find that they have fewer outbursts. Here are some body signals we send when we’re frustrated or angry.

• • Our body posture is stiff and rigid, with most muscles tensed and tight. Often our shoulders are stooped.
  • The expression on our faces says we don’t want to be there.  We don’t want to take care of them. We want to walk away because of what they did.  Our bottom lip is tight; eyes are cold, eyes roll up and away with comments, no direct eye contact, or if we look at them, it’s a hard, cold stare with long periods of no blinking.
  • Voice tone is cold, words clipped, comments derogatory, answers with grunts or not at all, may engage in arguments. The sound may get louder in anger or be very quiet and threatening.
  • Touch may be rough, rapid, without kindness or caring.

Walk Away

     When you feel yourself turning into the green-monster Hulk due to anger or frustration, it’s time to take a break and walk away. You cannot effectively communicate in this type of emotional state.

• Make sure your family member is safe. If you need to notify someone to watch over them while you are out, do so.
• Walk away.
• Use whatever technique works best for you to relax. Deep breaths, go for a run, ride your bike, call a friend, pray, whatever it takes, do it until you can feel yourself release the tension.
• Once your muscle tension is gone, then approach your mental tension. First, clear your mind of the confrontation. Next, remind yourself of your family member’s mental status and lack of self-control.
• Now, you’re ready to go back.

Examples to Watch!

     The two videos below present excellent demonstrations of approaching individuals who are agitated or showing aggression.  I recommend watching them to see some of the above techniques in action.

UCLA Health Caregiver Training Video Part 1:  Aggressive Language and Behaviors

UCLA Health Caregiver Training Video Part 2: Agitation and Anxiety

Resources:

https://alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation

https://alz.org/help-support/caregiving/stages-behaviors/aggression-anger

adear@nia.nih.gov

www.nia.nih.gov/alzheimers

https://www.verywellhealth.com/anger-and-aggression-in-dementia-4134488

https://www.seniorguidance.org/senior-living/how-to-deal-with-dementia-behavior-problems/

https://www.homecareassistanceedmonton.ca/how-to-keep-elderly-with-dementia-calm/