elderly lady with a rolling pin clenched in her fist
One of the most challenging aspects of caregiving is managing agitation or aggression from the person you are taking care of. These are two distinctly different behaviors. Agitation stems from anxiety, fear, or confusion. It is a restless state where it is difficult to calm down. Aggression refers to behaviors that include unrestrained physical or verbal abuse. The patient will verbally lash out in anger or may try to kick, punch, or push a person that is nearby. Both behaviors offer difficult challenges and are extremely stressful to manage.

These actions are frequently associated with people who have Alzheimer’s disease or sometimes other types of dementia. Attempts to protect the patient by restraining them can have an unintended consequence of exacerbating these behaviors.

The first thing to remember is why this occurs. By definition, people with these diagnoses have a medical condition that impairs their brain function. This leaves them with very poor impulse control in terms of emotions or behaviors. They are not deliberately trying to harm their caregiver although it certainly feels that way in the moment.

People suffering from Alzheimer’s Disease or severe dementia may not remember the steps involved in doing everyday tasks that we take for granted. They do not have a frame of reference to guide them through these actions. Imagine not knowing where you are or who you are with and they are telling you what to do. It can aggravate that condition. You can see why they might lash out because of confusion, anxiety, or feelings of fear, loss of control and helplessness. It is natural for a caregiver to feel frightened, frustrated, or angry in these circumstances which can escalate a confrontation. There are things you can do as a caregiver that as you respond to these difficult moments that can have a calming influence:

Determine the Cause-Are they in pain, hungry, frightened, or afraid because of a change of routine, place, or a new caregiver? Is depression a possible cause? Is it environmental or psychological? For example, if they are cold you can get a blanket or turn up the heat. If they are hungry get them some food.

Move beyond the behavior-When people lash out in these ways they are often trying to communicate something but are unable to find the right words. Ask yourself what message is

being given? Are they hungry, sleep deprived, or mad that they are not being allowed to do

something they incorrectly believe they can do?

Simplify the Steps-For example if you are dressing someone, have the clothes picked out and arranged so they can be easily accessed. Break down the task one step at a time. “We will start with putting on your shirt” is an example of how to approach a task.

Eliminate Distractions-When you are trying to get them to concentrate on a task don’t have the T.V. or the radio on. You want to try to help them focus and concentrate on the task at hand as much as possible.

Allow Time-Rushing someone who has difficulty doing a task increases frustration. Make sure you do a task when you have adequate time and don’t need to rush because you have to be somewhere else.

Allow the opportunity for your caree to be as independent as possible. For example, if they cannot cut a piece of meat give them food that is more easy to manage. If buttons are a challenge get a shirt that does not have buttons.

Limit the visitors-When trying to do a task don’t have several people in the room. This increases distractions. It also makes it harder to focus on a given task. Finally, this may result in the patient feeling like they are getting ganged up on and may result in creating more resistance.

Take a Moment to gauge how you are doing-The last thing you want to do as a caregiver is to ask the person you are caring for to do a task you know they are reluctant to do. Especially when you are feeling tired or stressed. If possible save it for another time when you are feeling more capable and calm.

     • Consider Things That Have a Calming Influence-Try to recall things that in the past were a source of comfort or joy and rely on them when needed. For example, some people positively respond to pets. Many people love music or reminiscing about happy times or looking through old photographs. Identify calming strategies. That alters their focus on the agitating trigger.

     • Exercise-Sometimes people get agitated because they are bored, isolated, or have been in the same place for a long time. If it is possible, use some type of exercise like taking a walk or maybe dancing to their favorite music to lighten the mood.

Try to anticipate what might be the source of agitation or aggression. Identify warning signs so you can try to be proactive and get a handle on these behaviors before they heighten. Finally, if these episodes get worse talk to a healthcare professional to get management suggestions.

You may want to have a doctor do a physical exam to determine if there is an unseen cause for these episodes. A doctor may be able to recommend a medication that can be used if necessary.


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