Caring for aggressive patients: What's the limit to tolerate and what can you do?

Everything in life has a limit. And only those who care for a person with a cognitive impairment, such as Alzheimer's or senile dementia, know what happens when their patient loses their temper.

What happens when caregivers work with aggressive patients? It's important to know how to handle this and recognize the warning signs.

Why do older people become aggressive?

To begin with, patients with dementia have the same needs as anyone else. However, due to their illness, they are unable to recognize them or know how to meet them or communicate them to others.

Aggression in the elderly may be due to some diseases related to cognitive decline.

• Senile dementia: This affects not only memory, but also other brain functions and the ability to perform daily activities. A person with dementia may have difficulty finding their way around, remembering people's names, often misplacing things, and experiencing behavioral changes.

• Alzheimer's: This is a part of dementia and affects aspects such as memory, thinking, and even the patient's personality. In advanced stages, there may even be problems caring for oneself. A person with Alzheimer's has difficulty with social or work tasks, learning new things, using the bathroom, sleeping, and activities such as eating and speaking.

Symptoms of Alzheimer's aggression

Alzheimer's patients go through three stages, and it is precisely in the second of these that aggressive behavior begins to manifest:

1. Mild stage: The patient typically experiences mild memory loss and minor personality changes. They may forget recent events or the names of familiar people or things, as well as difficulty making plans and staying organized (for example, when making a shopping list and stocking items in a store).
2. Moderate stage: The patient has trouble following instructions and may need assistance with dressing or using the bathroom. They may become more restless and repetitive, as well as experience more serious personality changes.
3. Severe stage: This is the final stage and is when the patient needs help with all of their daily needs. By then, they may not even be able to walk, talk, or eat.

As you can see, a dementia like Alzheimer's can affect various areas of the brain. This can lead to some people having trouble thinking, remembering, problem-solving, or engaging in certain violent behaviors.

Some symptoms of aggression may be

• Threaten.
• Accusing others (for example, of theft).
• Saying bad words.
• Kicking, hitting, or biting people nearby.
• Offending loved ones.
• Screaming or grabbing things.
• Not being able to control your emotions or feeling disrespected.
• Show apathy toward activities that you previously enjoyed.
• Lose certain inhibitions.
• Not caring about the feelings of others.

About 20% of dementia patients living at home exhibit aggressive behavior, but this figure increases to 50% among those in a care facility.

How to calm an aggressive person?

1. Don't get caught up in it. It's the golden rule in these cases. That's precisely why we shared with you at the beginning that these types of conditions are characterized by altering people's behavior on a mental level. Therefore, someone who has always been very calm and peaceful can become rude and aggressive.
2. Don't blame him. The illness is causing all these changes, and they're not up to the person. Regardless of his attitudes, always remember: It's not personal. It has nothing to do with you. It's part of HIS condition. It's a brain disorder.

3. Avoid arguments. Arguing with the patient about the issue can be a long and exhausting process that may not yield much. They may be able to understand you during the mild stage, but it's clearly something that will get worse.
4. Avoid confrontations and shouting. Avoid making the problem even bigger. Don't respond to shouting with shouting, as this will only increase the patient's anxiety.

Remember: the person who does have control over your behavior is you.

5. Stay calm. It's always important to address the person in a respectful and friendly manner. Your sanity should always come from you, so maintain constant eye contact and a safe distance to avoid invading their space. Always avoid confrontation.
6. Identify triggers. Many of the problems will be related to the disease itself, but there will clearly be others that are 100% preventable. They can be as simple as a certain time of day, a certain item of clothing, a specific person, the temperature, or certain noises. The fewer triggers, the better. This can help identify limits.
7. Take a time-out. These patients tend to forget things. And oddly enough, you could use this to prevent aggressive behavior. If you notice the person starting to exhibit this type of behavior, you might be able to leave and come back in a few minutes. It's possible that, after that time, the patient has forgotten why they were upset. Just be careful not to leave them in a place where there are objects they could hurt themselves with.
8. Redirect attention. No one knows your patient better than you do. That is, you know what they like and what their hobbies are. Focus their attention on those.

If the patient exhibits aggressive behavior, it may be helpful to shift the focus of attention to topics of interest.

9. Continue established care. As much as possible, it's important to maintain clear routines (such as mealtimes and bathing), involve the patient in everything they can still do independently and communicate it to them, keep meaningful objects (photos, artifacts), and always be the first to stop and calm down so as not to worsen an already difficult situation.

Pay attention to the warning signs, there are situations that you SHOULD NOT TOLERATE

Clearly, it's important to distinguish when this aggressive behavior crosses the line. Therefore, it's important to pay attention to the limits a caregiver should set and what attitudes they should pay close attention to:

• Physical and verbal harassment.
• Humiliations.
• Gender violence.
• Physical aggression inside and outside the home.
• Minors at risk of abuse.
• Actions that put life at risk.

If any of the aforementioned situations arise, it is recommended that you notify the family immediately and seek legal help, external professional help, or institutions.

They must take action to contain the patient, but also to protect the physical integrity of the caregiver and the patient's primary care unit.

Are you caring for a family member? Learn how to resolve family conflicts with this guide for caring for older adults .

Actions and phrases for aggressive people

Remember that every patient is different, and not all strategies may work the first time. Trials may be necessary to find what works for each individual.

Situation: Aggressive behavior before sleeping

Lesson to learn: Anticipate. Perhaps when night falls, the person already feels tired, and this triggers aggressive behavior. By being one step ahead, a problem can be avoided.

Situation: The patient claims to have lost some personal item

Instead of: Saying something like “That’s not true” or “Remember where you left off”

It's better to tell him that you've saved it so he'll be safer.

Lesson to learn: Identify items the patient still remembers and can locate (such as the lost item in question) and have them on hand for when they ask for them. Another option is to save them and, when they tell you the item is lost, help them "search" for it and eventually "find" it. You can even plan your responses.

Situation: The patient offends his caregiver and may even hit him.

It is instead of: Reproaching him or responding to the aggression.

It's best to: Respond with something like, "Okay. I'll be right out," and step outside for a moment or go to another room.

Lesson to learn: Let him cool off and come back later. Aggressive behavior can appear in a matter of seconds… and then disappear in that same amount of time. The important thing is not to contradict or confront him. After a few minutes, he may not even remember the cause of the anger and will talk to you as if nothing had happened.

Situation: The patient blames a specific person for stealing from him.

Instead of: Saying something like “It’s not true” or “You’re just imagining it.”

It's better to respond with something like, "I'm glad you said so. I'll take care of it."

Lesson to learn: Remember that your patient's logic is now that of Alzheimer's. Avoid arguing or questioning their point of view.

Situation: On a public street, the patient shouts at his caregiver about something that bothers him.

It's instead of: Shouting louder and hoping that it will shut him up.

It's better to say something like, "You're right, it bothers me too. Let's just do..."

Medications to reduce aggression

Medication is intended to delay the development of the disease as much as possible , but also to help the patient with their mood.

Remember that many of these patients' aggressive behaviors occur because they feel tired, frustrated, unwell, have trouble sleeping, or even depressed.

For example, the disease may be affecting areas of the brain related to vision or hearing. This can cause confusion and hallucinations.

What you should know about medications for people with dementia

• Talk to your doctor about each medication, including its function, dosage, whether it's available in liquid form, whether a generic version is available, and whether the patient can take it alone or requires assistance.
• Be aware that, at this time, none of these medications can cure or stop the disease.
• Consult with your specialist about possible side effects of the medication and whether caregivers can do anything about them.
• Consider that medications to treat behavioral problems should only be used after other non-pharmacological strategies have been tried.
• Always use the lowest possible dose, stop taking a certain medication if certain side effects occur, and remember that some drugs may take a few weeks to take effect .

To help Alzheimer's patients deal with issues related to depression, restlessness, anxiety, or aggressive behavior, experts mention the following:

• Antidepressants : These are used to treat depression and anxiety.
• Anxiolytics: Along with sleeping pills, anticonvulsants and antipsychotics, they should be used with extreme caution, as they can cause drowsiness, dizziness and confusion.

Sleeping pills are not recommended for Alzheimer's patients, as they can cause confusion and increase the risk of falls.

• Anticonvulsants: These are often used to treat severe seizures, although their side effects include drowsiness, dizziness, mood changes, and confusion.
• Antipsychotics: These are used for cases of paranoia, hallucinations, agitation, and aggression. However, side effects can be serious and even life-threatening.
• Anticholinergics: For sleep problems, stomach cramps, incontinence, asthma, dizziness, and muscle spasms. However, they are also not recommended for these patients, as they can cause confusion (these medications include ipratropium, dimenhydrinate, and diphenhydramine).

What can help avoid certain medications or accompany treatment?

• Physiotherapy.
• Music therapy.
• Established routines.
• Keep your place tidy.
• Exercise.
• Communication.

Your allies in the face of an aggressive reaction

• Doctors: Communication with experts is essential. It's vital to share the patient's changes with them to assess whether a different medication may be helpful.
• Loved ones: No one works alone. We all need each other. If an older adult is engaging in risky behavior, it's important to have support networks in place to provide support. Every caregiver needs their own space and may want to train someone to support them while they take a well-deserved break.
• External support: If the patient is exhibiting aggressive behavior that threatens his or her life or the lives of others, always have emergency phone numbers or someone who can intervene on hand.
• Professional caregivers: There are people trained to care for different types of patients. It never hurts to approach them and seek their advice.
• Foundations and care centers: In different countries, there are organizations specializing in diseases like Alzheimer's. Several even have special groups for caregivers and family members. There's nothing like surrounding yourself with people who know what it's like to care for someone like that.
• Psychologists: A mental health professional can help provide support to those caring for a patient in these conditions and channel their emotions in this regard.
• Your own love and patience: The sick person could be a loved one who has long provided you with love and care, and perhaps that could be a reason to continue caring for them. What they're going through is something no one wants to go through, but they're counting on you to help them cope as best they can.

The responsibility to care for others and to care for ourselves

Caring for another human being is a profound act of love . And precisely for that reason, there are ways for an aggressive patient to dispel that behavior. The important thing is to always stay one step ahead.

Dealing with an aggressive person is a daily challenge. It goes far beyond being patient . It's about knowing how to respond and how, but above all, knowing when it's time to act.

Knowing how to cope with it is the result of teamwork involving health professionals, medicines, loved ones, and specialists in the field.

If you want to continue reading on the topic, we share this article with you: DEPENDENT ELDERLY AND THE FAMILY'S ROLE IN THEIR CARE