Dementia is a complex and multifaceted condition. Among the many challenging behaviours associated with dementia, aggression stands out as particularly distressing for both patients and caregivers. Understanding the causes and triggers of this behaviour in people living with dementia is crucial for providing effective care and improving their quality of life. At Livewell, we prefer to describe such behaviours as frustration rather than aggression, recognising that this frustration can escalate if not properly managed. Our trained caregivers are experts in identifying and alleviating feelings of frustration, using strategies that address both the emotional and physical needs of our residents with dementia. By focusing on compassionate and tailored dementia care, we aim to reduce distress and enhance the well-being of those we support.

What triggers aggression in people with dementia?

Neurological damage
Dementia, particularly Alzheimer’s disease, causes significant changes in brain structure. Areas of the brain, responsible for controlling behaviour and emotion, such as the frontal lobes and limbic system, can become damaged. This damage may impair the ability to regulate emotions and reactions, leading to aggressive behaviours. Dementia often involves imbalances in neurotransmitters such as serotonin, dopamine, and acetylcholine. These chemicals play a critical role in mood regulation and cognitive function. Imbalances can result in mood swings, irritability, and aggression.

Medical conditions and pain

When people with dementia have infections and illnesses, we sometimes see them exhibiting more aggressive symptoms. Conditions such as urinary tract infections (UTIs) or pneumonia can cause delirium in dementia patients, which may manifest as aggression. Since individuals with dementia may have difficulty communicating their discomfort, they might express their pain through aggressive behaviour. Untreated or poorly managed chronic pain can also lead to aggression. Patients may lash out as a response to their constant discomfort, especially if they cannot articulate what they are experiencing.

Changes in environment

Moving to a new home or care facility can sometimes be disorienting for someone with dementia. The unfamiliar environment may trigger confusion and fear, leading to aggressive outbursts. Whilst this isn’t something we frequently experience at Livewell, due to our caregivers being able to settle new residents so calmly, it is something we look out for. Excessive noise, crowded spaces, and constant activity can also overwhelm a person with dementia. Sensory overload can result in agitation and aggressive behaviour as the individual tries to cope with the overwhelming stimuli.

People with dementia often thrive on routine and predictability. Disruptions to their daily schedule, such as changes in meal times, bathing routines, or sleep patterns, can lead to frustration and aggression. A lack of structured activities and engagement can result in boredom and restlessness, which may manifest as aggression.

Interpersonal interactions

Dementia can impair an individual’s ability to understand and respond to communication. Misunderstandings and confusion during interactions with caregivers or family members can lead to frustration and aggressive responses. The manner in which caregivers interact with dementia patients can significantly influence behaviour. A hurried or forceful approach may be perceived as threatening, triggering defensive aggression.

Emotional distress:

Dementia patients often experience heightened levels of fear and anxiety due to their cognitive decline. They may feel threatened by people or situations they do not understand, resulting in aggressive behaviour as a form of self-protection. Some forms of dementia, such as Lewy body dementia or Alzheimer’s disease, can also cause paranoia and delusions. Patients may believe that others are stealing from them or intend to harm them, leading to aggressive reactions.

Frustration and confusion:

The progressive loss of cognitive abilities can be incredibly frustrating for individuals with dementia. Difficulty with tasks that were once simple, such as dressing or eating, can result in anger and aggression. As dementia progresses, patients often lose their independence, relying more on others for care. This loss can be deeply distressing, leading to feelings of helplessness and subsequent aggressive behaviour.

Social isolation

Social isolation is a common issue for dementia patients, particularly in the later stages. The absence of social interaction can lead to feelings of loneliness and depression, which may manifest as aggression. Without meaningful activities and social engagement, people with dementia may become bored and restless, increasing the likelihood of aggressive behaviour.

Tips for managing frustration and aggressiveness

Understanding the causes and triggers of frustration and aggression in people with dementia is only the first step. Effective management requires a comprehensive approach that includes:

  • Reduce noise and minimise clutter in the environment.
  • Create a predictable daily routine.
  • Use simple, clear language when communicating.
  • Speak in a calm, reassuring tone.
  • Maintain eye contact and use positive body language.
  • Monitor and document potential triggers of aggressive behaviour.
  • Adjust care plans to avoid known triggers.
  • Tailor activities and environments to the person’s preferences and history.
  • Use familiar objects and settings to provide comfort.
  • Ensure the person is not in pain or discomfort.
  • Regularly check for signs of hunger, thirst, or the need to use the bathroom.
  • Provide meaningful and enjoyable activities to reduce boredom and restlessness.
  • Include physical exercise and social interactions in daily routines.
  • Redirect attention to a different, calming activity or topic.
  • Offer a favourite snack, music, or a walk to divert attention.
  • Remove potentially dangerous objects from the environment.
  • Ensure a safe space for both the patient and caregiver.
  • Use positive reinforcement to encourage desirable behaviours.
  • Avoid confrontational situations and adopt a patient approach.
  • Offer empathy and validation of their feelings.
  • Involve the person in decision-making as much as possible.
  • Consult healthcare professionals for advice on managing severe behavioural symptoms.
  • Consider counselling or support groups for both patients and caregivers.

Effectively managing the frustration experienced by individuals with dementia is crucial for their well-being and the peace of mind of their caregivers. At Livewell, we recognise that what might be perceived as aggression is often a manifestation of deep frustration. Our caregivers are skilled in identifying the underlying causes of these behaviours and are adept at implementing strategies that address both emotional and physical needs. By focusing on personalised and empathetic care, we strive to create a supportive environment that minimises distress and promotes a higher quality of life for those we care for. Our approach ensures that individuals with dementia receive the compassionate and individualised attention they deserve, helping to manage their frustrations before they escalate.