By Edna L. Ballard, ACSW

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Angry or aggressive behavior from an Alzheimer's patient can be very disturbing. This behavior may cause undue physical and emotional distress for the caregiver, leaving him or her with feelings of anger, guilt, or incompetence. Such feelings may lead to physical symptoms of distress, such as headaches, sleep problems, fatigue, tense muscles, breathing or eating problems. Fortunately, angry outbursts are generally short-lived and, in many cases, can be diffused or avoided if we know what to look for or how to respond. Most often it is NOT a personal attack at you but rather the result of a frustrating event or situation. The person may be fatigued, confused, or in pain and unable to express or describe what he or she is feeling. When the anger is directed towards you, it may be the result of a misunderstanding or a misperception of clues. An angry outburst may be the patient's way of telling you that something is wrong. It helps if you remain calm since your attitude and approach can calm the patient or add to his or her agitation.


* Ignore the behavior, even when the outburst includes profane or inappropriate language.

* Remove the individual from the area if the situation or environment is overwhelming. If the angry outbursts are frequent, try making the environment clutter free, noise free, limited in the number of activities or persons, and provide as much predictable routine and structure as possible.

* Simplify difficult tasks. Be sure your expectations and requests of your relative are realistic. At the same time it is important to support your relative in using his or her full potential by allowing him or her to be as independent as he or she can be.

* Use distraction. This is a simple but effective strategy (change the subject, offer a treat or a favorite object, suggest another activity, etc. ) IF THE PATIENT IS NOT EASILY DISTRACTED AND VIOLENT BEHAVIOR ESCALATES TO CREATE DANGER:

* Call for assistance. Your first obligation is to protect yourself and the patient/family member.

* Remove any object which could be easily used as a "weapon".

* Remove the person from the environment if it appears if it appears to be contributing to the angry outburst.

* Do not argue. Be sure your voice is calm and reassuring. Soothing music may be helpful

* Do not overwhelm the person with "why" questions or give to many instructions at one time.

* Do not startle the person by approaching unexpectedly, with raised hands,etc. or in any way whic appears threatening. * Provide ways of releasing tension, i.e. safe areas to pacem suitable physical activities.

* If you observe a pattern to the violent episode, try to determine the cause. Often a simple change in routine or environment can ease frustration or anxiety which may lead to or contribute to angry outbursts.

* Simply walk away.

* Medication may be necessary to control the behavior.

Consult your family physician. Keep in mind, however, that adverse effects of the medication, i.e. drowsiness, incontinence, etc., may be more undesirable than the occasional outburst. Caregivers find that they are more tolerant and capable of handling behavior problems, including angry, aggressive behavior, when they have to take care to attend to their own needs. It also helps to remember that this is a consquence of the disease process and not hostility towards you. Angry outbursts are often a response to feelings of fear, insecurity and frustration at one's own limitations. The loss of normal inhibition causes people to lose control. If you can reassure the person and arm yourself with ideas to handle the behavior, this aspect of the disease may become more tolerable for you and the person for whom you are caring for. It's worth a try!

(c) copyright 1992


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