It’s quite common for patients living with Alzheimer’s disease to display signs of agitation and aggression for a plethora of reasons. In fact, one study found that 52% of Alzheimer’s patients exhibited some form of aggressive behavior, with males and those with dyspraxia being at the highest risk of assaultive behavior. Knowing that certain conditions related to Alzheimer’s disease can cause aggressive behaviors in patients, healthcare professionals need to communicate with care and calmness.
In this article, we discuss the common reasons why patients living with Alzheimer’s act out aggressively. We also provide helpful de-escalation scripts for aggressive Alzheimer’s patients to help nurses communicate respectfully and effectively to reduce stimulation, provide comfort, and prioritize safety.
Why Alzheimer’s Patients Become Aggressive: Common Triggers Nurses Should Recognize
Alzheimer’s patients can be verbally or physically aggressive, with the former involving loudly swearing or threatening those around them, and the latter involving actions including hitting, punching, or throwing things.
It is widely believed that anger and aggression in Alzheimer’s patients can stem from various reasons. Some of the common triggers of aggression in Alzheimer’s patients include:
- Frustration due to memory loss or language problems
- Discomfort or pain that they are not able to properly express
- Loneliness or social isolation
- Changes in brain pathology
- A sense of being out of control
- Sensory impairment
Responding with Calmness, Compassion, and Skill
Before you even start communicating with an aggressive Alzheimer’s patient, there are ways to help assuage their fears and keep them calm. The following are things worth noting when dealing with Alzheimer’s patients who are exhibiting aggressive behaviors:
- Check the patient’s surroundings to see if anything is causing excessive stimulation. For example, if the lights are off when they’re usually on, or if the TV volume is at a higher level than what’s comfortable for the patient. Make the necessary adjustments to make the patient feel comfortable.
- Check if the patient’s environment is cluttered or in disarray. Make sure that the patient’s environment is free of clutter.
- Make sure that their comfort items, such as their blanket, photographs, or personal items, are where they are supposed to be.
- Before approaching the patient, make sure that you identify yourself using a calm and steady voice. Approach the patient within their visual field.
- Make sure that they can see your hands, and that your hands are in a relaxed and open position.
- If there are persons in the room who are causing the patient to become agitated and aggressive, ask them to leave.
- Play familiar, calming, and comforting music for the patient at a low volume.
- Make sure that the patient has adequate personal space.
De-escalation Scripts: What to Say When a Patient Becomes Aggressive
It’s vital to understand that when Alzheimer’s patients become aggressive, it’s not something that they’re doing purposefully for the sake of being difficult — it’s something they can’t necessarily control. This is where de-escalation strategies come in. Knowing what to say to an aggressive Alzheimer’s patient can help reduce their agitation and overstimulation and make patients feel supported and safe.
When speaking with Alzheimer’s patients, it’s important to validate their feelings. Avoid correcting them or being confrontational toward them, as such behavior can only exacerbate an Alzheimer’s patient’s aggression. Use a calm and neutral tone of voice when speaking with aggressive patients and use short sentences so as not to confuse them.
- “I know you’re upset, and I’m here to listen to you.”
- “Tell me about what’s bothering you.”
- “I understand how you feel. Tell me how I can make you feel more comfortable.”
- “I know you’re going through a tough time right now. But I know you’ll get through it. You always have.”
- “You’re safe in your room. I’m here for you.”
Offer specific options to help make decision-making less stressful and confusing:
- “Would you like to use the pink or blue towel?”
- “What treat would you prefer after your shower, your favorite tea or a pudding cup?”
- “Do you want to wear your blue or green cardigan today?”
- “Would you like to read a book or a magazine?”
There are ways to gently distract Alzheimer’s patients who are exhibiting agitated or aggressive behaviors, such as redirecting their attention to different activities:
- “Would you like to water these plants with me?”
- “Let’s take a short walk to see what’s blooming outside.”
- “Would you like a warm drink while we chat?”
- “Would you like to try this puzzle with me?”
- “Let’s take a look at this photo album together.”
- “Let’s talk about the Christmas presents you’d like to get this year.”
- “Tell me about your favorite vacation place.”
Remember to focus on your patient’s feelings, and not just the facts, as this can help de-escalate aggressive behaviors.
