Ask the Expert: Kate Pomplun, AOS Care Management Care Manager

Q: My dad’s dementia has led to moments of anger and aggression—how can I de-escalate these situations without upsetting him more?

A: There are many tough aspects about dementia progression and difficult/angry/aggressive behaviors are some of the toughest. They are heartbreaking, especially when it’s very different from the person’s “normal” or pre dementia personality.

Here are some factors to consider:

• It’s important to evaluate whether or not there is an underlying medical issue causing pain or discomfort which often leads to agitation and possibly aggression. Every situation is different but some common factors could be a urinary tract infection, pain from arthritis or similar diagnosis, mouth/tooth pain, untreated stomach or digestion discomfort. With cognitive decline also comes heightened challenges in diagnosing issues, but taking notes about symptoms and behaviors and advocating for them in medical appointments can help.
• Even if a person has a history of anger, it’s important to remember the dementia disease changes their brain’s abilities to process inputs and outputs. Most often a person is not acting this way on purpose, but is a result of (or can be heightened by) the disease.
• You may not be able to prevent all outbursts of anger or aggression, but, as mentioned above, taking notes about patterns and symptoms may help prevent some occurrences or give hints about how to de-escalate. Pay attention to time of day these issues may occur, whether or not a person is hungry, tired, cold, bored, is being told to bathe, needs exercise etc. If you can prevent some of this type of discomfort, confusion, unbalance, it could reduce instances.

When it’s not possible to prevent:

Remember the part of the brain used to logically understand and think through behavior and its consequences is not functioning. So, arguing with your dad or trying to talk him into a better option will be difficult. (You probably already noticed this!)

If his anger or agitation is brought on by conversations like “you didn’t tell me we were going to the doctor today…”, even though you just reminded him that morning. Most often, you’ll be better off simply taking the blame and responding with patience and kindness: “I’m sorry dad, I can be forgetful sometimes, I think we should go ahead and start getting ready even though I forgot to remind you…”

Research shows that re-directing is often effective. There may be no discoverable rhyme or reason to his agitation. Try to redirect him to a task he enjoys such as looking at a familiar photo on the wall or album, playing his favorite music, offering a snack, going for a walk, talking about his favorite hobby, asking him to tell you about a loved one (this is especially effective if he is seeking out someone like a wife or boss at work).

Lastly, some people benefit from medication to assist with these behaviors. Again, taking notes about patterns of behavior will be helpful in advocating for the right type with your dad’s practitioners. It’s best to start with small dosages, be aware of side effects, and to consider other medications and chronic conditions. He may need more care or supervision while the best dose and medication are being figured out.

Again, there is no one size fits all solution, but thinking about the whole person, who he has been and what has brought him joy in his life, can help as tools for re-directing and de-escalating. You can even share these key tips with others involved in his care or who visit.