Dementia is a medical condition that deteriorates the brain of a human and adversely affects its cognitive functions.  It affects the memory, attention, judgment, language and problem-solving abilities, which can make memory, communication, and comprehension a challenge for those who suffer from it.

Because of these challenges, some dementia patients become aggressive, which can result from their inability to recognize their needs, know how to meet them, or communicate with others about them. As their frustration mounts, so can their aggression. To effectively care for dementia patients, it is imperative we understand the causes of their behaviour, and develop a plan of action to mitigate dangerous behaviours.

The causes of aggressive behaviour in dementia patients can be attributed to social, biological and psychological factors.

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Biological factors:

  • Pain, illness or physical discomfort can cause an aggressive behaviour.
  • Side effects of medication, including confusion and drowsiness, may trigger aggression.
  • Hallucinations and delusions can cause fear and confusion, which may make a dementia patient respond in an aggressive way.

Social factors:

  • Lack of social contact and loneliness.
  • Boredom, inactivity and sensory deprivation.
  • Different caregivers or rotating nurses providing their care.

Psychological factors:

  • Perception that their rights are being infringed upon or that they are being ostracized, sometimes due to difficulties in the brain when processing and interpreting information.
  • Lack of understanding of the intentions of their caregivers or nurses.

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Dementia patients are faced with numerous biological, social and psychological challenges that can trigger aggression, making it imperative for nurses to adopt caring practices that can help manage aggressive behaviour.

Things that are as simple as consistent communication, getting to know the patient, creating a pleasant environment, and listening to their thoughts and feelings can make a world of difference in some cases.

You can incorporate techniques and strategies to lessen aggression in dementia patients in your own care practice by trying the following:

  • Keep things simple. Ask or say one thing at a time and avoid open-ended questions. Use pleasant directives, such as “It’s time for our walk.”
  • Keep a daily routine. Consistency helps combat confusion, which can help avoid new daily struggles due to lack of understanding. 
  • Reassure the patient. If they feel unsafe, reassure them that they are in a caring environment and that you are there to help.
  • Focus on their feelings rather than words. They may be struggling to express what they are feeling verbally, so take note of other signs of communication, such as body language, to understand what they are feeling.
  • Use humour when possible. Keep things light-hearted and avoid the escalation of aggression whenever possible.
  • Use distractions. Ask for help, such as, “Let’s set the table” or “I really need help folding the clothes.” Helping them fill up their time with social contact can help keep them engaged with something positive and channel their attention in a productive way.
  • Avoid arguments. It is not necessary to deny, correct, or try to reason with harmless delusions. They think the sky is a beautiful shade of pink today? Why yes, yes it is!
  • Provide support. Dementia patients also need emotional support, especially when they feel scared or grieved. While their family of these patients can play a significant role in helping them maintain a positive attitude, not all patients have close ties with their family, and may need extra care in this area.

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Safety and comfort are the top priorities when caring for dementia patients – and your safety is included.  By learning how you can effectively de-escalate situations of violence, you can help protect yourself and your patients from potentially harmful situations.

There is a fantastic online course available to help nurses learn to manage violence in the workplace, and we recommend that every nurse take the course and take action to create a safer environment for themselves, their co-workers and their patients alike.