People with dementia can sometimes get aggressive and angry. They may shout, hit or act inappropriately. This behaviour can be very different from their usual character. They can be disinhibited, meaning, they use words that are rude and not appropriate. They may do things that embarrass others or forget how to act in public.

This type of behaviour may be happening to a loved one you are caring for. Here are some problems you may notice and strategies to help you deal with this caregiving challenge.

Aggressive Behaviour

Here are some common behaviour challenges:

• Shouting
• Looking at you in an angry way
• Using bad language
• Screaming at you or screaming for no reason
• Hitting
• Pushing
• Kicking
• Pinching
• Biting

Reasons for Aggressive Behaviour

Your loved one may be acting aggressive because they:

• Don’t understand what you want them to do.
• Don’t know why they need to do what you’re asking them to do.
• Don’t like being told to do something.
• Are trying to regain independence in their life.
• Feel afraid.
• Think they’ve already done what you’ve asked them to do.
• Feel frustrated because they forget how to do what you’re asking them to do.
• Can’t see very well and are confused.
• Are in pain and not able to tell you.
• Think you’re angry with them.

Tips for Aggressive Behaviour

Determine what makes your loved one angry:

• Keep a notebook and write down when they get angry. Answer questions like: What time of day did they get angry? Did something trigger the anger? How did you respond? Did this help? Did it make things worse?
• Use this information to try and prevent an outburst or to calm your loved one down.
• Know what triggers the anger. For example, a change of routine, being hungry or thirsty, a certain time of day, someone coming to visit.

How to approach:

• Slowly approach from the front so you don’t startle your loved one.
• Keep your voice calm and speak slowly.
• Don’t raise your voice even if your loved one does. Raising your voice will make things worse.
• If they don’t understand you, try saying it in a different way. Use simple words and short sentences.
• Only ask one question at a time to avoid confusing your loved one..
• Don’t rush.

The environment:

• Keep the noise level down. Turn off loud TVs or radios.
• Try not to have too many people around.
• Make sure the lighting is good.
• Remove things that could be used as a weapon.
• Put knives and scissors in a secure place.
• Make sure all exits are kept clear.
• Consider getting a personal alarm, so you can call for help. (see Other Community Services)

Get some extra help:

• Your loved one may respond better to someone else. For example, they may get angry when you want to bathe them. They may prefer another family member and accept extra help in the home.
• You may be together too much. Consider getting relief from an adult day program if one is available in your neighbourhood.
• Have someone else stay with them to get a much-needed break. The person you’re caring for may respond better to someone else for certain things.

Inappropriate Behaviour

You may experience some of these behaviours with the loved one you are caring for:

• Swearing
• Making rude remarks
• Saying rude things about other people
• Taking their clothes off
• Touching their private parts
• Touching themselves in a sexual way
• Touching other people in a sexual way
• Spitting, belching, passing wind or nose picking

Tips for Inappropriate Behaviour

• Keep a notebook and write down when they behave badly. Answer questions like: What time of day did they get angry? Did something trigger the behaviour? Where did it happen? How did you respond? Did this help? Did it make things worse?
• Don’t argue with your loved one.
• Distract them so they get busy with something else.
• Try different things and use what works best.
• Choose clothes that are more difficult to take off. Look for clothes that fasten at the back or that have fastenings that are difficult to see.
• Keep your loved one occupied.
• Protect other people.
• Make sure you supervise them when children are around.
• Keep them away from places where their behaviour upsets people.
• Explain to others that this is part of the disease.

Things to Remember

• Try not to be ashamed if your loved one is behaving badly. Remember this behaviour is a symptom of the disease.
• Remind yourself that they are not being unkind to you on purpose.
• Don’t be afraid to ask for help.
• Bad behaviour can be part of the disease process. Ask your physician if you are unsure.
• Your loved one doesn’t don’t understand that the behaviour is inappropriate.
• Don’t get angry with them.
• Don’t blame yourself.

When to Ask a Professional

• Call 911 if it’s an emergency. If you, someone else or the person you are caring for is at risk, call for help.
• If the person you are caring for becomes aggressive, tell the doctor. The doctor will assess them to ensure your loved one is not having a bad reaction to prescribed medication. Or there may be an underlying health reason why the person is behaving this way. The doctor may be able to prescribe medication to calm your loved one down.
• Ask for an Occupational Therapist (OT) to visit. The OT can help you find ways to reduce the outbursts and give you strategies to deal with angry outbursts. He or she can also link you to an adult day program, arrange for respite help in the home or give you information about support groups where you can meet other caregivers.

People with dementia often wander. You may notice your loved one keeps getting up in the middle of the night or sometimes tries leaving the house. There are many reasons for this. Here are some common explanations for this behaviour and some solutions to help you cope with this problem.

What Is Wandering

You may notice that your loved one:

• Walks around the house all day.
• Has no reason for walking around the house and just wanders.
• Paces around the room.
• Seems to be looking for something but cannot say what it is.
• Says “I want to go home,” but they are at home.
• Keeps trying to leave the house.
• Gets up in the middle of the night and wanders around.
• Walks until they feel completely exhausted.

Why Do People with Dementia Wander?

Your loved one may wander because they may be:

• Hungry or thirsty and can’t tell you.
• Hot or cold and don’t know what to do about it.
• Looking for the bathroom.
• Trying to do the work they used to do.
• Thinking they should be at work.
• Looking for the home where they grew up as their memories and concept of time can sometimes get muddled.
• Confused and don’t know who you are.
• Distracted by loud noises or bothered by too many people around them.
• Confused by reflections in a window or mirror.
• Looking for something and can’t tell you what it is.
• Trying to find someone but can’t say who it is.
• Comforted by moving around.
• Disoriented and mix up day and night.

Help With Wandering

Look for reasons why your loved one is restless and try to figure out what is upsetting them by ask yourself these questions:

• Can they tell you why they are upset?
• Are they restless at the same time every day?
• Do they show sign of anxiety when a family member is out of the house?
• Does a lot of noise in the house bother them?
• Is it when the TV is on?

Looking at safety:

• It is important that your loved one does not hurt themselves when they wander.
• Make sure that where they like to walk in the house is safe. (see “Home Safety”)

Try these tips if they try to get out of the house:

• Sometimes seeing outdoor clothing makes them think they should go outside. Put coats, hats and boots out of sight.
• If they can unlock the door, try a safety chain. If you put it near the top of the door, they may not see it.
• Hanging a bell on the door may help. You will hear the bell ring if they try to leave.
• If they keep trying to leave the house, you can use an alarm that goes off if the door opens. These are sold to people who travel and are for hotel doors.
• Some house alarm systems can be set to make a noise if the outside doors are opened.
• Covering the door with a curtain so they can’t see the handle can help.
• If they really want to go outside, it might help if you go for a short walk with them. When they get back they may feel more relaxed.
• Put a card with their name, address and phone number in their purse or wallet.
• Put a label in their coat with their name, address and phone number.
• Keep a recent photo in case they get lost.
• If they have a medical alert bracelet, make sure they wear it.

Making them comfortable:

• Give them regular meals.
• Make sure they have enough to drink.
• Check that their clothes fit comfortably.
• Make sure they are warm enough but not too hot.
• Don’t give them big drinks just before bedtime.
• Make sure they have some exercise every day, such as taking a walk outside with you, sweeping leaves or walking around the house.
• Try not to upset them with too much noise.
• Ask family and visitors to be quiet and calm when they are with them.
• Pull drapes over windows if it upsets them to see their reflection.
• Cover mirrors if seeing their reflection upsets them.
• Put daytime clothes out of sight at night time. If they see their clothes, they may think it is time to get up and get dressed.

Things you can do:

• Give them a simple job to do each day.
• Talk to them in a calm, quiet voice even if they can’t answer you.
• Tell them what you are doing.
• Explain to them what is going on around them.
• Sit down with them and reassure them.
• Put an arm around them. Let them know you are there and that you care about them.

What Is a Wandering Registry?

A wandering registry is a system that tracks people who wander. This program is run by the Alzheimer Society of Canada. In Canada the wandering registry is known as “Safely Home.” Safely Home’s computerized tracking system is in place all over Canada. The Alzheimer Society and police work together and use the system to help find people with dementia who have wandered away.

There is a registration form and charge for the service. All information about someone who may wander is kept on file and used to help find someone when they are lost. Someone who is registered with the program is given a Medic Alert bracelet to wear. The bracelet has a number to call if someone finds a lost person.

For more information call: Alzheimer Canada at: 1-800-616-8816 toll free.

Things to Remember

• Your loved one is not wandering on purpose and is often a symptom of the disease. If you aren’t sure, ask your loved one’s doctor.
• Your loved one may be frightened or confused.

When to Ask a Professional

• If the person you are caring for is often very upset or has trouble sitting down to eat or drink, you should talk to your doctor.
• People with dementia can get weak from walking or their feet can get sore. If this happens, you should tell the doctor.
• You can ask for help from an occupational therapist. The therapist may help you to find out what is making them so restless and can help you cope with what is going on.