Visiting Angels Care Connections, Charleston, WV

Helping families and caregiver's cope with dementia and Alzheimer's related issues.

Hostility and Violence

 Gaining insight into the causes of behavoral issues helps you take things less personally. It helps you to not blame the person with Alzheimer’s for behaviors he can’t fully control.  Lashing out is usually a result of both brain changes and environmental factors.  It’s upsetting and sometimes dangerous for caregivers and family members. These behaviors are usually directed toward the caregiver but may also be done to others in the household, animals or objects.

It’s easy to misread the hostility and violence of someone with dementia as lack of gratitude, rudeness or meanness.  Though those things may seem true on the surface, it’s important to remember that the aggression is telling you something quite different.  Lacking the ability to fully process what’s happening or express feelings of discomfort well, these behaviors are a physical expression of mood: “I’m upset.” “I’m angry.” “I’m scared.” “I’m so confused.”  “I feel overwhelmed and out of control.”

Some reasons that behavior changes may occur: 

  1. Personality changes rooted in mental changes.  When someone with dementia becomes increasingly paranoid, frightened, or angry, he’s more prone to explosive behavior.
  2. Loss of inhibition and social appropriateness.  When angry impulses are tripped, self-control and self-censoring don’t work the way they do in a healthy person.
  3. Misperceptions, a noisy child, and unfamiliar new caregiver.
  4. An underlying illness or physical problem.  An infection, sleep deprivation, dehydration or some other stressor can bring on delirium which can trigger aggressive behaviors. 

Things that you can try that may help:

  1. Don’t raise you voice.
  2. Back off, don’t try to restrain.
  3. Stay calm and keep a pleasant expression.  Keep a smile.
  4. Give a mild verbal response: “Everything’s all right now.” “I’m sorry you’re upset.” “Let’s watch the birds out the window until you feel better.”
  5. Step out of the room for a few minutes if you need a moment to collect yourself. 
  6. Avoid returning to the same activity that initiated the hostile outburst.
  7. Offer a security object (stuffed animal)
  8. Do not try to “teach” or use logic-avoid elaborate explanations.

Sexuality-related problems

Many people with dementia still have sexual urges and want to act on them but with poor impulse control and self -censorship, and lacking the ability to read a social situation as they once did, these feelings can lead someone to behave in ways considered socially wrong.

Advances can range from suggestive comments to propositioning, and from flirtatious touches to groping.  Anyone can be a target.  The advances seldom reveal some long-simmering desire now being acted on (as caregivers often believe).  The target is usually someone who’s handy out of sheer proximity.

Bathing is a common trigger. Sexual inappropriateness can also be a bid for attention.  Other things that can contribute include a lack of a regular partner (a widower who develops dementia), boredom, or misinterpreting cues seen on TV or overheard.  Delirium, a behavior syndrome caused by a physical stress such as an infection or pain can also cause sexually inappropriate behavior.

Things to consider:

  1. If the behavior is sudden and new, consider a medical evaluation to rule out delirium or related causes. (Urinary tract infection?)
  2. If behavior is ongoing, see if you can identify and remove a trigger for the behavior.  Is it always directed to a particular person?  You may need to remove the caregiver and make a staff change. 
  3. Gently but firmly set a boundary.  “That’s not how we say hello.”  “Please don’t talk that way, okay?”
  4. Respond quickly with distractions to get his mind off sexual activity.  Find a fresh activity or move to a different room.  Offer a snack to satisfy a different kind of physical craving.
  5. Avoid flirtatious teasing.
  6. If bathing is a trigger, have someone of the same sex handle this task.

Tip:  Drugs used to treat dementia and Alzheimer’s enhance libido (sexual desires).


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