Sometimes people caring for those who are living dementia must deal with situations where the person in their care becomes combative, and even aggressive.

In this article, we will look at ways to help caregivers de-escalate these challenging situations, without feeling as though the only option is physical restraint or medication.

Why do people become aggressive in the first place?

Dementia is a condition in which the functioning of the brain gradually declines. The symptoms of dementia usually include loss of memory, changes in personality, and impaired reasoning.

Understandably, people who are living with dementia can become frustrated by their condition, and this can lead to them becoming angry, and even combative or aggressive.

Three types of factors can cause aggressive symptoms

Biological Factors

Sometimes an angry response will be caused by the person being in pain, or feeling unwell, or uncomfortable. They may be experiencing hallucinations, or delusions that are making them act aggressively. Aggression can also be a side effect of some medications.

Social factors

People living with dementia can become angry if they are lonely, or bored.

Psychological factors

If a person with dementia feels they are being left out, or if their rights are being infringed in some way, they may become angry.

Triggers

For some people with dementia, particular triggers can cause them to become agitated. In this situation, it’s important to know what the triggers are, and to remove or minimise their exposure to those triggers to avoid challenging situations from arising.

What is de-escalation?

De-escalation is a person-centered approach to reducing and preventing conflict. It is based around using verbal and physical expressions of empathy and building an alliance with the person.

Communication is the key to de-escalation. There are three types of communication:

  • Verbal – the words that you use to calm the person
  • Paraverbal – the tone, pitch and volume of your voice
  • Non verbal – your facial expressions, your eye contact, posture, body language, and your proximity to the person

It can be helpful to take a deep breath before you initially respond to a crisis situation, reminding yourself that you are going to respond to the situation in a calm and controlled way, and you are not reacting emotionally.

When dealing with de-escalation, the more you know about the person, the easier it might be to help them. You may understand they have been exposed to a trigger, so you may be able to remove the trigger. Or you may know they are very gentle, so you can keep that in mind when you are talking to them and interacting with them.

Use simple clear concise language when you are dealing with a situation of de-escalation; you may need to repeat what you say.

Use a calm, low, quiet voice, although allow for those who may be hard of hearing.

Place yourself physically at the person’s eye level, or below. Make sure your body language is non-threatening.

Allow plenty of time for the person to respond to what you are saying, and listen closely to their responses.

Attend to the person’s needs, and explain what you are doing in a gentle and kind voice.

Breathing in sync with the person can aid in calming them down.

According to the University of Birmingham’s Future Learn Dementia presentation, useful phrases could be:

  • “Please tell me more about what’s happened”
  • “I’d like to see if we can work this out”

Try to be honest, non judgemental, confident, non-authoritarian and empathetic.

“Be willing to go where they are, ” says well known dementia care expert and pioneer, Teepa Snow.

After the event

Once a crisis is over, it is useful to go over what happened to find room for improvement, and to assess what you did well. Consider:

  • What happened?
  • How did you feel during the crisis?
  • How did they feel?
  • Could the event have been prevented? How
  • What did you do well?
  • What could you have done better?
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