Loddon Mallee Regional Dementia Management Strategy

Preventing and managing aggression

The following scenario describes the recommended approach and responses to aggressive behaviour. Below the flow chart you will find specific strategies to manage aggression.

How do we prevent aggression?

• avoid putting the person in situations which may produce anxiety, fear, frustration or disorientation
• always prepare the person by explaining what is going to happen, or where they are going
• try to avoid arguments. It can be better to agree with what the person says or does,then try distraction or humour, or provide friendly help
• try to use encouragement, praise & affection, rather than criticism, anger or frustration

How do we deal with aggression?

• If the person is not causing harm to themselves or others then leave them alone
• Avoid approaching until the person has settled down
• Stay out of reach & try to ensure that the person can’t do any real damage to anything or anyone
• Allow ample inter-personal space between you and the person. Aggressive people need more space because of their heightened perception and increased vigilance. Maintenance of personal space promotes feelings of security for the person and for others
• Avoid making the situation worse by shouting, abusing, or touching the person
• React in a calm voice with reassuring words
• Give the person time to settle down
• Redirect the person to some other activity to distract them from anxiety
• Avoid punishment after the event. The person is unlikely to remember what happened & the punishment won’t have a helpful effect

Practical management strategies

(Please refer to: the Ten Top Tips for dealing with people who have dementia and Communication strategies)

• Talk to the person in a calm, confident & reassuring manner.
• Do not respond to anger with anger.
• The carer needs to let the person know that their anger is recognised but that they are not frightened by it.
• Encourage the person to vent their feelings.
• It may be necessary to remove the person to a secluded area well away from others - this avoids others becoming anxious or frightened by violent threats or swearing. It also allows the carer to devote attention to the angry person & cuts down on distractions.
• If the person is known to be aggressive at particular times approach with two staff.
• Try to distract the person by talking about things that they enjoyed in the past.
• Give the person a face-washer or other object to hold while you are providing care.
• When showering or dressing an aggressive person, provide care from the side of the person, not in front of them.
• When walking with a person who is known to be aggressive, walk with them between you & the wall. Don’t walk in between the person & the wall as this leaves you nowhere to go & is potentially dangerous.
• Remain calm at all times.
• After an aggressive incident it is important to ‘debrief’ staff involved.

References and recommended reading

Alzheimer's Association Australia (2000).  Help Sheets for people with dementia and their families and carers. Alzheimer's Association Australia. www.alzheimers.org.au.

Chou, K.R. Kaas, M.J. & Richie, M.F. (1996).  Assaultive Behaviour in Geriatric Patients. Journal of Gerontological Nursing, Vol.22: No.11,pp.30-38.

Department of Veterans Affairs - Health Promotion Section & Alzheimer's Association Australia (2001).  Living with Dementia - A guide for Veterans and their Families. Commonwealth of Australia www.dva.gov.au

International Psychogeriatric Association (1998).  Behavioural and Psychological Symptoms of Dementia (BPSD) Educational Pack - Module 1. www.ipa-online.org

Keane, B. & Dixon, C. (1999).  Caring for people with problem behaviours. 2nd Ed. Ausmed Publications, Australia

Poole, J. (2000).  Poole's Algorithm Aged Care Facilities: Nursing Management of Disturbed Behaviour in Aged Care facilities. Lecture notes & resource kit. Department of Aged care and Rehabilitation Medicine, Royal North Shore Hospital & Community Health Services. Government Print Office NSW

Robinson, A. Spencer, B. & White, L. (1991).  Understanding Difficult Behaviours: Some practical suggestions for coping with Alzheimer's Disease and related illnesses. Eastern Michigan University, USA

Smith, P.A. (1993).  Professional Assault Training (PART) Manual – Revised, Australian version. Australian revisions by Reid, G.V. Sheahan, C. & Sheahan, P.

Teri, L. (1999).  'Latest advances in the assessment and management of behavioural symptoms: an international perspective'. Paper presented to a Symposium reporting the latest evidence-based practices in the care of behavioural symptoms of dementia, Melbourne.

Teri, L. (1999).  'State of the art strategies in approaching behavioural disturbance and depression in dementia'. Paper presented to a Symposium reporting the latest evidence-based practices in the care of behavioural symptoms of dementia, Melbourne.