Bob Elmer: What are the sources of an aggressive reaction?

Bob Elmer: What are the sources of an aggressive reaction?

The Westerly Sun

When I lecture, there are three things I try to impress on everyone. Regardless if they’re formal or informal caregivers of one with Alzheimer’s/dementia they need to always remember the following: The No. 1 thing your loved ones are looking to you for is to feel safe. No. 2, you can’t reason with someone that has literally lost the ability to reason. And No. 3, it’s the illness that’s making them behave that way.

Today, we’re going to be looking at  their behaviors. I say behaviors but are they really behaviors or are they reactions to what’s happening in their environment?  I should remind you that as long as you never forget Nos. 1 and 2 above, dealing with No. 3 shouldn’t be to hard. I say that as someone who doesn’t have to do it myself.

Those with Alzheimer’s and other dementias are not genetically predisposed to behave aggressively. However, the disease can cause some to behave unpredictably and they may become anxious or aggressive. Some will become paranoid and accusatory, and when you add the symptom of difficulty speaking and understanding others, you have the potential for real problems.

If they are in pain, are constipated, are hungry, are afraid of a noise they hear or of a new aide they don’t know, and they can’t tell you that, they will often strike out. Imagine you or an aide are trying to help feed a loved one but they’re being stubborn and not cooperating. The aide insists and manages to get some food into their mouth only to have them strike out at them. Were they angry with the aide for putting food in their mouth, or do they have a dental problem that they can’t share with you? Are they on a new med that has upset their stomach?

When you find you’re dealing with aggressive behavior, rule out pain as the cause first. Controlling their environment is another key to success. Simply put, is there too much going on around them that they can’t process? I’ve seen loved ones forget what a ringing telephone means, and recently heard that a father had forgotten the words to “Happy Birthday” when he tried to sing it to his son on his special day. It’s no wonder that finding themselves in a restaurant, surrounded by people they don’t know or remember, with music in the background, with a server standing over them reading a list of specials, doesn’t go over really well. That’s because it’s all happening at once. They are barraged by the music, the noise and the conversation and can’t separate it.

I do staff training and at a recent session I was asked to share my thoughts on why a particular resident punched and kicked a staff member. It was shower time and it appears that Miss Resident wasn’t having it and struck out. I asked the staff member how much time she had spent sitting and talking with the resident before trying to get her in the shower? She confessed, very little, as she was a little behind. Was the resident vain and didn’t like being naked? Was she cold? Did she know the aide and did she feel safe around her? No one wants anyone in harm’s way, which is why in your home and in any community, it’s always best to put off the shower rather than end up with a very angry, agitated but clean woman.

So is the bad behavior caused by pain or illness? Overstimulation? Unfamiliar surroundings? Are you asking too much of them? Or is their inability to communicate leaving them afraid and or anxious?

Remember, that this is when you want to be cool, calm and collected when you approach  these situations. To do otherwise is to add to the problem.

Questions? Email me at

Robert E.P. Elmer III, of Stonington, is a senior care adviser and Alzheimer’s care specialist. His website is






Latest Videos