Reducing the risk of aggression in dementia
In my previous June blog, I talked about the myth of aggression in dementia in the late stages of the disease. In that blog, I discussed the need for agency (control of your world) and empathic communication which enables a person to live well.
In part 2 I will briefly discuss 2 other elements that can cause an individual with memory loss to become anxious and possibly angry; hyper-arousal and the environment. These two elements are less common and simpler to manage but worth being aware of.
Hyper-Arousal causing aggression in dementia
Someone living with dementia needs to live in balance with the world around them, neither over-stimulated nor under-stimulated, and in a similar way to some neuro-divergent people, can easily become overwhelmed.
Hypo-arousal means the absence or lack of stimulation, feeling under-whelmed. For most people, this can affect their eating, sleeping, and positivity, but for those diagnosed with dementia, it can result in more rapid confusion or cognitive deterioration. This is why The Ness dementia daycare centre offers cognitive stimulation and works to educate people about the risks of under-stimulation.
Hyper-arousal means excessive overstimulation or excessive sensory input. For those with normal cognitive function, this is rarely a problem, our brains have something called ‘The Cocktail Effect’ in which we can filter out noise and sensory information to concentrate on one thing or person at a time. This stops our brains from becoming overwhelmed and unable to make decisions, understand communication and function in a normal way.
An individual living with dementia finds it harder to filter out noise, talking, colour, touch, and people and this overstimulation can become stressful. The result is heightened anxiety, increased confusion, and emotional dysregulation. In some instances, this can lead to behaviour that is aggressive, which can be understandable in the hyper-aroused context.
Once you are aware of the importance of a balanced stimulus then you can reduce the risk of emotional dysregulation. For example, you can make sure that you aren’t talking at the same time as playing music or having the TV playing. Avoiding highly stimulating situations like busy shopping areas, busy parties, or loud pubs/cafes/restaurants will also help reduce the risk of a loved one with dementia getting aggressive. Talking face to face and mostly in a 1:1 scenario or in a small group without other distractions will also make a difference. Equally, you will need to find a balance and ensure an individual has some form of social stimulation and avoids hypo-arousal which can be equally damaging.
Environment causing aggression in dementia
The final element to managing emotion is the environment. This is linked to hyper-arousal and to validation therapy. We all have a subconscious emotional reaction to the environment around us, sometimes walking into a space and feeling calm or feeling engaged and active etc. Our own homes or our childhood homes particularly fill us with calm.
In someone living with dementia, this emotional reaction to an environment is heightened. This is also linked to states of arousal, too much colour, objects, music or noise and the environment feels stressful and confusing and can create upset.
Understanding where you are and what you are doing helps to orientate and create calm. Those in the moderate to advanced stages of the disease may link an environment back to a good or bad time in their life. For example, they may have been a teacher and they come into an environment and believe they are back at school, in their job, working. If this is positive and creates a positive emotion or calmness, then we validate that presumption and agree that it is their school/place of work.
Equally a dark room or house that has too much or too little stimulation can create a sense of danger, and a fight or flight response. If the person links the environment to an unhappy or stressful time in their life then this creates a negative, anxious and even aggressive emotion.
Clear, simple, bright colours with lots of light (especially natural light) and not too much furniture/objects can help to improve mood or maintain stability. It is worth being aware of an environment and working to make it feel as calm/happy as possible.
That brings us to the end of our blog on aggression but to briefly summarise; aggression in dementia is a myth and most people never (or rarely) experience aggression.
If there are angry outbursts or aggressive physical reactions they are often the correct emotions/reactions within the context that person is living. With careful management of communication, offering a sense of agency, reducing hyper-stimulation and managing the environment you can mostly enable someone to remain in a stable emotion. That is not always the case and there is no magic formula but a simple understanding of dementia and an empathic understanding of what that person is going through can help a huge amount.
If you are looking for support in stimulating your loved one with dementia, or are in need of a safe place for your loved one to be social get in touch with our friendly team. We will get to know more about you and your loved one in our complementary consultation and will be able to advise how our services may be able to help you.