Managing Agitation and Aggression in Alzheimer's: Strategies for Professional and Family Caregivers

As the population ages, more and more people are becoming caregivers for family members with Alzheimer's disease. Alzheimer's is a progressive disease that affects the brain, causing cognitive decline and memory loss. One of the challenges of caring for someone with Alzheimer's is managing their behavior when they become agitated or aggressive. 

According to a recent report by the Alzheimer's Association, over 1 in 9 seniors in the United States currently live with Alzheimer's disease. The report further reveals that this number is anticipated to double within the next two decades, potentially affecting 13 million people by the year 2050.

2023 Alzheimer's Disease Facts and Figures Annual Report

The cost of providing care for individuals living with Alzheimer's or other dementias in the US has risen by $24 billion from the previous year, reaching a total of $345 billion in 2023. Long-term care services are costly, and those costs are increasing nationwide.

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Limited Traditional Insurance Coverage

Since Long-term health care, including Alzheimer's and dementia care, is not covered by traditional health insurance, including Medicare, families often find themselves in crisis mode trying to provide the necessary care and supervision.

Medicaid is the primary payer of long-term health care in the United States, but the care recipient must have little or no income and assets to qualify for those benefits. Long-Term Care Insurance will pay for comprehensive long-term care benefits, but you cannot purchase a policy once you have a significant health diagnosis, like Alzheimer's, and it is usually purchased when someone is in their 40s or 50s. 

How Does Long-Term Care Insurance Differ from Other Types Of Insurance?

Without LTC Insurance or Medicaid benefits, families will use income and assets to pay for professional care or provide the care themselves despite the stress and burdens that are placed on untrained family caregivers.

Caregivers Face Challenges with Dementia Care

Alzheimer's care can be especially difficult for both professional and family caregivers, who lack experience in this aspect of caregiving. Part of the reason is that agitation and aggression are common symptoms of Alzheimer's disease. 

These behaviors can be caused by various factors, including pain, discomfort, fear, confusion, and frustration. As the disease progresses, the person with Alzheimer's may become more prone to these behaviors, and they can become more frequent and severe over time.

Jose Dominguez, Director of Operations for Amada Senior Care in Orange County, California, says that even professional caregivers face challenges in providing care when an older adult becomes agitated or aggressively acts out due to the symptoms of their illness. 

Symptoms can manifest depending on the disease stage, as a side effect of medication, or during a state of confusion known as 'sundowning.'

For caregivers, managing these behaviors can be challenging and emotionally taxing. However, there are strategies that both professional and family caregivers can use to handle care recipients with Alzheimer's who are becoming aggressive or agitated.

Since changes in behavior and mood swings are common symptoms through all the stages of this incurable and progressive disease, caregivers receive training on how to respond appropriately while ensuring the care recipient's safety.

Dominguez says that as the relationship between the care recipient and caregiver strengthens, the caregiver becomes familiar with the senior's behavioral patterns and develops specific strategies to prevent or de-escalate a hostile situation. 

Finding Underlying Cause of Behavior

One of the first steps in managing agitation and aggression in Alzheimer's is to identify the underlying cause of the behavior. According to Dr. Constantine George, an internal medicine specialist and founder of Epilocal in Las Vegas.

It is important to remember that aggression or agitation in Alzheimer's disease can be caused by a range of factors, including environmental triggers, such as noise or overstimulation, and medical issues like pain or medication side effects.

Once the underlying cause of the behavior has been identified, caregivers can take steps to address it. For example, if the person with Alzheimer's is agitated due to noise or overstimulation, the caregiver can create a calm and quiet environment. If the behavior is due to pain or discomfort, the caregiver can consult with a health care provider to determine the best course of action.

Dr. George says that another effective strategy for managing agitation and aggression in Alzheimer's is redirecting the person's attention to a different activity. 

One technique that can be useful is to distract the person with Alzheimer's by engaging them in an activity that they enjoy, such as listening to music, looking at photos, or doing a puzzle. This can help redirect their attention away from the behavior that is causing the agitation.

Caregivers Face Health Problems

For family caregivers, it is also important to take care of their own emotional well-being, according to Dr. Susan Wehry, a geriatric psychiatrist and chief of the Division of Geriatric Psychiatry at the University of Vermont Medical Center.

Caregiving can be very stressful, and it is important for caregivers to take care of themselves, both physically and emotionally. This may involve getting enough rest, exercising regularly, and seeking support from other caregivers or healthcare professionals.

For professional caregivers, such as nurses or home health aides, it is important to receive training on handling agitated or aggressive behavior in Alzheimer's patients. According to the Alzheimer's Association:

Training can help professional caregivers understand the behavior and develop effective strategies for managing it. It can also help them to better communicate with family members and healthcare providers about the care recipient's needs.

In some cases, according to Dr. George, medication may be necessary to manage agitation and aggression in Alzheimer's.

There are medications that can be prescribed to help manage the behavior. However, it is important to use these medications judiciously and under the guidance of a healthcare professional, as they can have side effects.

Calm and Supportive Environment

Overall, managing agitation and aggression in Alzheimer's can be a challenging task for both professional and family caregivers. However, by identifying the underlying cause of the behavior, redirecting the person's attention, and taking care of their own emotional well-being, caregivers can help to create a calmer and more supportive environment for their loved one or care recipient with Alzheimer's. 

As Dr. Wehry puts it, "With the right support and strategies in place, caregivers can provide compassionate and effective care for people with Alzheimer's, even when dealing with challenging behaviors."

Dominguez says that learning what triggers negativity or hostility in a particular care recipient will allow the caregiver to take preemptive action whenever possible. 

A professional caregiver will assess the living environment to ensure it's not too cold or hot or too noisy. She or he will rely on nonverbal cues to redirect their behavior through eye contact, a gentle touch, and a calm demeanor.

He says that caregivers will avoid correcting the care recipient or over-explaining, as someone who is struggling with memory loss or hallucinations will only get more frustrated and upset. 

Introducing a meaningful activity may calm an agitated Alzheimer's patient. Sometimes getting the senior with dementia outside the house and into the fresh air and sunshine can help redirect the brain.

Difficult Journey for Loved Ones

It is also important to note that caregiving for someone with Alzheimer's can be a long and difficult journey for untrained family members. As the disease progresses, family caregivers may need to adapt strategies and seek additional support to manage the person's behavior. This may include working with health care professionals, joining support groups, or considering respite care to give the caregiver a break.

Dr. George explains it is important for caregivers to remember that they are not alone in this journey. 

There are resources available to help them manage the behavior and provide the best possible care for their loved one or care recipient with Alzheimer's.

Managing agitation and aggression in Alzheimer's is a complex and challenging task for both professional and family caregivers. However, by identifying the underlying cause of the behavior, redirecting the person's attention, and taking care of their own emotional well-being, caregivers can help to create a calmer and more supportive environment for their loved one or care recipient with Alzheimer's. 

For informal family caregivers, the use of respite care (either professional in-home care or adult day care, or memory care facilities) can help alleviate some of the stress and burden of caregiving. 

Professional care is always the best option as someone with Alzheimer's or dementia progresses. For those with Long-Term Care Insurance do delay in using benefits to obtain quality care options to improve their quality of life. 

Dr. Wehry emphasizes the importance of quality care.

With the right strategies and support, caregivers can provide compassionate care and help to improve the quality of life for people with Alzheimer's and their families.

Planning for the consequences of aging should be part of your retirement planning. Don't delay until you face chronic health problems, including dementia, to take action. 

Aging is a reality we all face. Long-term care is costly and adversely changes someone's lifestyle and legacy. Most people would agree they don't want to put their spouse or adult children into the position of caregiver. The solution is to include Long-Term Care Insurance in your retirement plan.

Most people get coverage in their 40s or 50s. Seek professional help in finding affordable coverage. Long-Term Care Insurance specialists are well-equipped to provide accurate quotes from all the major insurance companies.