More About Combative Behaviors In People with Dementia

Do not argue with or say no to someone with dementia.

One of the most common complaints I hear from families involves the agitation and anger of the person with Alzheimer’s disease. Comments like: “He always argues with me when I tell him to take a shower.” Or “I told her not to feed the dog at the table and she got angry at me.”  Or even, “He is always angry, I’m afraid he will hit me.”

Why do these behaviors occur?  I always tell caregivers to try to imagine themselves in the place of the person with dementia.  What must it be like to lose your memory bit by bit?

• You can't remember appointments, when to take your medications, the names of all of your grandchildren, or even whether or not you had breakfast this morning.
• You want to drive your car to the supermarket but your daughter has taken the keys and won’t let you drive.
• You have to eat when someone else tells you it’s time to eat, and you have to eat what they want.
• You can never find the damn bathroom.
• Why is everything so hard? You can’t figure it out.
• Sometimes you get really confused because you can’t find your purse, and you're sure someone took it.

How do you think you would react to all of this?  Would you be frightened? Angry? Paranoid about whether or not you can trust the people around you?

There are communication skills that caregivers can learn that will help put the person with dementia more at ease. They will also foster a sense of trust.

The first thing to learn, is never argue with or say no to a person with dementia. This can be difficult to do, even if you understand that dementia is caused by the death of brain cells.

The person with dementia is not capable of understanding both sides of an argument. Their brain is “broken,” so they react with agitation and anger. They have the same reaction if they want something or do something and we tell them no. They do not understand why, and will be threatened by our negativity.

Does this mean that we should simply allow the person with dementia to do whatever they want, even if it is dangerous to them or others? Absolutely not.

But we can learn a few tricks that will help.

First, try to prevent the situation from occurring. An example might be “Dad, you need to take a shower tonight” and dad replies “I just had one.” (You know he has not had one in a week) An argument ensues.

Instead, you could try laying everything out for Dad, give him a treat he likes to put him in a good mood -- such as chocolate chip cookies -- and then say: I laid everything out in the bathroom for your shower.

If that doesn't work, try it this way next time. “Dad, I bought your favorite apple pie. We can have some when you get out of the shower.” 

In addition to treats for mood change and bribes, we can also use distraction, especially in situations where we might want to say “no”. For instance: You walk into the kitchen and see your mom eating sugar out of the sugar bowl. If you say “no, don’t do that” it will upset her. However, if you say: “Mom, lets go in the other room, I have some pictures to show you,” -- you'll have stopped the behavior.  When Mom's distracted from the sugar bowl, you can remove it now that you know she 'll eat from it.

The bottom line is simple: Arguing and saying no will cause agitation and perhaps combative behaviors. Actually, most of what we describe as combative behaviors, are DEFENSIVE behaviors, because the person with dementia feels threatened by our arguments or negativity.

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The book Kisses for Elizabeth: Common Sense Guidelines for Alzheimer’s and Dementia Care was written to help both families and professional caregivers learn how to cope with the daily problems they encounter when working with people who have dementia. It is available at amazon.com or at http://www.kissesforelizabeth.com/