My Alzheimer's Journey
Part 111 - Alzheimer’s Caregivers Tips: Management of Patient Agitation and Aggression
On March 17, I wrote about how caregivers deal with personality and behavior changes of their loved one. Today, let’s dig deeper into the common causes and management of agitation and aggression.
Agitation is defined as an emotional state of excitement or restlessness. While not all agitation leads to aggression, it is a significant risk factor that frequently escalates into aggressive behavior. Aggressive behavior can quickly become violent and dangerous.
According to the Alliance for Aging Research, the symptoms of agitation in Alzheimer’s often include restlessness, pacing, wandering, shouting, and repetitive questions. The Alliance goes on to say that about 44% of people with Alzheimer’s show signs of agitation.
An article written in 2022 by Malissa A Mulkey, PhD, APRN, CCNS, CCRN, CNRN and Cindy L Munro, PhD, RN, ANP-BC, FAAN, FAANP, FAAAS provided strategies for calming an agitated patient. While this article is geared toward clinicians, I believe many of the strategies are applicable for caregivers.
This article lists three main goals when managing patient agitation:
early recognition and treatment of the underlying cause of the agitation
rapid control of the behavior
prevention of harm to the patient and those around him or her
I have studied agitation extensively in recent weeks. Based on information from a variety of resources, I believe there are six primary causes of agitation:
Change in residence. This is often one of three situations: downsizing, moving into an adult child’s home, or moving into some type of managed care facility.
Changes in caregiver arrangement. For example, if a family member has been the caregiver and then a professional caregiver is hired.
Environmental changes. This may be as simple as an overnight guest to more challenging travel or hospitalization.
Environmental triggers. These triggers often include noise, crowds of people, light glare, and a perceived hectic situation.
Fear and confusion of the changes taking place in their life.
A unitary tract infection (UTI) and other medical conditions.
The first goal from the Mulkey and Munro study is to recognize and treat the cause of the agitation. Using my broad list of causes, recognition should be somewhat easy. The challenge is treatment or elimination of the cause.
In my opinion, environmental changes, environmental triggers, and an UTI are the easiest cases of aggression to treat or eliminate. A change of residence and a change of caregiver generally can’t be avoided. Fear and confusion seems to the most difficult aggression cause to manage.
Recognizing and treating aggression is complicated by cognitive deficiencies and communication difficulties of the person with Alzheimer’s. As all caregivers know, you often can’t reason with someone with Alzheimer’s.
I believe that time, patience, and love can go a long way in helping someone with Alzheimer’s adjust and accept a new living arrangement and a new caregiver. This is why good caregivers are gentle, tolerant, caring, and loving individuals.
Rapid control is the second goal from the Mulkey and Munro study. In their study, they cite how clinicians (caregivers) should remain calm and emotionally neutral around the patient. Smiling is stated as a simple, yet effective method for rapidly controlling an aggressive situation. Distraction is also a good technique. If I ever When I become aggressive, ice cream or a Krispy Kreme donut would be a very effective distraction. In 1939, the British had a propaganda poster that said, Keep Calm and Carry On. I believe that sentiment is applicable to managing aggressive behavior.
The story behind “Keep Clam and Carry On” is fascinating.
If you have successfully, recognized and treated the cause of the aggression, and you have rapidly controlled the behavior, the next goal is preventing harm to the patient and the caregiver (and others around the person with Alzheimer’s).
I have three basic safety principles:
maintain a safe environment - no knives or guns, nothing that could be picked up and used as a weapon, no hazardous cleaning supplies, etc
put space between yourself and the loved one or patient - always have a clear path out of the room
always have a telephone or an emergency notification device (Silent Beacon is one option) on your person
You must remember that the aggressive person is ill. If they are a loved family member, they are not the person you loved prior to their becoming ill. Their behavior is a result of their Alzheimer’s disease.
Your first priority must be protecting yourself and other family members.
A Milestone of 100 Posts—and a Tribute to the Journey
When I recently wrote my 100th post on Substack, it gave me a chance to look back at the stories we’ve shared and the community we’ve built. My writing has always been about the intersection of Alzheimer’s, life, business, and the heart—and today, I’m bringing that same spirit to Greg’s AZ Store.
To celebrate this milestone, I’ve launched a collection that is deeply personal to me: the Caregiver’s Appreciation Collection.
Caregiving is one of the most profound roles a person can take on. It’s a journey of immense compassion and quiet resilience. To honor those who walk this path, I’ve designed a signature series featuring the message: “Tough Enough To Be A Caregiver, Crazy Enough to Love It.”
This collection—featuring a premium t-shirt, insulated water bottle, and durable apron—is more than just merchandise. It’s a wearable tribute to the strength required for the journey, and every piece proudly features the Cat Man logo to raise Alzheimer’s awareness.
As a thank you for being part of my first 100 posts, I invite you to head over to the store and see what I’ve created. Whether you’re a caregiver yourself or supporting a hero in your life, this 3-piece set is designed with the quality and passion you’ve come to expect from my work.
Visit the Caregiver Collection at Greg’s AZ Store