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Just the Facts and More: Combativeness
When an Alzheimer patient becomes combative, angry or agitated, it may be because of frustration. The individual may feel that he's being pushed to do something that simply can't be done. Consider the following factors as possible sources of frustration:
Deal with combativeness by trying to examine the underlying causes. Consider the following issues:
One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.
The primary resource for this fact sheet was Peter V. Rabins, MD, a geriatric psychiatrist and director of the Price Teaching Service and associate professor of psychiatry at the Johns Hopkins University School of Medicine, Baltimore, Maryland.
Special thanks to the following Chapters of the Alzheimer's Association: Indianapolis Area, Eastern Massachusetts, South Central Michigan, Cincinnati, Cleveland, Dallas, and South Central Michigan.
Posted August 3rd, 2007
- Dressing - The person who can't get his arm through a sweater may grow increasingly upset and start to thrash around.
- Bathing - The person who's frightened by running water in the bathtub may push away a caregiver who is trying to give him a bath.
- Eating - The person who doesn't like a certain type of food may refuse to eat it.
Deal with combativeness by trying to examine the underlying causes. Consider the following issues:
Physical Causes
- Is the person tired because of inadequate rest or sleep?
- Are mediations such as sedatives and tranquilizers creating side effects?
- Is the person unable to express the fact that he's in pain?
Environmental Causes
- Is the person over-stimulated by loud noises, people or physical clutter?
- Is the environment unfamiliar?
- Does the person feel lost or abandoned by the caregiver?
Poor Communication
- Are you asking too many questions or making too many statements at once?
- Are your instructions simple and easy to understand?
- Is the person picking up on your own stress and irritability?
- Are you making the person more frustrated by being overly negative or critical?
| Action Steps |
Be on the lookout for frustration.
Look for early signs of frustration in such activities as bathing, dressing, or eating, and respond in a calm and reassuring tone.Don't take aggression and combativeness personally
Keep in mind that the person isn't necessarily angry with you. Instead, he may misunderstand the situation or be frustrated with his own disabilities.Avoid teaching.
Offer encouragement, but keep in mind the person's capabilities and don't expect more than he can do. Avoid elaborate explanations or arguments.Use distraction.
Don't persist in making the person perform a particular task, especially if she has repeatedly been unsuccessful. If you see the person getting frustrated with buttoning a shirt, try to distract her with another activity such as putting on a pair of pants. After a time, you can return to the shirt. Or take the person to a quiet room, have a cup of tea, or go for a walk.Communicate directly with the person.
Avoid expressing anger or impatience in you voice or physical actions. Instead use positive, accepting expressions such as "please," "thank you," and "Don't worry, everything's going to be fine." In addition, use touch to reassure and comfort the person. For example, you might want to put your arm around the person or give him a kiss. In addition, follow these tips:- Speak slowly and clearly.
- Use short, simple sentences.
- Approach the patient slowly and from the front.
- Use repetition and frequent reminders.
Decrease your level of danger.
Assess the level of danger - both for yourself and for the person. In other words, if the person becomes combative, ask this question: "How much trouble am I in - and what can I realistically do about it?" Often you can avoid harm by simply taking five steps back and standing away from the person for a short period of time. On the other hand, if the person is headed out of the house and onto a busy street, you need to be more aggressive.Be conservative in using restraint or force.
Unless the situation is serious, try to avoid physically holding or restraining the person. By fighting with the individual, you'll probably make him even more frustrated and anxious.Experiment with objects that have a soothing effect.
Some caregivers believe that stuffed animals have a soothing effect on the person, while others find that pets - from cats and dogs, to birds or goldfish - have a calming effect.Learn from previous experiences.
Try to avoid situations or experiences that make the person combative. For example, if the individual tires easily when she visits with family members, you might want to limit the length of these visits. Try to identify early signs of agitation. For example, restlessness, frustration, fidgeting, or blushing sometimes precedes outbursts.Restructure tasks and the person's environment.
- Simplify tasks or plan more difficult tasks for the time of the day when the person is at his best.
- Give the person adequate time to respond to your directions or requests.
- Allow the person to make some choices, but limit the total number of choices. Having too many decisions to make about what to eat or wear might be confusing or overwhelming.
- Break down each task into small steps and allow the person to complete one step at a time.
- Keep the environment calm, quiet and free of clutter.
| Resources |
One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.
The primary resource for this fact sheet was Peter V. Rabins, MD, a geriatric psychiatrist and director of the Price Teaching Service and associate professor of psychiatry at the Johns Hopkins University School of Medicine, Baltimore, Maryland.
Special thanks to the following Chapters of the Alzheimer's Association: Indianapolis Area, Eastern Massachusetts, South Central Michigan, Cincinnati, Cleveland, Dallas, and South Central Michigan.
Other Resources include:
- Miriam K. Aronson, Ed.D. Understanding Alzheimer's Disease. New York: Scribner's. 1988.
- David L. Carroll. When Your Loved One Has Alzheimer's Disease: A Caregiver's Guide. New York: Harper and Row, 1989.
- Donna Cohen, Ph.D. and Carl Eisdorfer, Ph.D., MD. The Loss of Self: A Family Resource for the Care of Alzheimer's Disease and Related Disorders. New York: Norton and Company, 1986.
- Lisa P. Gwyther. Care of Alzheimer's Patients: A Manual for Nursing Home Staff. Washington, DC: American Health Care Association, and Alzheimer's Disease and Related Disorders Association. 1985.
- Nancy L. Mace and Peter V. Rabins, MD. The 36-Hour Day. Baltimore: The Johns Hopkins University Press. 1991.
Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.
- Alzheimer's Association of the Great Plains , 402-420-2540 or 1-800-487-2585 (Helpline)
- Midlands Chapter , 402-502-4301 or 1-800-272-3900 (Helpline)
