Physical and verbal aggressive behaviors are common with all types of dementia. In the healthcare vernacular, we have a name which is BPSD (Behavioral and Psychological Symptoms of Dementia). The symptoms vary from individual to individual and may be acute or persistent. The acute symptoms are usually due to an acute illness, and the persistent symptoms are due to the brain changing and its response to the disease.
The behaviors are frustrating for both the caregiver and the person manifesting them. However, unless they cause safety issues for either person, they can be observed without treatment. When the behaviors begin to impact on the safety of the care team or individual, it's necessary to intervene.
The interventions depend on the presentation of the behavior. The level risk to the safety of the behavior and the resources available to the family and individual with dementia. If the behavior has a rapid onset, it is likely due to an acute illness and the healthcare team may be able to help identify the cause. The caregiver needs to observe the individual for clues of the cause.
If the behavior is not harmful to the person or caregiver, observation is appropriate. For instance, if the individual believes that his brown shoes are contaminated, the caregiver doesn't let him wear the brown shoes. There are resources available that will help the caregiver and individual in their environment. If the caregiver is an elderly spouse and must be awake and alert 24/7 to monitor them, the resources are not adequate.
If the individual is safe while demonstrating their behavior, it can be left alone. Even if the behavior is repeated hundreds of times a day, if it's not providing an unsafe situation, it can be observed without treatment. An example of this is repetitive verbal questioning. Asking the same question over and over or telling the same story over and over. This can be annoying to the caregiver, but it is not causing any harm to the individual. In situations like this, the caregiver may be the person who is acting out verbally or physically to protect their mental health.
Behaviors can be frustrating. They are real to both the caregiver and the individual with dementia. Unless they are providing an unsafe environment, they can be observed. Even though they may irritate and agitate the caregiver, they are best left alone. They cannot be managed by redirecting the person with dementia because of the risk of exacerbation.
If you are in the frustration position of a caregiver, reach out for help. You are the lifeline for the person with dementia, and you need to stay healthy and intact physically and emotionally.