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Alzheimer’s and Violence; A common misconception

By Debbie Selsalvage Posted on October 10, 2021

Often, when I am counseling a family that has just received a diagnosis of Alzheimer’s disease, someone will ask, “When will they become violent?”

This question reveals one of the most common and tragic misconceptions about the disease; that Alzheimer’s leads to violent behavior; that their person will become unpredictable and dangerous.

It is true that one of the results of Alzheimer’s – and many other forms of dementia – is personality change.  But this change is not consistently toward violent behavior.  If your person has a cooperative personality, this is likely to continue.  If they have been difficult and combative, dementia is not likely to cause them to improve!  But Alzheimer’s does not invariably change a person toward unpleasant, confrontational, or violent behavior.

The misconception that Alzheimer’s leads to violent behavior is too often caused by US, the care partners.  It is the result of literally centuries of incompetent, unskilled, and misunderstood care.  It is the result of how WE treat individuals living with dementia!

Everyone knows Alzheimer’s causes memory loss.  But what many don’t know – including many care professionals – is that it also causes degradation of all of our cognitive and physical functions, including all five of our senses. 

I place great emphasis on this fact in my workshops because we cannot become effective care partners unless we learn to see, feel, and hear the world as they do.

Alzheimer’s and Violence; A common misconception

What Alzheimer’s does not attack equally is our emotional structure; our “feelings,” our ability to experience joy, fear, pleasure, and pain.  In fact, I believe that as the person’s functional abilities change, their emotions become even more important. It is how they experience their world, and their fright-flight-fight response remains intact when they feel threatened or unsafe.

Too many people believe that a person with Alzheimer’s declines into a kind of vegetative state where they don’t know what is going on.  This is not the case.  They still feel fear, confusion, and loss.

Care partners who do not understand their loved one’s emotional capabilities too often treat them as a task; not like a fellow human being.  We speak and move too quickly.  We touch them without warning.  We raise our voice in frustration because they do not respond as we think they should. 

This approach leads to reactions we consider combative, but sadly, we are actually the ones provoking this unpleasant but predictable behavior.  We victimize our loved ones without even realizing it.  We blame them for both their behavior and our unskilled actions that caused it. This leads to a relationship of fear and distrust, which makes our care tasks even more difficult.

So, what can we do differently? Learn about the disease from a practitioner who believes in person-centered, compassionate care.  Slow down.  Speak slowly and lovingly.  Make no physical contact without first making eye contact, and make eye contact with a smile. Verbalize love, praise, and validation.  Never argue, correct them, or challenge their perceptions of reality.

Learn the skills and philosophy of hand-under-hand management. Practice empathy and patience.  And analyze your every move.  If it gets a bad response, focus on yourself as the possible cause of that response rather than immediately blame your person.

People with Alzheimer’s are not inherently violent.  Let’s not make them so.

About Debbie Selsavage

Debbie Selsavage is a Certified Trainer and Consultant in the Positive Approach to Care and a Certified Dementia Practitioner.  She authors a monthly column to assist caregivers in coping with Dementia. Her company, Coping with Dementia LLC is dedicated to making life better for individuals living with dementia.  Contact Debbie at [email protected].

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