When a person with Alzheimer's disease feels frustrated, angry or fearful, they can become aggressive and combative. While these feelings can be caused by internal or environmental factors, they can also be the result of physical factors such as the person being tired because of inadequate rest or sleep, the side effect of medications such as sedatives and tranquilizers or the person being in pain.

Once you rule out physical factors, such as those above, your best defense against combative behavior is to try to figure out and eliminate its cause.

Frustration is often a trigger for combative behavior, and can be caused by the inability to do everyday tasks that you both used to take for granted. The person who can't get his arm through a sweater may grow increasingly upset and start to thrash around. The person who is frightened by running water in the bathtub may push away a caregiver who is trying to give him a bath. The person who doesn't like a certain type of food may refuse to eat. The individual may feel that he's being pushed to do something that simply can't be done.

Ask yourself the following questions to determine if the person is...

• over-stimulated by loud noises, an overactive environment or physical clutter?
• feeling lost or abandoned?
• feeling overwhelmed by questions being asked?
• having difficulty understanding what is being said?
• picking up on your stress and irritability?
• responding to your being negative or critical?

Keep in mind that combativeness takes many forms. Sometimes the person may simply try to push your hand away, while at other times the person may resist or strike you.

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Even when you understand why aggression occurs, you often can't prevent it. The following ideas may prove helpful when you find yourself dealing with combative behavior:

Look for early signs of frustration

If you see aggression developing, during activities such as bathing or dressing, take a time-out before pressing on.

Try to avoid confrontation

Use distraction when possible. If a person is frustrated because they can't put on their shoes, go to another activity, and come back to the shoes later.

Keep explanations as simple as possible

Cognitively impaired people often become frustrated when conversations are too complex and lengthy.

Avoid expressing anger or impatience in your voice or physical action

Use positive, accepting expressions, such as "don't worry" or "thank you." Also, use touch to reassure and comfort the person. For example, put your arm around the person or give him or her a kiss.

Decrease your own level of danger

Assess the level of danger – for yourself and the person with Alzheimer's. You can often avoid harm by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, you must of course, be more assertive.

Avoid using restraint or force

Unless the situation is serious, avoid physically holding or restraining the person. He or she may become more frustrated and cause personal harm.

Don't take the behavior personally

The person isn't necessarily angry with you. He or she may have misunderstood the situation or be frustrated with lost abilities caused by the disease.

Perhaps what is most important is realizing that not all aggressive behavior can be prevented. Caregivers can easily consider themselves failures when it does occur. It is much easier to write about possible preventive measures than to always use them in the day-to-day care of a person with Alzheimer's disease. Aggression may happen and it's best to deal with it and move on. It may be especially helpful to talk about it with someone who has also had the experience of caring for an impaired person. The New York City Chapter of the Alzheimer's Association sponsors Support Groups where you can find other people with whom to share your concerns and thoughts.

Click here to find a Support Group in your area.

Sources: This information is based on materials prepared by the National Alzheimer's Association, the Alzheimer's Associations of National Capital Area and Orange County and the Alzheimer's Disease and Related Disorders Association, Inc.

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